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Erschienen in:

01.12.2007 | Leitthema

Konventionelle und experimentelle Systemtherapie des fortgeschrittenen Urothelkarzinoms

verfasst von: P. Wolter, V. Grünwald, G. Beutel, Prof. Dr. P. Schöffski

Erschienen in: Die Onkologie | Ausgabe 12/2007

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Zusammenfassung

Das Urothelzellkarzinom der Harnblase ist der zweithäufigste urologische Tumor. Etwa die Hälfte der Patienten entwickelt nach radikaler Zystektomie im weiteren Verlauf ein Rezidiv des Tumors, entweder lokal oder als Fernmetastasen. Für diese Patienten stellen Cisplatin-haltige Polychemotherapieprotokolle wie Cisplatin/Gemcitabin oder MVAC die Standardtherapie dar. Prognostische Parameter vor Beginn der Chemotherapie werden durch den Allgemeinzustand des Patienten sowie den Befall von viszeralen Organen bestimmt. Trotz hoher Remissionsraten in der Erstlinientherapie ist das mediane Überleben mit ca. 14 Monaten unbefriedigend und unterstreicht die Notwendigkeit neuer Therapieansätze für diese Erkrankung. Eine multimodale Therapie mit sekundärer Resektion kommt lediglich für eine kleine Gruppe von Patienten mit sehr gutem chemotherapeutischem Ansprechen in Frage. Viele Patienten weisen Begleiterkrankungen auf, sodass eine aggressive Polychemotherapie nicht durchgeführt werden kann. So sind für Patienten mit eingeschränkter Nierenfunktion oder ältere Patienten Kombinationen mit Carboplatin und Gemcitabin oder Gemcitabin und Docetaxel oder Paclitaxel therapeutische Alternativen. Gesicherte Daten aus großen randomisierten Phase-III-Studien zur Wirksamkeit dieser Regime liegen jedoch bislang nicht vor. Der Stellenwert einer Chemotherapie nach Versagen der Erstlinientherapie konnte ebenso noch nicht überzeugend etabliert werden. Unser wachsendes Verständnis der genetischen und molekularbiologischen Vorgänge in der Entstehung des Urothelzellkarzinoms der Harnblase hat in jüngster Zeit zu neuen therapeutischen Ansätzen geführt. Diese werden gegenwärtig in frühen klinischen Studien getestet.
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Metadaten
Titel
Konventionelle und experimentelle Systemtherapie des fortgeschrittenen Urothelkarzinoms
verfasst von
P. Wolter
V. Grünwald
G. Beutel
Prof. Dr. P. Schöffski
Publikationsdatum
01.12.2007
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 12/2007
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-007-1277-x

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