Aktuelle Standards in der Therapie des Magenkarzinoms

 

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Zusammenfassung

Während Magenfrühkarzinome endoskopisch reseziert werden können, stellt die Gastrektomie mit D2 Lymphadenektomie den Standard für die lokal weiter fortgeschrittenen Stadien dar. Eine perioperative Chemotherapie verbessert das Überleben beim lokal fortgeschrittenen Magenkarzinom. Eine neoadjuvante Radiochemotherapie ist für die Adenokarzinome des ösophago-gastralen Übergangs eine gut etablierte Alternative zur perioperativen Chemotherapie. Im metastasierten Stadium verbessert eine Chemotherapie das Überleben, die Lebensqualität und Symptomkontrolle. Bei HER2 positiven Tumoren sollte Trastuzumab in die Erstlinien-Systemtherapie integriert werden. Eine Zweit- und Drittlinientherapie ist mittlerweile ebenfalls gut etabliert. Der anti-VEGFR2 Antikörper Ramucirumab ist in der Zweitlinientherapie alleine und in Kombination mit Paclitaxel wirksam und stellt eine neue Behandlungsoption dar.

Abstract

Endoscopic resection is established in the treatment of early gastric cancer. More advanced gastric cancer requires gastrectomy and D2 lymphadenectomy. Perioperative chemotherapy improves overall survival in locally advanced gastric cancer representing a standard of care. Locally advanced adenocarcinomas of the esophago-gastric junction can alternatively be treated with concurrent radiochemotherapy. In metastatic disease, systemic chemotherapy improves survival, quality of life and symptom control. Trastuzumab plus chemotherapy should be used together with first-line chemotherapy in HER2 positive gastric cancer patients. Second- and third-line therapy is now well established. The anti-VEGFR2 antibody Ramucirumab improves survival in second line treatment both as a monotherapy and in combination with paclitaxel and represents a novel treatment option.

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