Ettrich Thomas J, Ebert Matthias, Lorenzen Sylvie, Moehler Markus, Vogel Arndt, Witkowski Lukas, Seufferlein Thomas, Reinacher-Schick Anke
Klinik für Innere Medizin, Universitätsklinikum Ulm, Ulm.
Medizinische Klinik des Universitätsklinikums Mannheim der Universität Heidelberg.
Z Gastroenterol. 2018 Apr;56(4):384-397. doi: 10.1055/s-0044-101757. Epub 2018 Apr 11.
At ASCO 2017, and subsequently the ESMO congress 2017, a number of studies were presented which, in part, may change the present standard of therapy in gastrointestinal oncology. The German FLOT4 trial established perioperative Docetaxel, Oxaliplatin and 5-Fluorouracil (5-FU) as the new treatment standard for resectable adenocarcinoma of the gastroesophageal junction and the stomach. In hepatocellular carcinoma (HCC), two large studies did not show a survival benefit for selective internal therapy (SIRT), so an increasing use of SIRT in HCC is not recommended. On the other hand, the multityrosinekinase inhibitor Lenvatinib seems to be a promising alternative to sorafenib in first line treatment of metastatic HCC. In early colon cancer-following the data from the large IDEA initiative-three months of capecitabine and oxaliplatin is recommended for low-risk stage III cancers (T1 - 3, N1), while in high-risk stage III cancers (T4 or N2) patients should still receive six months of oxaliplatin and a fluoropyrimidine. Aside from regular exercise, one study found that regular intake of tree nuts (at least 2 servings per week), may decrease the risk of recurrence. In first line metastatic colorectal cancer (mCRC), SIRT should not be applied, whereas in BRAF mutant cancers, the combination of irinotecan, cetuximab and vemurafenib seems to be a promising second line treatment option. In biliary tract cancer, after curative resection, six months of capecitabine is considered the new treatment standard. Finally, in pancreatic cancer, targeting the tumor stroma with pegylated hyaluronidase (PEGPH20) may be a new treatment option that needs to be proven in phase 3 studies.
在2017年美国临床肿瘤学会（ASCO）会议以及随后的2017年欧洲肿瘤内科学会（ESMO）大会上，多项研究被公布，部分研究可能会改变目前胃肠道肿瘤的治疗标准。德国的FLOT4试验确立了围手术期多西他赛、奥沙利铂和5-氟尿嘧啶（5-FU）作为可切除的胃食管交界腺癌和胃癌的新治疗标准。在肝细胞癌（HCC）方面，两项大型研究未显示选择性肝内治疗（SIRT）对生存有益，因此不建议在HCC中增加SIRT的使用。另一方面，多靶点酪氨酸激酶抑制剂仑伐替尼似乎是转移性HCC一线治疗中索拉非尼的一个有前景的替代药物。在早期结肠癌方面，根据大型IDEA计划的数据，对于低风险的III期癌症（T1-3，N1），推荐使用三个月的卡培他滨和奥沙利铂，而对于高风险的III期癌症（T4或N2）患者，仍应接受六个月的奥沙利铂和氟嘧啶治疗。除了定期锻炼外，一项研究发现，经常食用坚果（每周至少两份）可能会降低复发风险。在一线转移性结直肠癌（mCRC）中，不应应用SIRT，而在BRAF突变的癌症中，伊立替康、西妥昔单抗和维莫非尼联合使用似乎是一个有前景的二线治疗选择。在胆管癌中，根治性切除术后，六个月的卡培他滨被认为是新的治疗标准。最后，在胰腺癌中，用聚乙二醇化透明质酸酶（PEGPH20）靶向肿瘤基质可能是一种新的治疗选择，需要在3期研究中得到证实。
