Novosti v sistemskem zdravljenju karcinoma želodca Advances in systemic treatment of stomach cancer

Abstract

Veliko bolnikom s karcinomom želodca (KŽ) in gastroezofegealnega prehoda (GEP) se bolezen po resekciji ponovi. Ponovitve so lokalne ali z oddaljenimi zasevki ali pa gre za kombinacijo obojega. Adjuvantna kemoterapija lahko pri nekaterih vrstah solidnih tumorjev celotno preživetje podaljša predvsem z zmanjšanjem ostanka mikrozasevkov. Vloga adjuvantne kemoterapije pri teh karcinomih ni tako jasna, adjuvantna radiokemoterapija pa značilno podaljša čas brez bolezni in celotno preživetje. Perioperativno zdravljenje s kemoterapijo ECF značilno podaljša preživetje brez bolezni in v celoti. Standardno zdravljenje za bolnike z napredovalim KŽ in GEP je kemoterapija ECF ali njene izpeljanke EOF, ECX in EOX. Učinkovito je tudi zdravljenje s taksani v kombinaciji s 5-FU in cisplatinom (TCF). Z novimi kombinacijami citostatikov in z uvajanjem novih citostatikov se srednje preživetje bolnikov s KŽ in GEP podaljšuje. V zdravljenje metastatskega KŽ in GEP pa prihajajo tudi tarčna zdravila. Določanje biomarkerjev in uvajanje tarčnega zdravljenja v kombinaciji s kemoterapijo odpira novo ero bolniku prilagojenega zdravljenja, tudi pri bolnikih z napredovalim KŽ in GEP.

Abstract (Eng)

In a great deal of patients operated on for gastric and gastroesophageal junction cancer, the disease is likely to recur as local recurrence, distant metastases or the combination of both. In the treatment of certain types of solid tumors, adjuvant chemotherapy can prolong the overall survival by reducing residual micrometastases. The effect of adjuvant chemotherapy in the treatment of gastric and gastroesophageal junction cancer is not very clear, whereas adjuvant radiochemotherapy significantly prolongs the relapse-free interval as well as the overall survival. Perioperative treatment with ECF-based chemotherapy also prolongs significantly the disease-free and overall survival. ECF-based chemotherapy and the analogue regimens, such as EOF, ECX and EOX, are considered to be the standard treatment for advanced gastric and gastroesophageal junction cancer. The treatment with taxanes applied in combination with 5-FU and cisplatin (TCF regimen) is also very efficient. New combinations of cytostatics and application of new cytostatics in the treatment of patients with gastric and gastroesophageal junction cancer have significantly improved the median survival of these patients. Recently, also target drugs are being introduced in the treatment of gastric and gastroesophageal junction cancer. With the measurement of biomarkers and application of target drugs, a new era in the patient-adjusted treatment is opening, also in the treatment of patients with advanced gastric and gastroesophageal junction cancer.