Napredek zdravljenja bolnikov z razsejanim rakom debelega črevesa in danke z vidika internista onkologa Progress in the treatment of patients with metastatic colorectal cancer from the perspective of an medical oncologist

Abstract

Metastatski rak debelega črevesa in danke je v večini primerov še vedno neozdravljiva bolezen, vendar pa sta se prognoza ter preživetje teh bolnikov močno izboljšala v zadnjem desetletju. Od srednjega desetmesečnega preživetja, ki smo ga dosegali z zdravljenjem s 5-fluorouracilom, ki je bilo do pred nekaj leti edino učinkovito zdravilo za zdravljenje teh bolnikov, smo prešli na preživetja daljša od 20 mesecev, kar so omogočila nova citostatska zdravila. V zadnjih desetih letih je bilo registriranih šest novih zdravil za zdravljenje matastatskega raka debelega črevesa in danke: citostatiki - kapecitabin, irinotekan, oksaliplatin in tarčna zdravila - cetuksimab, bevacizumab in panitumumab. Kombinirano zdravljenje omogoča boljšo kakovost življenja in daljše remisije, s tem pa tudi daljša celotna preživetja. Uporaba kombinacije citostatikov s tarčnimi zdravili vodi še v nadaljnje podaljšanje srednjega preživetja teh bolnikov, tako zdravljeni bolniki imajo srednja preživetja daljša od 30 mesecev. Tovrstno zdravljenje, v kombinaciji z operacijo pljučnih ali jetrnih zasevkov, pa omogoča tudi zazdravitve. Pomembno je določanje mutacij na genu KRAS. Za kolorektalni rak je gen KRAS prvi biomarker, ki napoveduje, kako se bodo bolniki odzvali na zdravljenja z EGFR inhibitorji. ; slv - slovenski

Abstract (Eng)

Metastatic colorectal cancer is in the majority of cases still an incurable disease, but the prognosis and the survival of these patients have improved considerably in the last decade. From the median survival of 10 months achieved with 5-fluorouracil, which had been, until few years ago, the only effective drug for the treatment of these patients, we have obtained survival times of more than 20 months as a result of treatment with new cytostatic drugs. In the last ten years, six new drugs were registered for the treatment of metastatic colorectal cancer: cytostatics – capecitabine, irinotecan, oxaliplatin, and target drugs – cetuximab, bevacizumab and panitumumab. Combined treatment assures a better quality of life and longer remissions, and also increased overall survival. Combining cytostatics with target drugs further improves the median survival of these patients, and patients undergoing treatment have a median survival of more than 30 months. Such treatment in combination with surgery of lung or liver metastases also enables remissions. Identification of mutations in the KRAS gene is of utmost importance. For colorectal cancer, the KRAS gene is the first biomarker that predicts the response of patients to treatment with EGFR inhibitors.