Systemtherapie des ösophaguskarzinoms und stellenwert zielgerichteter substanzen

Esophageal carcinomas are known to be moderately chemosensitive tumors. The value of chemotherapy with respect to improvement in prognosis of patients with metastasized disease is not clarified. The position on indications follows individual recommendations and takes palliative aspects into consideration. The two most common subtypes, adenocarcinoma and squamous epithelial carcinoma, respond to chemotherapy with an approximately equal probability. Combination therapies based on cisplatin and 5-fluorouracil are established regimes. In principle all regimes which can be used for gastric carcinoma can also be active for esophageal carcinoma. Approximately 25-30% of adenocarcinomas of the esophagogastric junction show an overexpression of HER2 protein. Tumors overexpressing HER2 profit from treatment with the Her-2 antibody trastuzumab in combination with cisplatin-fluoropyrimidine chemotherapy. Squamous epithelial carcinomas of the esophagus often show an overexpression of epidermal growth factor receptor (EGFR).Whether anti-EGFR antibodies and other targeted therapies contribute to improved effectiveness of conventional chemotherapy is the subject of currently planned studies.