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07.03.2023 | Onkologie

Molekularpathologisch determinierte multimodale Therapie gastrointestinaler Stromatumoren

verfasst von: Lennart Schardt, PD Dr. Moritz Kaths, Prof. Dr. Sebastian Bauer

Erschienen in: Wiener klinisches Magazin

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Zusammenfassung

Hintergrund

Gastrointestinale Stromatumoren (GIST) lassen sich mithilfe moderner molekularpathologischer Methoden zunehmend besser molekular differenzieren. Die Bestimmung des Genotyps ist integraler Bestandteil bei der Entwicklung eines Behandlungskonzepts.

Ziel

Es erfolgt die Darstellung der aktuell verfügbaren Daten mit Relevanz für Therapieentscheidungen.

Resultate und Schlussfolgerungen

Patienten mit KIT-Mutationen in Exon 11 und einem hohen Rückfallrisiko profitieren von einer perioperativen Therapie mit Imatinib. Für Patienten mit Exon-9- oder den noch selteneren primären Exon-13- und –17-Mutationen ist die Studienlage weniger klar. Im Kontext lokal fortgeschrittener Tumoren, bei denen eine erhöhte Operations-bedingte Morbidität zu erwarten ist, haben sich neoadjuvante Therapien bei Imatinib-sensiblen Mutationen etabliert. Der Einsatz multimodaler Therapien in der metastasierten Situation sollte bei Imatinib-sensiblen Genotypen zum Zeitpunkt des maximalen Therapieansprechens erwogen werden – wenn eine makroskopisch komplette Resektion möglich erscheint. Inwieweit operative Therapien im Kontext neuer Inhibitoren wie Ripretinib bei stark vorbehandelten Patienten oder Avapritinib bei GIST mit PDGFRA-D842V-Mutationen („platelet-derived growth factor receptor A“) auch sinnvoll sind, wird sich erst in den kommenden Jahren zeigen.
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Metadaten
Titel
Molekularpathologisch determinierte multimodale Therapie gastrointestinaler Stromatumoren
verfasst von
Lennart Schardt
PD Dr. Moritz Kaths
Prof. Dr. Sebastian Bauer
Publikationsdatum
07.03.2023
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-023-00488-x