Publications (217) View all
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Article: ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making.
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ABSTRACT: Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.Annals of Oncology 10/2012; 23(10):2479-516. · 6.43 Impact Factor -
Article: Die Therapie des Gallenblasenkarzinoms Eine Standortanalyse
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ABSTRACT: Einleitung: Die Möglichkeiten zur Therapie des Gallenblasenkarzinoms sind vielfältig, wenngleich nur durch eine Tumorresektion eine entscheidende Verlängerung des Patientenüberlebens realisiert werden kann. Methode: Das Ziel dieser Studie war, Patienten mit einem Gallenblasenkarzinom an der chirurgischen Abteilung eines Schwerpunktkrankenhauses retrospektiv zu analysieren. Von 1986–1999 waren 77 Patienten mit einem solchen Karzinom in Behandlung. Das mediane Patientenalter betrug 71,3 Jahre. Ergebnisse: Es wurden 28 Patienten reseziert, 22 Personen wurden einem chirurgisch palliativen Verfahren zugeführt, und 16 Operationen mussten als explorative Laparotomie beendet werden. Keine chirurgische Therapie erhielten 11 Patienten. Zehn Personen wurden entweder mit Gemcitabin oder mit einem Kombinationsregime von Leucovorin, 5-Fluorouracil und Mitomycin C chemotherapiert. Die Patienten, die keine postoperative Therapie erhielten, überlebten nach einer Resektion mit tumorfreien Schnitträndern (n=15) im Median 10,7 Monate (1 Patient mit Fernmetastasen exkludiert), nach einer Resektion mit tumorpositiven Schnitträndern (n=8) im Median 3,2 Monate (p=0,023). Ohne Chemotherapie (n=17) wurde nach einem palliativen chirurgischen Verfahren ein medianes Überleben von 1,5 Monaten, nach einer explorativen Laparotomie (n=15) ein medianes Überleben von 2,1 Monaten ermittelt. Das mediane Überleben der nichtoperierten Patienten betrug 1,6 Monate. Eine Chemotherapie erhielten 4 der resezierten Patienten (medianes Überleben 16,5 Monate), 5 palliativ operierte Patienten und 1 Patient nach einer explorativen Laparotomie (medianes Überleben 4,3 Monate) (p=0,034). In der multivariaten Analyse erwiesen sich sowohl die Tumorresektion (p=0,034) als auch tumorfreie Resektionsränder (p=0,025) als prognostisch signifikante Variablen. Schlussfolgerungen: Die Tumorresektion ist der entscheidende Faktor für ein verlängertes Patientenüberleben. Mit einer radikalen Resektion im möglichst frühen Tumorstadium und einer Kombination mit einer etablierten Chemotherapie könnte das Patientenüberleben deutlich verbessert werden. Introduction: There are various options for the treatment of gallbladder carcinoma; however, only radical resection offers a chance for prolonged survival. Methods: The aim of this study was to analyze retrospectivly patients suffering from gallbladder carcinoma in a central hospital in Austria. From 1986 to 1999, 77 patients were treated in this surgical department. The median age of the patients was 71.3 years. Results: In 28 patients the cancer was resected and 22 persons underwent palliative surgery. An explorative laparotomy was performed in 16 patients. Eleven patients had no surgical therapy, 10 persons received gemcitabine or a combination chemotherapy regimen consisting of leucoverin, 5-fluorouracil and mitomycin C. The median survival of patients without chemotherapy following radical resection (n=15) was 10.7 months (one patient with metastatic cancer was excluded) and for patients with tumor remaining margins (n=8) 3.2 months (P=0.023). Without chemotherapy the median patient survival following palliative resection (n=17) and explorative laparotomy (n=15) was 1.5 months and 2.1 months. The median survival without surgical therapy was 1.6 months. Chemotherapy was administered to four of the resected patients (median survival 16.5 months), in five patients following palliative surgery and in one patient after explorative laparotomy (median survival 4.3 months) (P=0.034). In a multivariate analysis, tumor resection (P=0.034) and tumor-free resection margins (P=0.025) proved to be the most important determinants for patient survival. Conclusion: Tumor resection is the most important factor for a prolonged patient survival. Following radical resection in an early tumor stage and combining this approach with an established chemotherapy, patient survival could be increased significantly.Der Chirurg 04/2012; 73(1):50-56. · 0.70 Impact Factor -
Article: VEGF and EGFR inhibition: opening a new door to cancer treatment
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ABSTRACT: Targeted therapies have provided the first agents that can overcome resistance to chemotherapy in metastatic colorectal cancer and have allowed for unprecedented survival rates in lung cancer. To date, the use of the VEGF inhibitor bevacizumab and the EGFR inhibitors cetuximab, panitumumab, gefitinib and erlotinib have been explored in various clinical settings. Bevacizumab has shown promising results in the treatment of breast cancer, colorectal carcinoma and renal cell carcinoma. Cetuximab, gefitinib and erlotinib are treatment options in non-small-cell lung cancer. Patients with metastatic colorectal cancer can derive great benefit from cetuximab or panitumumab therapy. However, patient selection is essential, since individual characteristics, such as KRAS mutation status, can determine response to treatment. Experts presented the current situation at the Annual Meeting of the Austrian Society of Surgical Oncology in St. Wolfgang, Austria, in October 2009 Zielgerichtete Therapien sind die ersten Substanzen, mit denen bei metastasiertem Kolonkarzinom Resistenzen gegen Chemotherapien überwunden werden können, und ermöglichen bei Lungenkarzinom bisher unerreichte Überlebensraten. Bis dato wurden der VEGF-Hemmer Bevacizumab und die EGFR-Inhibitoren Cetuximab, Panitumumab, Gefitinib und Erlotinib in verschiedenen klinischen Settings erforscht. Bevacizumab zeigt vielversprechende Ergebnisse in der Therapie des Mammakarzinoms, des kolorektalen Karzinoms und des Nierenzellkarzinoms. Cetuximab, Gefitinib und Erlotinib stellen bei nicht-kleinzelligem Lungenkarzinom Behandlungsoptionen dar. Patienten mit metastasiertem kolorektalen Karzinom können maßgeblich von einer Therapie mit Cetuximab oder Panitumumab profitieren. Allerdings spielt die Patientenselektion eine entscheidende Rolle, da individuelle Merkmale wie der KRAS-Mutationsstatus das Ansprechen auf die Therapie beeinflussen können. Im Rahmen der Jahrestagung der Österreichischen Gesellschaft für Chirurgische Onkologie in St. Wolfgang, Österreich, präsentierten Experten im Oktober 2009 die aktuelle Situation. KeywordsIndividualised treatment-Biomarkers-KRAS mutation status-Activating EGFR mutation-Non-small-cell lung cancer-Breast cancer-Colorectal carcinoma-Liver metastases-Renal cell carcinoma-Bevacizumab-Cetuximab-Panitumumab-Gefitinib-Erlotinib SchlüsselwörterIndividualisierte Therapie-Biomarker-KRAS-Mutationsstatus-Aktivierende EGFR-Mutation-Nicht-kleinzelliges Lungenkarzinom-Mammakarzinom-Kolorektales Karzinom-Lebermetastasen-Nierenzellkarzinom-Bevacizumab-Cetuximab-Panitumumab-Gefitinib-ErlotinibEuropean Surgery 04/2012; 42(1):24-28. · 0.28 Impact Factor -
Article: Consensus on the medical treatment of colon cancer
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ABSTRACT: PURPOSE: To throw light on some of the issues in the choice of therapy for patients with metastatic colorectal cancer (mCRC) and to provide consensus recommendations on which combination(s) and sequence(s) of systemic therapy to be used in different treatment situations. MATERIAL AND METHODS: An expert panel comprising clinicians from Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Romania, Slovakia, Slovenia, Spain and the UK with expertise in medical oncology, clinical oncology, surgery and dermatology, and specialist knowledge of the treatment of patients with CRC was convened by the Central European Cooperative Oncology Group (CECOG) in Vienna in 2007. Members were then asked to agree on a consensus statement following a period of discussion at the end of a series of presentations. RESULTS AND CONCLUSIONS: The consensus recommendations for the state-of-the-art treatment of colon cancer arrived at by an "expert panel" of clinicians were that: oral 5-fluorouracil (5-FU) prodrugs or protracted intravenous infusion of the antimetabolite are preferable to bolus administration; all active drugs (fluoropyrimidines, irinotecan, oxaliplatin, bevacizumab, cetuximab) should be used during strategic patient management; after neoadjuvant treatment and consultation of an interdisciplinary team, surgery should be considered for metastatic disease wherever possible and "fit" elderly patients should not be denied the same treatment as younger patients.memo - Magazine of European Medical Oncology 04/2012; 1(2):79-90. -
Article: FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer-subgroup analysis of patients with KRAS: mutated tumours in the randomised German AIO study KRK-0306.
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ABSTRACT: The AIO KRK-0306 trial compares the efficacy of infusional 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) plus cetuximab with FOLFIRI plus bevacizumab in first-line treatment of metastatic colorectal cancer (mCRC). In October 2008, an amendment terminated the inclusion of patients with KRAS-mutated tumours. This subgroup of patients is evaluated in the present analysis, while the study is ongoing for patients with KRAS wild-type tumours. Patients were randomly assigned to FOLFIRI (Tournigand regimen) every 2 weeks plus cetuximab (400 mg/m2 day 1, followed by 250 mg/m2 weekly=arm A) or bevacizumab (5 mg/kg every 2 weeks=arm B). Among 336 randomised patients, KRAS mutation was demonstrated in 100 assessable patients. The primary study end point was objective response rate (ORR). ORR was 44% [95% confidence interval (CI) 29% to 59%] in arm A versus 48% (95% CI, 33% to 62%) in arm B. Progression-free survival was 7.5 versus 8.9 months (hazard ratio: 1.0) and overall survival was 22.7 versus 18.7 months (hazard ratio: 0.86) in arms A versus B, respectively. This is the first head to head comparison of cetuximab versus bevacizumab in first-line treatment of mCRC. In the present evaluation of patients with KRAS-mutated tumours, neither strategy demonstrated a clearly superior outcome.Annals of Oncology 01/2012; 23(7):1693-9. · 6.43 Impact Factor
