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Behandlung von medikamentenassoziierten Nebenwirkungen in der gynäkologischen Onkologie

Treatment for iatrogenic side effects in gynecologic oncology

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Zusammenfassung

Der Einsatz der Systemtherapie hat vor allem beim Mammakarzinom zu einem deutlichen, nachweisbaren Überlebensvorteil geführt. Umso mehr ist die Behandlung therapieassoziierter Nebenwirkungen eine wichtige Aufgabe, deren erfolgreiche Erfüllung Grundvoraussetzung für die planmäßige, komplette Applikation von Systemtherapien ist und die einen wichtigen Beitrag zur Verringerung der Mortalität leistet. Entscheidend für die erfolgreiche Behandlung der chemotherapieassoziierten Infektion sind rasche Diagnosestellung und die unverzügliche Einleitung einer angemessenen Therapie. Bei Auftreten einer klinisch relevanten febrilen Neutropenie sollte zunächst eine ausführliche Diagnostik durchgeführt und die Therapie mit Leukopoesestimulationsfaktoren sowie einer empirische Antibiotikatherapie begonnen werden. In der antiemetischen Therapie kommen viele verschiedene Substanzklassen zum Einsatz. Die potentesten Antiemetika sind 5-HT3- und Neurokinin-1-Rezeptorantagonisten. Ebenfalls eine sehr gute antiemetische Wirkung haben Kortikosteroide, die Kombination mit 5-HT3- und NK-1-Antagonisten ist die wirksamste Dreierkombination. Auch andere gastrointestinale Symptome, wie Diarrhö, Obstipation und Mukositis können erfolgreich behandelt werden. Der Übersichtsartikel fasst die verfügbaren Optionen zur supportiven Behandlung therapieassoziierter Nebenwirkungen zusammen und gibt konkrete Handlungsanweisungen für den klinischen Alltag.

Abstract

Systemic therapy has led to significant mortality reductions, particularly in breast cancer. Treatment of side effects resulting from such therapy is therefore also of major importance in controlled and thorough systemic treatment. Speedy diagnosis and initiation of the indicated therapy is decisive in countering infection associated with chemotherapy. In the case of clinically relevant febrile neutropenia, complete diagnostics should be done and treatment started with leukopoiesis stimulation factors and empiric antibiotics administration. Many different substance classes are used for antiemetic treatment, the most potent of which are 5-HT3 and neurokinin-1 receptor antagonists. Corticosteroids also show good antiemetic results, and their combination with 5-HT3 und NK-1 antagonists is the most effective. Other gastrointestinal symptoms such as diarrhea, obstipation, and mucositis can be successfully treated. This article summarizes supportive treatment options for adverse events during cytostatic treatment and gives hands-on recommendations for clinical practice.

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Interessenkonflikt

Referententätigkeit für Sanofi Aventis, Novartis, Amgen, Astra Zeneca, Chugai, Lilly Deutschland.

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Correspondence to Prof. Dr. W. Janni.

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Janni, W., Jückstock, J., Schneeweiss, A. et al. Behandlung von medikamentenassoziierten Nebenwirkungen in der gynäkologischen Onkologie. Gynäkologe 41, 575–584 (2008). https://doi.org/10.1007/s00129-008-2168-y

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Schlüsselwörter

  • Chemotherapie
  • Radiotherapie
  • Endokrine Therapie
  • Rezidiv
  • Mammakarzinom
  • Supportive Therapie
  • Nebenwirkungen

Keywords

  • Chemotherapy
  • Endocrinal therapy
  • Radiotherapy
  • Recurrence
  • Breast cancer
  • Supportive therapy
  • Adverse events