34
Onco
l
Vol 7
l
Nr 3
l
2013
Bijkomend werd het effect van cetuximab in combinatie met
FOLFIRINOX geëvalueerd in de POCHER-studie. Hier zagen
we een responsratio van 79 procent en een resectieratio van
63 procent (35). De PRIME-studie kon geen significant verschil
maar wel een trend in superieure responsratio aantonen bij
FOLFOX in combinatie met panitumumab (5).
We besluiten dat er op vandaag dringend behoefte is aan bij-
komende studies die aantonen welk schema het meest
efficiënt is om tot resectie te komen bij patiënten met niet-
reseceerbare levermetastasen.
Duur chemotherapie en interval tot leverresectie
Het tijdstip van heelkunde is afhankelijk van de tumordownsta-
ging en de mogelijkheid van resectie. Verscheidene studies
toonden echter aan dat het aantal cycli chemotherapie recht
evenredig is met de incidentie van postoperatieve complicaties
(37, 38). Daarom dient men bedacht te zijn bij heelkunde aan-
sluitend op langdurige behandeling met chemotherapie. Lang-
durige chemotherapie kan evenwel het macroscopische aspect
van de letsels op beeldvorming doen verdwijnen, wat dan weer
kan resulteren in een onvolledige resectie. We benadrukken
het belang van multidisciplinair overleg om het tijdstip van heel-
kunde te bepalen. Het optimale interval tussen chemotherapie
en leverresectie is ongeveer vijf weken. Een recente studie
toonde aan dat bevacizumab, welke theoretisch mogelijk kan
interfereren met de wondheling, veilig kan toegediend worden
preoperatief zonder een verhoogde morbiditeit. Stopzetting
van bevacizumab volstaat zes weken voor heelkunde.
Conclusie
De voornaamste doelstelling in de behandeling van (initieel) niet-
reseceerbare levermetastasen is heelkundige resectie te bekomen.
Bijkomende gerandomiseerde studies zijn noodzakelijk om het
superieure effect van associatie van biologische therapieën aan te
tonen evenals de ideale combinatie met chemotherapie.
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Ontvangen: 03/03/2013 Aanvaard: 09/04/2013