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  • 1 Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház Onkológiai Osztály Budapest Nagyvárad tér 1. 1096
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A neuroendokrin tumorok a ritka daganatok igen heterogén csoportját alkotják, amelyek a test különböző területein elhelyezkedő neuroendokrin rendszerből indulnak ki. A neuroendokrin daganatok lehetnek funkcionálók, sokféle mediátort termelhetnek, nagyobb részük azonban a nem funkcionáló csoportba tartozik. Szövettani jellegük és biológiai viselkedésük alapján lehetnek jól differenciált formájú alacsonyabb malignitású, valamint rosszul differenciált nagy malignitású tumorok. Az előrehaladt alacsony malignitású daganatok esetében a szomatosztatinanalógok nemcsak csökkentik a tumor okozta tüneteket, hanem közvetlen tumorgátló hatásuk is van. Azoknál a betegeknél, akiknél a standard szomatosztatinanalóg-terápia ellenére progresszió észlelhető, az új szelektív agonistáktól, illetve kimerikus készítményektől és panszomatosztatinagonista alkalmazásától további terápiás előnyt remélünk. Vizsgálatok utalnak arra is, hogy a szomatosztatinanalógok interferonnal együtt adva szinergista hatást mutatnak. A jelenleg elfogadott kemoterápiás kombinációkat a progresszív folyamatok esetében főleg a rosszul differenciált formáknál alkalmazzuk, de a jól differenciált carcinomák esetében is javasoltak, ha azok más kezelésre nem alkalmasak, illetve ha a terápia ellenére előre haladnak. Az újonnan kifejlesztett daganatellenes szerek, a közeljövőben felválthatják a régi protokollokat. Klinikai vizsgálatok azt mutatják, hogy a telozolomiddal és capecitabinnal kedvezőbb mellékhatásprofil mellett magasabb és tartósabb terápiás választ lehet elérni jól differenciált tumorokban. A célzott terápia neuroendokrin daganatok esetén is a figyelem központjába került. A vascularis endothelialis növekedési faktor receptorra ható monoklonális antitest, a bevacizumab mind monoterápiában, mind szomatosztatinanalóggal vagy oxaliplatinnal/capecitabinnal kombinált kezelés során terápiás előnyt hozott. A kis molekulasúlyú multikinázgátló sunitinib hatékonyságát a pancreas neuroendokrin daganataiban fázis III-as vizsgálat igazolta. Az mTOR-gátló everolimus is szignifikánsan növeli a túlélést ugyanebben a daganataltípusban. További vizsgálatok szükségesek annak meghatározásához, hogy más lokalizációjú, illetve rosszul differenciált daganatok esetén melyik célzott terápia nyújthat előnyt. A 131I-MIBG, 90Y-DOTA-TOC és 177Lu-DOTA-TOC radionuklidkezelések előrehaladt, illetve metasztatikus daganatokban hatékony és jól tolerálható kezelések. Jelen összefoglaló célja, hogy áttekintse és elemezze a rendelkezésre álló kemoterápiás kezelések eredményeit annak érdekében, hogy meghatározható legyen a legmegfelelőbb terápia a neuroendokrin daganatok esetében. Orv. Hetil., 2011, 152, 379–391.

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