Individualization in Multimodal Therapy of Primary Tumors (“personalized medicine”)
Challenge:
Addition of chemotherapy or radiochemotherapy improves outcome of curative primary tumor surgery, but also increases morbidity and mortality! Overtreatment occurs in up to 85% of the patients. – Response varies individually.
Aim:
Avoid unneccessary chemotherapy or radiochemotherapy by individualizing therapy with new prognostic factors.
Achievements:
FOGT was one of the first groups worldwide who demanded and found out additional molecular prognostic factors that might help to better select patients for multimodal treatment. Internationally respected results.
In the BIC/ICRCC meetings „treatment individualization“ was adressed in scientific sessions from the beginning in 2002.
The FOGT has provided evidence, that patients with tumors expressing high TS and low DPD have the highest benefit from multimodal therapy involving 5-FU or modulation protocols with 5-FU. The FOGT results helped to stimulate active research.
Up to date research results of FOGT 4:
Questions:
Is adjuvant FOLFIRI better than 5-FU+FA?
Prospective evaluation of molecular prognostic factors.
Answers:
– Adjuvant FOLFIRI did not improve adjuvant 5-FU+FA.
– A subgroup of patients with molecular determinants seems to profit from adjuvant FOLFIRI.
Up to date research results of FOGT 5:
Questions:
Can molecular factors from metastatic tumor tissue help to select for the optimal treatment with either 5-FU+FA or FOLFIRI?
Answers:
Patients with nonresectable metastases who benefit from FOLFIRI may be selected by TS determination (individualization).
Patients who benefit from 5-FU+Folonic Acid (5-FU+FA) at the same success rate as with the more toxic FOLFIRI may be individually selected by TS determination.
If TS determination gets easily accessable to the medical oncologic community, treating their patients with potentially toxic chemotherapy, they might like to use it for the benefit of their patients.
Invited presentations of surgical oncological results and visions on future developments on very high level interdisciplinary expert meetings and in review papers by K. H. Link.
see also: Liver Metastases