Das Medizinportal


Was spricht für eine frühe Integration der Palliativmedizin in die Onkologie

Gesine Benze, Bernd Alt-Epping,  Friedemann Nauck; Klinik für Palliativmedizin, Universitätsmedizin Göttingen (S. 10-11)


  1. WHO Definition of Palliative Care. www.who.int/cancer/palliative/definition/en/. Zugriff 22.11.2016
  2. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH. American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. J Clin Oncol. 2012; 30:880-887
  3. Ferris FD, Bruera E, Cherny N, Cummings C, Currow D, Dudgeon D, Janjan N, Strasser F, von Gunten CF, Von Roenn JH. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol. 2009; 27(18):3052-3058. 
  4. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363: 733-742
  5. Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC, Byock IR, Hull JG, Li Z, McKinstry E, Seville JL, Ahles TA.The Project ENABLE II randomized controlled trail to improve palliative care for patients with advanced cancer. JAMA. 2009; 302: 741-749 
  6. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C. Early palliative care for patients with advanced cancer: A cluster-randomized controlled trial. Lancet. 2014; 383: 1721-1730
  7. Rugno FC, Piava CE. Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic cancers. Gynecol Oncol. 2014; 135: 249-254
  8. Lowery WJ, Lowery AW, Barnett JC, Lopez-Acevedo M, Lee PS, Secord AA et al. Cost-effectiveness of early palliative care intervention in recurrent platinum-resistant ovarian cancer. Gynecol Oncol. 2013; 130: 426-430
  9. Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): A multicenter randomized controlled trial in patients with lung cancer. Lancet Oncol. 2014; 15: 1168-1176
  10. Grundzen CR, Richardson LD, Johnson PN, Hu M, Wang B, Ortiz JM, Kistler EA, Chen A, Morrison RS. Emergency department-initiated palliative care in advanced cancer: a randomized clinical trial. JAMA Oncol. 2016; Jan 14. doi: 10.1001/jamaoncol.2015.5252. [Epub ahead of print]
  11. Pirl WF, Greer JA, Traeger L, Jackson V, Lennes IT, Gallagher ER, Perez-Cruz P, Heist RS, Temel JS. Depression and survival in metastatic non-small cell lung cancer: Effects of early palliative care. J Clin Oncol. 2012; 30: 1310-1315
  12. Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, Dionne-Odom JN, Frost J, Dragnev KH, Hegel MT, Azuero A, Ahles TA. Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015; 33: 1438-1445 
  13. Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, Gallagher ER, Temel JS. Effect of early palliative care on chemotherapy use and end-of-life care in patients with non-small-cell lung cancer previously treated with chemotherapy. J. Clin Oncol. 2012; 30: 394-400
  14. Weeks JC, Catalano PJ, Cronin A et al. Patients´ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012; 367: 1616-1625
  15. Yoong J, Park ER, Greer JA, Jackson VA, Gallagher ER, Pirl WF, Back AL, Temel JS. Early palliative care in advanced young cancer: A qualitative study. JAMA Intern Med. 2013; 173: 283-290 
  16. Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: Results of a randomized study of early palliative care. J Clin Oncol. 2011; 29: 2319-2326
  17. McNamara BA, Rosenwax LK, Murray K, Corrow DC. Early admission to community-based palliative care reduces use of emergency departments in the ninety days before death. J Palliat Med. 2013; 16: 774-779
  18. Hui D, Kim SH, Roquemore J, Dev R, Chrisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014; 120:1743-1749- 
  19. Kwon JH, Hui D, Chrisholm G, Ha C, Yennurajalinggam S, Kang JH, Bruera E. Clinical characteristics of cancer patients referred early to supportive and palliative care. J Palliat Med. 2013; 16: 148-155       
  20. Wallen GR, Baker K, Stolar M, Miller-Davis C, Ames N, Yates J, Bolle J, Pereira D, St Germain D, Handel D, Berger A. Palliative care outcomes in surgical oncology patients with advanced malignancies: A mixed methods approach. Qual Life Res. 2012; 21:405-415
  21. Back AL, Park ER, Greer JA, Jackson VA, Jacobsen JC, Gallagher ER, Temel JS. Clinician roles in early integrated palliative care for patients with advanced cancer: a qualitative study. J Palliat Med. 2014; 17: 1244-1248
  22. Bakitas M, Lyons KD, Hegel MT, Ahles T. Oncologists´ perspectives on concurrent palliative care in a National Cancer Institute-designated comprehensive cancer center. Palliat Support Care. 2013; 11(5): 415-423
  23.  Schenker Y, Crowley-Matoka M, Dohan D, Rabow MW, Smith CB, White DB, Chu E, Tiver GA, Einhorn S, Arnold RM. Oncologist factors that influence referrals to subspecialty palliative care clinics. J Oncol Pract. 2014; 10(2):e37-44

Palliativtherapie in der Gynäkologie

Eva-Maria Grischke, Eva Stauss, Universitäts-Frauenklinik Tübingen (S.16-19)


  1. Ferrell B et al. (2015) J Pain Symptom manage 50: 758–767
  2. Sun V et al. (2015) Cancer 121: 3737–3745
  3. Bergqvist J, Strang P (2016) Palliate Med 30: #FC71, oral presentation
  4. Grischke, E-M., et al (2013)  Isolated loco-regional Recurrence of Breast Cancer – Established and Innovative Therapy Concepts. Geburtsh Frauenheilk 2013; 73: 1 – 12 
  5. Mali B, Jarm T, Snoj M, Sersa G, Miklavcic D. (2012) Antitumor effectiveness of electrochemotherapy: a systematic review and meta-analysis. Eur. J. Surg. Oncol. 2012; 39(1), 4–16

Off-Label-Use in der Palliativmedizin

Constanze Rémi, Claudia Bausewein; Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München (S.20-25)


  1. Hafner K, Schweim H. Off-Label-Use von Arzneimitteln in der Palliativmedizin [Internet]. Vol. Doctor, Mathematisch-Naturwissenschaftlichen Fakultät. [Bonn]: Rheinische Friedrich-Wilhelms-Universität Bonn; 2013. Available from: hss.ulb.uni-bonn.de/2013/3189/3189.htm
  2. Atkinson C V, Kirkham SR. Unlicensed uses for medication in a palliative care unit. Palliat Med. 1999;13:145–152. 
  3. Todd J, Davies A. Use of unlicensed medication in palliative medicine. Palliat Med. 1999;13:466. 
  4. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. Br Med J [Internet]. 2003;327(7414):523–8. Available from: www.ncbi.nlm.nih.gov/entrez/query.fcgi
  5. Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Manage. 2007;33(4):473–81. 
  6. Currow DC, McDonald C, Oaten S, Kenny B, Allcroft P, Frith P, et al. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011/04/05. 2011;42(3):388–99. 
  7. Jennings AL, Davies AN, Higgins JP, Broadley K. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001;(4):CD002066. 
  8. Gremaud G, Zulian GB. Indications and Limitations of Intravenous and Subcutaneous Midazolam in a Palliative Care Center. J Pain Symptom Manage [Internet]. 1998;15(6):331–3. Available from: www.sciencedirect.com/science/article/pii/S0885392498000207
  9. Amesbury BDW, Dunphy KP. The use of subcutaneous midazolam in the home care setting. Palliat Med. 1989;3:299–301. 
  10. Gemeinsamer-Bundesausschuss. www.g-ba.de Anwendung eines Arzneimittels außerhalb der genehmigten Anwendungsgebiete (Off-label-use) [Internet]. Vol. 2009. 2009. Available from: www.g-ba.de/institution/themenschwerpunkte/arzneimittel/off-label-use/
  11. Gazarian M, Kelly M, McPhee JR, Graudins L V, Ward RL, Campbell TJ, et al. Off-label use of medicines: consensus recommendations for evaluating appropriateness.[see comment]. Med J Aust. 2006;185(10):544–8. 

INTERVIEW - Kognition korreliert mit traumatischem Stress

Dr. Kerstin Hermelink im Gespräch zu kognitiven Defiziten bei Krebspatienten (S. 28-30)


  1. Hermelink K., Chemotherapy and Cognitive Function in Breast Cancer Patients: The So-Called Chemo Brain. J Natl Cancer Inst Monogr. 2015 May;2015(51):67-9.
  2. Wieneke, M.H. and E.R. Dienst, Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology, 1995. 4(1): p. 61-66.
  3. Shilling, V., V. Jenkins, and I.S. Trapala, The (mis)classification of chemo-fog – methodological inconsistencies in the investigation of cognitive impairment after chemotherapy. Breast Cancer Research and Treatment, 2006. 95(2): p. 125-129.
  4. Hermelink, K., et al., Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer, 2007. 109(9): p. 1905-13.
  5. Vardy, J.L., et al., Cognitive Function in Patients With Colorectal Cancer Who Do and Do Not Receive Chemotherapy: A Prospective, Longitudinal, Controlled Study. J Clin Oncol, 2015. 33(34): p. 4085-92.
  6. Ono, M., et al., A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol, 2015. 5: p. 59.
  7. Hermelink, K., et al., Elucidating Pretreatment Cognitive Impairment in Breast Cancer Patients: The Impact of Cancer-Related Post-Traumatic Stress. Journal of the National Cancer Institute, 2015. 107(7).
  8. Hermelink K, Bühner M, Harbeck N. Response. J Natl Cancer Inst. 2016 Apr 13;108(8).
  9. Voigt, V., et al., Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psycho-Oncology, 2016: p. n/a-n/a.
  10. Schagen S.B., Das E, Vermeulen I. Information about chemotherapy-associated cognitive problems contributes to cognitive problems in cancer patients. Psychooncology. 2012 Oct;21(10):1132-5. 

KOMPLEMENTÄRMEDIZIN - Was können Mistel & Co. leisten

Dr. Marion Hofmann-Aßmus (S. 34)


  1. Kienle GS, Kiene H. Integr Cancer Ther 2010; 9(2):142-157
  2. Horneber MA et al. The Cochrane Collaboration, Wiley 2008
  3. Roman M et al. Metallomics 2014; 6:25-54
  4. Mücke R et al. Int j Radiation Oncol 2010;78:828-835
  5. Goodwin JP et al. J Clin Oncol 2009; (10) 27:3757-3763

UPDATE - Neuroendokrine Neoplasien des Gastrointestinal-Traktes: Diagnostik und interdisziplinäre Therapie

Christian Fottner, Matthias M. Weber; Universitätsmedizin der Johannes Gutenberg-Universität Mainz, ENETS center of excellence (S.39-44)


  1. Oberg K, Castellano D. Current knowledge on diagnosis and staging of neuroendocrine tumors. Cancer Metastasis Rev. 2011 Mar;30 Suppl 1:3-7.
  2. Rindi G, Wiedenmann B. Neuroendocrine neoplasms of the gut and pancreas: new insights. Nat Rev Endocrinol. 2011 Aug 2. doi: 10.1038/nrendo.2011.120. 
  3. Rindi G, Klöppel G, Alhman H, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system.; European Neuroendocrine Tumor Society (ENETS). Virchows Arch. 2006 Oct;449(4):395-401.
  4. Rindi G, Klöppel G, Couvelard A et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2007 Oct;451(4):757-62.
  5. Fottner C, Weber MM. Neuroendocrine neoplasms of the gastrointestinal tract. Classification, clinical presentation and diagnosis. Internist (Berl). 2012 Feb;53(2):131-44. 
  6. Miederer M, Weber MM, Fottner C. Molecular imaging of gastroenteropancreatic neuroendocrine tumors. Gastroenterol Clin North Am. 2010 Dec;39(4):923-35.
  7. Fendrich V, Bartsch DK. Surgical treatment of gastrointestinal neuroendocrine tumors. Langenbecks Arch Surg. 2011 Mar;396(3):299-311. 
  8. Modlin IM, Kidd M, Drozdov I et al. Pharmacotherapy of neuroendocrine cancers. Expert Opin Pharmacother. 2008 Oct;9(15):2617-26. 
  9. Fazio N, de Braud F, Delle Fave G et al. Interferon-alpha and somatostatin analog in patients with gastroenteropancreatic neuroendocrine carcinoma: single agent or combination? Ann Oncol. 2007 Jan;18(1):13-9.
  10. Delle Fave GF, O'Toole D, Sundin A, Taal B, Ferolla P, Ramage J, Ferone D, Ito T, Weber W, Zheng-Pei Z, De Herder WW, Pascher A, Ruszniewski P; all other Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. Neuroendocrinology. 2016 Jan 19. [Epub ahead of print]
  11. Rinke A, Müller HH, Schade-Brittinger C et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009 Oct 1;27(28):4656-63.
  12. Ruszniewski P. Oral presentation European Society od Medical Oncology – ESMO 2013
  13. Kouvaraki MA, Ajani JA, Hoff P et al. Fluorouracil, doxorubicin, and streptozocin in the treatment of patients with locally advanced and metastatic pancreatic endocrine carcinomas. J Clin Oncol. 2004 Dec 1;22(23):4762-71
  14. Raymond E, Dahan L, Raoul JL et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med. 2011 Feb 10;364(6):501-13.
  15. Yao JC, Shah MH, Ito T et al. RAD001 in Advanced Neuroendocrine Tumors, Third Trial (RADIANT-3) Study Group. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med. 2011 Feb 10;364(6):514-23.
  16. Yao JC, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin E, Tomasek J, Raderer M, Lahner H, Voi M, Pacaud LB, Rouyrre N, Sachs C, Valle JW, Delle Fave G, Van Cutsem E, Tesselaar M, Shimada Y, Oh DY, Strosberg J, Kulke MH, Pavel ME Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study with RAD001 in Advanced Neuroendocrine Tumors, Fourth Trial (RADIANT-4) Study Group. Lancet. 2016 Mar 5;387(10022):968-77. 
  17. Pavel M, Baudin E, Couvelard A, et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157-76.
  18. Teunissen JJ, Kwekkeboom DJ, Valkema R et al. Nuclear medicine techniques for the imaging and treatment of neuroendocrine tumours. Endocr Relat Cancer. 2011 Oct 17;18 Suppl 1:S27-51.
  19. Strosberg J et al. NETTER-1 phase III: Efficacy and safety results in patients with midgut neuroendocrine tumors treated with 177Lu-DOTATATE. J Clin Oncol 34, 2016 suppl; abstr 4005

PHARMAFORUM - Liquid Biopsy ist im klinischen Alltag angekommen (NSCLC: Vor Therapiebeginn alle Patienten auf EGFR Mutationen testen)

S. 48


  1. Onkopedia-Leitlinie, online: www.onkopedia.com/de/onkopedia/guidelines/lungenkarzinom-nicht-kleinzellig-nsclc/@@view/html/index.html; Stand: November 2016, Abruf 9.11.2016
  2. Reinmuth N, Grohe C, Seese B. DKK 2016, Abstract ID 0321
  3. Reck M, Hagiwara K, Han B, et al. J Thoracic Oncol 2016; 11(10):1682-1689
  4. Fachinformation IRESSA, September 2016

PHARMAFORUM - Perjeta® + Herceptin in der neoadjuvanten Situation ist für sehr viele Patientinnen indiziert

S. 49


  1. Fachinformation Perjeta®, Stand Sep. 2015
  2. Gianni L et al., Lancet Oncol 2012, 13:25–32
  3. Gianni L et al., Lancet Oncol 2016, 17:791–800

PHARMAFORUM - Chemotherapie beim Non-Hodgkin-Lymphom sicherer machen (Supportivtherapie)

S. 50


  1. Aapro MS et al. Eur J Cancer 2011; 47: 8–32
  2. Lee S et al. Support Care Cancer 2013; 21: 841–6
  3. Fietz T et al. Prophylaxis of chemotherapy-induced neutropenia with Lipegfilgrastim in patients with Non-Hodgkin- Lymphoma (NHL): results from an interim analysis of the non-interventional study NADIR. DGHO-Jahrestagung 2016 vom 14.–18. Oktober 2016 in Leipzig, Posterabstract P950. Unterstützt von der TEVA GmbH
  4. Pettengell R et al. Br J Haematol 2009; 144: 677–85

PHARMAFORUM - Jetzt zielgerichtete Therapie mit monoklonalem Antikörper Necitumumab (Plattenepitheliales nicht kleinzelliges Lungenkarzinom (NSCLC))

S. 51


  1. Fachinformation Portrazza®. Stand: Februar 2016
  2. Thatcher N et al., 2015, Lancet Oncol 16:763–774
  3. Reck M., 2016. SQUIRE German subgroup data: Necitumumab as add-on to first-line GC for sqNSCLC