Kleinzelliges Lungenkarzinom

Das kleinzellige Lungenkarzinom stellt eine besonders aggressive Tumorentität dar und ist durch schnellen Progress, sehr frühe Metastasierung und eine schlechte Prognose charakterisiert. Nur wenige Patienten werden in einem frühen Erkrankungsstadium diagnostiziert. Die systemische Therapie stellt die entscheidende Therapieform für die Mehrzahl der Patienten dar. Kürzlich konnte das systemische Therapiespektrum durch die Implementierung der Immuntherapie erstmal seit Jahrzehnten erweitert werden.

Abstract

Small cell lung cancer is an aggressive cancer entity and characterized by rapid progression, early distant metastasis and poor prognosis. Only the minority of patients presents with a non-metastatic stage disease where chemo-radiotherapy or – in very selected cases – even surgical resection may be discussed. For most patients, the efficacy of systemic therapy is crucial. However, although most patients respond to platinum doublet chemotherapy, virtually all patients with metastatic disease eventually develop tumor progression for which there are limited treatment options. Recently and for the first time since decades, the systemic approaches have been enriched by the implementation of immunotherapy. Moreover, novel therapeutic approaches such as new cytotoxic agents or further immune modulatory strategies are being tested in clinical studies that might broaden our treatment options in the future even further.

Kernaussagen

• Das kleinzellige Lungenkarzinom ist durch eine äußerst aggressive Verlaufsform, eine frühe Metastasierung und schlechte Prognose charakterisiert.

• Alle Patienten sollten nach der aktuellen TNM-Stadieneinteilung klassifiziert und im Tumorboard interdisziplinär besprochen werden.

• Bei kurativer Zielsetzung ist die Standardtherapie eine kombinierte Radiochemotherapie, die idealerweise simultan durchgeführt werden sollte.

• Im frühen Tumorstadium (N0, N1) kann eine vollständige Resektion mit adjuvanter Chemotherapie abgestrebt werden.

• Die Mehrzahl der Tumoren werden bereits im metastasierten Stadium diagnostiziert, bei denen eine (Kombinations-)Chemotherapie mit palliativer Intention die Standardtherapie darstellt.

• Als neuer Therapiestandard im fortgeschrittenen Stadium gilt die Kombination aus Platin, Etoposid und den Checkpointinhibitoren Atezolizumab oder Durvalumab.

Schlüsselwörter

Lungenkrebs - Bronchialkarzinom - Chemotherapie - Strahlentherapie - Tumorresektion - Checkpointinhibitor

Keywords

pulmonary cancer - bronchial carcinoma - chemotherapy - radiation therapy - tumor resection - checkpoint inhibitor

Publication History

Article published online:
19 April 2021

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