Medikamentöse Therapie von malignen Lidtumoren

Im Kontakt mit ophthalmologischen Patient*innen sind Fragestellungen hinsichtlich tumoröser Prozesse der Augenlider alltäglich. Meist handelt es sich um gutartige Läsionen, deren Therapieoptionen übersichtlich und deren Prognose gut ist. Dennoch ist hierbei stets höchste Sorgfalt geboten, denn maligne Läsionen lassen sich teilweise schwer von benignen unterscheiden. Ein Übersehen kann fatale Folgen für die Patient*innen bedeuten.

Abstract

Introduction Although surgical therapy is often the first-line treatment for malignant eyelid tumors, pharmacological treatment approaches can also be included and pursued in the treatment plan.

Methods Narrative review with a selective literature search on PubMed and Google Scholar.

Results Various pharmacological therapeutic principles are currently available. One option is the local application of agents within the tumor area. This can be achieved through cytostatically active drugs such as 5-fluorouracil for superficial basal cell carcinomas and precursors of squamous cell carcinomas, or through mitomycin C in specific cases of sebaceous gland carcinoma. Another form of pharmacological local therapy is local immunomodulation using Imiquimod for superficial basal cell carcinomas, actinic keratosis, and Bowenʼs disease. Furthermore, there are systemic pharmacological therapies like chemotherapies, for example in sebaceous cell carcinoma, or systemic immunomodulation using checkpoint inhibitors for example in basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma. Additionally, targeted therapies offer yet another treatment modality that exploits the molecular biological characteristics of various tumor entities. Examples of this include Hedgehog inhibitors for basal cell carcinomas, EGFR inhibitors for squamous cell carcinomas, or BRAF inhibitors for melanomas. This review addresses these treatment options for malignant tumors of the eyelid and systematically organizes them for the reader.

Conclusion Even though the data on these eye tumors is still limited, the reported case studies using systemic therapies for malignant eyelid tumors demonstrate the potential of this treatment modality. However, the need for further research is high especially concerning the combination of different therapy principles for increasing the effectiveness of eyelid tumor therapy.

Kernaussagen

• Der Vormarsch molekularbiologischer Methoden in der Charakterisierung von Malignomen ist auch bezüglich Lidtumoren präsent.

• Dies ermöglicht die Identifizierung von Tumoreigenschaften, welche pharmakologische Angriffspunkte liefern.

• Hierdurch entsteht die Möglichkeit neben etablierten Methoden wie Chirurgie oder Radiotherapie gezielt mit einer Systemtherapie gegen Lidmalignome vorzugehen.

• Am prominenten Beispiel des Basalzellkarzinoms zeigt sich jedoch auch, dass die Nutzung einzelner molekularbiologischer Ziele nicht dauerhaft ausreicht.

• Entwickeln sich Resistenzen der Malignomzellen gegen eine Substanzklasse, bedarf es neuer pharmakologischer Angriffspunkte.

• Hierdurch ergibt sich ein weiterer Forschungsbedarf, um zukünftig ein längerfristiges Ansprechen auf Systemtherapien für die Patient*innen gewährleisten zu können.

Schlüsselwörter

Hautkrebs - Augenlid - Systemtherapie - topische Therapie

Key words

Skin cancer - eyelid - systemic therapy - topical therapy

Publication History

Article published online:
27 February 2024

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