Kleinzelliges Lungenkarzinom

Zusammenfassung

Das kleinzellige Lungenkarzinom stellt eine besonders aggressive Tumorentität dar und ist durch schnellen Progress, sehr frühe Metastasierung und schlechte Prognose charakterisiert. Nur wenige Patienten werden in einem frühen Erkrankungsstadium diagnostiziert, bei dem in ausgewählten Fällen eine chirurgische Resektion diskutiert werden kann. Chemotherapie und Strahlentherapie sind initial häufig effektiv. Allerdings erleiden die meisten Patienten im metastasierten Stadium nach zunächst gutem Ansprechen auf eine platinhaltige Chemotherapie einen Progress mit dann nur limitierten Therapieoptionen.

Abstract

Small cell lung cancer accounts for roughly 14% of all lung cancers and is characterized by rapid progression, early distant metastasis and poor prognosis. Only a minority of patients presents with early stage disease upon initial diagnosis where surgical resection may be discussed. In addition, various treatment modalities demonstrate effectiveness including chemotherapy and radiotherapy. 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. Novel therapeutic approaches such as immune checkpoint inhibitors or the antibody drug conjugate rovalpituzumab tesirine show promising results in early clinical trials and might broaden our treatment options in the future.

Kernaussagen

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

• Alle Patienten sollten im Tumorboard interdisziplinär besprochen werden.

• Im frühen Tumorstadium (N0, N1) sollte ein multimodales Therapiekonzept mit chirurgischer Resektion (Lobektomie und systematische Lymphadenektomie) angestrebt werden.

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

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

• Verschiedene neue Therapieansätze wie Checkpointinhibitoren und zielgerichtete Chemotherapie befinden sich in klinischer Testung.

Schlüsselwörter

Lungenkrebs - Bronchialkarzinom - Chemotherapie - Strahlentherapie - Tumorresektion - Immuntherapie

Key words

pulmonary cancer - bronchial carcinoma - chemotherapy - radiation therapy - tumor resection - immunotherapy

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