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TumorDiagnostik & Therapie 2022; 43(06): 375-380
DOI: 10.1055/a-1744-2100
Übersicht
Schwerpunkt

Neuerungen in der Systemtherapie des Anaplastischen Schilddrüsenkarzinoms

Christine Dierks
,
Dirk Vordermark
,
Kerstin Lorenz
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Das anaplastische Schilddrüsenkarzinom ist eine hochaggressive Tumorerkrankung mit einer sehr schlechten Prognose, und fast alle Patient*innen benötigen eine Systemtherapie. Dieser Review gibt einen Überblick über alle systemischen Therapiemöglichkeiten von der klassischen Chemotherapie über Immuntherapien und molekular-basierte Kinase-Inhibitoren und zeigt auf, welch enormes Potenzial in den neuen Therapieformen steckt.
Kernaussagen

  • Anaplastische Schilddrüsenkarzinome haben eine sehr schlechte Prognose von 4–5 Monaten trotz multimodaler Therapien mit Operation, Bestrahlung und Chemotherapie.

  • Ein schneller Therapiebeginn ist aufgrund des aggressiven Tumorwachstums von entscheidender Bedeutung.

  • Klassische Chemotherapien als Erstlinientherapien haben eine begrenzte Wirksamkeit.

  • Die frühe molekulare Diagnostik auf BRAF-Mutationen, RET- und NTRK-Fusionen ist von entscheidender Bedeutung.

  • Beim BRAF-V600E-mutierten ATC ist die Kombination aus Dabrafenib/Trametinib (BRAF- und MEK-Inhibitor) einer Dabrafenib-Monotherapie überlegen.

  • RET- und NTRK-fusionierte ATCs können mit spezifischen Kinase-Inhibitoren therapiert werden.

  • 75% der ATCs haben keine spezifische Mutation und können effektiv mit einer Kombination aus dem Kinase-Inhibitor Lenvatinib und dem Immuncheckpoint-Inhibitor Pembrolizumab behandelt werden.

  • Eine Whole-Exome-Sequenzierung und RNA-Sequenzierung im Rahmen des Master-Programms eröffnen häufig weitere Therapieoptionen.

Schlüsselwörter

Anaplastisches Schilddrüsenkarzinom - ATC - Immuntherapie - Molekulare Diagnostik - Kinaseinhibitor


Publikationsverlauf

Artikel online veröffentlicht:
03. August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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