Systemische Behandlung nicht kleinzelliger und kleinzelliger Lungenkarzinome – Multimodale und molekulare Therapiekonzepte

Die Therapie des Lungenkarzinoms ist multidisziplinär und basiert neben klinischen, radiologischen und histologischen Kriterien auch auf molekularen Befunden. Grundsätzlich unterscheidet sich die Behandlung nicht kleinzelliger Lungenkarzinome (NSCLC) von der kleinzelliger Lungenkarzinome (SCLC). Werden nicht kleinzellige Lungenkarzinome in den Stadien I und II (gegebenenfalls auch im Stadium IIIA) in kurativer Intention reseziert, so rücken in den fortgeschrittenen Stadien multimodale Therapiekonzepte bestehend aus Chemo- und Radiotherapie in den Fokus. In metastasierten Stadien sind platinbasierte Kombinationstherapien etabliert. Insbesondere diese Patientengruppe benötigt eine umfassende palliative Versorgung. Die Testung molekularer Faktoren wie EGFR oder EML-4-ALK ermöglicht immer häufiger den Einsatz neuer zielgerichteter Therapeutika und kann zu einer verbesserten Prognose beitragen. Charakteristisch für die Therapie des kleinzelligen Lungenkarzinoms ist hingegen ein inital oftmals gutes Ansprechen auf die Behandlung – bei gleichzeitig hoher Rezidivneigung. In dieser Situation haben platinbasierte Kombinationschemotherapien unverändert einen festen Stellenwert. Abhängig von der Ausdehnung des Tumors werden diese auch um strahlentherapeutische Verfahren erweitert.

Lung cancer treatment is a multidisciplinary approach and is based on clinical, radiologic, histologic and molecular decisions. In principle, treatment of non-small cell lung cancer (NSCLC) differs from small cell lung cancer (SCLC). Whereas NSCLC in stage I and II (also stage IIIA when indicated) undergo curative resection, multimodal therapy concepts, consisting of chemotherapy and radiotherapy receive priority in advanced stages. In metastasized settings platin-based chemotherapy combinations are established. Especially these patients need extensive palliative care. Testing for molecular factors (i. e. EGFR or EML-4-ALK) offers the application of molecular targeted therapies in order to improve the prognosis. Therapy of SCLC however is characterized by an initially good response with strong relapse tendency. Still platin-based chemotherapy combinations are the therapy of choice for SCLC. Depending on tumor-size and tumor spread radiotherapeutic approaches are applied in addition.

Key words

NSCLC - SCLC - multimodal therapy concepts - individualised therapy - receptor tyrosine kinases - EGFR - palliative care - palliative regional therapy

• Literatur

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