Immunsuppressive Therapie bei Tumoranamnese

Zusammenfassung

Bei der Frage, ob eine immunsuppressive Therapie bei Malignomanamnese möglich und sicher ist, kann man sich nur auf eine sehr begrenzte Datenlage berufen. Die französische sowie die kanadische Fachgesellschaft und das American College of Rheumatology unternehmen dennoch den Versuch konkrete Empfehlungen zu dieser Problematik zu geben. Direkte Evidenz bezieht sich vor allem auf Daten aus 3 nationalen Registern, die den Schluss nahelegen, dass eine Therapie mit traditionellen Basistherapeutika oder Biologika bei der üblichen vorsichtigen Vorauswahl der Patienten mit Malignomanamnese möglich erscheint. Darüber hinaus kann man versuchen Erfahrungen zu diesem Thema aus der Transplantationsmedizin zu extrapolieren. Für sämtliche konventionellen Basistherapeutika, Immunsuppressiva und Biologika ergeben die zum Teil widersprüchlichen Daten kein eindeutig erhöhtes de novo Malignomrisiko. Dies gilt jedoch ausdrücklich nicht für Cyclophosphamid in hoher Kumulativdosis. Die aktuelle Datenlage zu den einzelnen Substanzen wird dargestellt. Abschließend wird der Versuch eines Therapiealgorithmus für eine immunsuppressive Therapie bei Malignomanamnese unternommen.

Abstract

As far as the question is concerned whether immunosuppressive therapy is feasible and safe in a patient with a history of malignoma, only fairly insufficient data is available. Nevertheless, the Société Francaise de Rhumatologie, the Canadian Rheumatology Association, and the American College of Rheumatology have tried to make recommendations for this delicate topic. Direct evidence mainly originates from data of 3 national registries which suggest that treatment with traditional disease-modifying anti-rheumatic drugs (DMARDs) and biologics seems safe for carefully selected patients. Furthermore, conclusions can be drawn from the experience with immunosuppressive medication in the transplant setting. With the exception of cyclophosphamide in a high cumulative dosage, for which an increased risk of malignoma is evident, all traditional DMARDs, all immunosuppressants and all biologics available probably do not lead to an increased risk of de novo malignancy in spite of sometimes conflicting data. The current data for each drug of interest is presented. Finally, an algorithm for treating patients with a history of malignoma with immunosuppressive drugs is suggested.

Schlüsselwörter

Tumor - Malignom - Immunsuppression

Key words

tumours - malignancy - immunosuppression

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