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Adjuvante und induktive Systemtherapie beim nichtkleinzelligen Lungenkarzinom

Adjuvant and inductive systemic treatment in non-small cell lung cancer

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Zusammenfassung

Die randomisierten Studien zur adjuvanten Chemotherapie konnten einen zweifelsfreien Vorteil für eine adjuvante Chemotherapie im Vergleich zur alleinigen Operation nachweisen. Dies trifft für alle nodal-positiven NSCLC-Fälle sowie auf nodal-negative NSCLC ab einer Tumorgröße von ca. 4 cm zu. Die Durchführung einer adjuvanten Chemotherapie ist daher beim Vorliegen der oben genannten Kriterien heute weltweiter Standard. Die positiven Ergebnisse zur adjuvanten Chemotherapie haben zum vorzeitigen Abbruch nahezu aller neoadjuvanten Studien geführt, da ein alleiniger Operationsarm als ethisch nicht mehr zu rechtfertigen angesehen wurde. In Metaanalysen scheint der Effekt der neoadjuvanten Therapie aber dem der adjuvanten zu entsprechen. In Frühstadien ist ein neoadjuvantes Konzept in der Praxis aber nicht etabliert. Dieses Vorgehen findet häufiger erst in weiter fortgeschrittenen Stadien Anwendung wie beispielsweise bei N2-Lymphknotenbefall oder bei Patienten, deren Tumor mit hoher Wahrscheinlichkeit nur mittels Pneumektomie zu resezieren ist. Die Möglichkeiten der systemischen Therapie haben sich in den letzten 10 Jahren dramatisch geändert. Zur Chemotherapie sind die zusätzlichen Optionen der zielgerichteten Therapie bei nachweisbaren molekularen Veränderungen und der Immuntherapie hinzugekommen. Vor diesem Hintergrund muss auch die additive Therapie bei resektablen Tumoren neu evaluiert und definiert werden. Dieser Artikel möchte die etablierten und die neuen Optionen in der additiven systemischen Therapie zusammenfassen und den gegenwärtigen Stand der Behandlung darstellen.

Abstract

A large number of randomized trials have demonstrated an undoubted advantage of adjuvant chemotherapy in comparison to surgery alone. This is true for all lymph node positive cases of non-small cell lung cancer (NSCLC) with a tumor size of 4 cm or more. Worldwide, the application of adjuvant chemotherapy for these indications is regarded as standard treatment. Due to the positive results of adjuvant chemotherapy, nearly all studies focusing on neoadjuvant chemotherapy were stopped early because control arms with surgery alone were no longer regarded as ethically justified; however, in meta-analyses the effect of neoadjuvant chemotherapy seems be as strong as the effect of adjuvant chemotherapy. In clinical practice neoadjuvant chemotherapy is not routinely established in early stage disease. This approach is more often applied in advanced stages, such as N2 lymph node involvement or in patients where the tumor most probably requires pneumectomy for resection. In the last decade the options for systemic treatment of NSCLC have dramatically changed. In addition to chemotherapy, targeted treatment of patients with molecularly altered tumors and immunotherapy have been used very successfully in advanced stages. The options might also have a high impact on survival in early stages and the integration of these treatment modalities in the management of early stage disease is warranted. This article summarizes the established and new options in additive systemic treatment and presents the current state of treatment.

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  1. Klinik für Hämatologie/Onkologie/Immunologie, Klinikum Kassel, Mönchebergstraße 41–43, 34125, Kassel, Deutschland

    M. Wolf

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Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wolf, M. Adjuvante und induktive Systemtherapie beim nichtkleinzelligen Lungenkarzinom. Chirurg 90, 982–990 (2019). https://doi.org/10.1007/s00104-019-01063-z

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