Neoadjuvante Therapie des resektablen, nicht-kleinzelligen Lungenkarzinoms

Zusammenfassung

Die Behandlungsaussichten beim nicht-kleinzelligen Lungenkarzinom (NSCLC) haben sich durch die Integration von Immuncheckpoint-Inhibitoren in multimodale Therapiekonzepte deutlich erweitert. Aktuell rücken kombinierte, Immuncheckpoint-Inhibitor-basierte Therapiekonzepte auch in frühe, resektable Stadien des NSCLC vor. Die neoadjuvante und perioperative Chemoimmuntherapie eröffnet einen vielversprechenden neuen präoperativen Behandlungsansatz, impliziert aber auch einige neue Fragen und Herausforderungen. Mit den erweiterten perioperativen Therapiemöglichkeiten und der Aussicht auf eine weitere mögliche Verbesserung der Rezidivfreiheit nach Tumorresektion verschiebt sich damit auch die Notwendigkeit, therapierelevante Befunde zur Bildgebung, molekularen und histopathologischen Diagnostik frühzeitig und umfassend zu erheben, weiter nach vorne: Alle Patienten mit Lungenkarzinom sollen unabhängig von der Therapieintention in einem interdisziplinären Tumorboard mit thoraxonkologischer Schwerpunktexpertise vorgestellt werden. Dies ist regelhaft in zertifizierten Lungenkrebszentren gegeben.

Ein standardisiertes Vorgehen trägt zur optimierten prätherapeutischen Diagnostik bei und erleichtert die Abstimmung für das bestmögliche multimodale Vorgehen im interdisziplinären Tumorboard. Bei zentral gelegenen resektablen Tumoren erhöhen sich durch die neoadjuvante Behandlung z.B. die Aussichten auf ein möglichst parenchymsparendes Vorgehen. Einige Fragestellungen lassen sich noch nicht abschließend beantworten. Die perioperative Systemtherapie mit molekular-zielgerichteten und Immuncheckpoint-Inhibitoren ist Gegenstand zahlreicher laufender Studien. Die erhebliche Dynamik bei den Neuzulassungen und die Entwicklung perioperativer Therapiekonzepte macht eine kontinuierliche Anpassung der diagnostischen Algorithmen und Standards erforderlich. Die Integration in die prächirurgische Standardroutine macht eine zügige Einordnung der relevanten Befunde sowie enge Abstimmung zwischen den diagnostischen und interventionellen Fachdisziplinen unerlässlich.

Abstract

Treatment perspectives for non-small cell lung cancer (NSCLC) have been significantly expanded by the integration of immune checkpoint inhibitors into multimodal therapy concepts. Currently, combined, immune checkpoint-inhibitor-based therapy concepts are also advancing into early, resectable stages of NSCLC. Neoadjuvant and perioperative chemoimmunotherapy opened up a promising new preoperative treatment approach, but also raises some new questions and challenges. With the expanded perioperative treatment options and the perspective on a further improvement in the absence of recurrence after tumor resection, there is push towards comprehensively collecting therapy-relevant findings for imaging, molecular and histopathological diagnostics at an early stage. All patients with lung carcinoma, regardless of the therapy intention, should be presented to an interdisciplinary tumor board with thoracic oncological expertise. This is regularly given in certified lung cancer centers.

A standardized procedure contributes to optimized pre-therapeutic diagnostics and facilitates coordination for the best possible multimodal approach in the interdisciplinary tumor board. In the case of centrally located resectable tumors, for example, neoadjuvant treatment increases the chances of a procedure that is as parenchymal sparing as possible. Some questions cannot yet be answered conclusively. Perioperative systemic therapy with molecular-targeted and immune checkpoint inhibitors is the subject of numerous ongoing studies. The considerable dynamics in newly approved therapies and the development of perioperative therapy concepts require continuous adaptation of diagnostic algorithms and standards. Integration into standard pre-surgical routine makes rapid classification of the relevant findings as well as close coordination between the diagnostic and interventional disciplines essential.

Schlüsselwörter

neoadjuvant - kombinierte Chemoimmuntherapie - multimodal - interdiszipliniäres Tumorboard - Chirurgie - Regressionsgrading

Keywords

neoadjuvant - combined chemo immunotherapy - multimodal - interdisciplinary tumor board - surgery - regression gradient

Publication History

Received: 11 June 2024

Accepted after revision: 25 October 2024

Article published online:
06 December 2024

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