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DOI: 10.1055/a-1744-2100
Neuerungen in der Systemtherapie des Anaplastischen Schilddrüsenkarzinoms
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.
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Anaplastische Schilddrüsenkarzinome haben eine sehr schlechte Prognose von 4–5 Monaten trotz multimodaler Therapien mit Operation, Bestrahlung und Chemotherapie.
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Ein schneller Therapiebeginn ist aufgrund des aggressiven Tumorwachstums von entscheidender Bedeutung.
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Klassische Chemotherapien als Erstlinientherapien haben eine begrenzte Wirksamkeit.
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Die frühe molekulare Diagnostik auf BRAF-Mutationen, RET- und NTRK-Fusionen ist von entscheidender Bedeutung.
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Beim BRAF-V600E-mutierten ATC ist die Kombination aus Dabrafenib/Trametinib (BRAF- und MEK-Inhibitor) einer Dabrafenib-Monotherapie überlegen.
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RET- und NTRK-fusionierte ATCs können mit spezifischen Kinase-Inhibitoren therapiert werden.
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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.
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Eine Whole-Exome-Sequenzierung und RNA-Sequenzierung im Rahmen des Master-Programms eröffnen häufig weitere Therapieoptionen.
Schlüsselwörter
Anaplastisches Schilddrüsenkarzinom - ATC - Immuntherapie - Molekulare Diagnostik - KinaseinhibitorPublication History
Article published online:
03 August 2022
© 2022. Thieme. All rights reserved.
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