Zielgerichtete Therapie beim nicht-kleinzelligen Lungenkarzinom

Zusammenfassung

Die Therapie des NSCLC hat sich in den letzten Jahren erheblich verändert, die Möglichkeiten sind komplexer geworden. Bei mehr als jedem zehnten NSCLC kann bereits heute eine zugrundeliegende und therapierbare Treibermutation nachgewiesen werden. Dies gilt insbesondere bei Nicht-Plattenepithelkarzinomen. Werden diese Patienten mit einem TKI behandelt, ergeben sich im vergleich zur Poly-Chemotherapie viele Vorteile:

• orale statt intravenöse Therapie

• deutlich verbesserte Ansprechraten

• bessere Lebensqualität (bedingt durch moderatere Nebenwirkungen)

• bessere Symptomkontrolle

• mediane progressionsfreie Überlebenszeiten von bis zu 1,5 Jahren bereits unter Erstlinientherapie

Angesichts dieser positiven Entwicklungen in der Lungenkrebstherapie und des klinischen Nutzens für NSCLC-Patienten mit einer entsprechenden Mutation, ist unseres Erachtens eine molekularpathologische Testung des Tumorgewebes für eine bestmögliche Therapieentscheidung unverzichtbar. In jedem Fall sollte eine Testung bezüglich EGF-R und ALK erfolgen. Darüber hinaus sollten Patienten mit seltenen Treibermutationen nach Möglichkeit erkannt und in klinische Therapiestudien eingebracht werden. Diesbezüglich kann man sich regional an großen Therapiezentren, wie beispielsweise Lungenkrebszentren, beraten lassen.

Abstract

Advanced non-small-cell lung cancer is no longer one disease but the collective name for different diseases defined by clinical, histological, immunohistochemical and, to an increasing extent, molecular biomarkers. This article deals with the treatment options we gained by identifying so called driver mutations in a growing subset of these cancers. For patients whose tumors are characterized by a targetable molecular alteration such as an activating EGFR-Mutation, an ALK-translocation or a ROS1-rearrangement, we see prolonged survival and oral treatments with tyrosine kinase inhibitors demonstrate superiority to chemotherapy in terms of response (remission rate), progression free survival and quality of life. We provide a review of the literature and discuss the status quo of the diagnostic need and the therapeutic options in Germany and Europe.

Schlüsselwörter

Lungenkarzinom - NSCLC - Treibermutation - zielgerichtete Therapie - Tyrosinkinaseinhibitor

Key Words

lung carcinoma - NSCLC - driver mutation - targeted therapy - tyrosine kinase inhibitor

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