Molekulare Diagnostik und Therapie des Differenzierten Schilddrüsenkarzinoms

Molekulare zielgerichtete Therapien und Immuntherapien revolutionieren die Therapielandschaft des radiojodrefraktären differenzierten Schilddrüsenkarzinoms. Dieser Review fasst alle neuen Entwicklungen bzgl. einer zielgerichteten und effizienten molekularen Diagnostik sowie der verschiedenen Möglichkeiten an molekularen Therapien mit Kinase-Inhibitoren und Immuntherapien zusammen und zeichnet einen Pfad für ein stufenweises, auf den einzelnen Patienten/die einzelne Patientin zugeschnittenes individualisiertes Therapiekonzept.

Kernaussagen

• 15–20% der differenzierten Schilddrüsenkarzinome benötigen im Laufe der Erkrankung eine Systemtherapie.

• Klassische Chemotherapien und eine externe Strahlentherapie sind beim radiojodrefraktären Schilddrüsenkarzinom kaum wirksam.

• In der Erstlinie werden breit wirksame Neoangiogenese-Inhibitoren wie Lenvatinib und Sorafenib eingesetzt.

• Bei Versagen ist eine gezielte molekulare Diagnostik auf BRAF-Mutationen sowie RET- und NTRK-Fusionen notwendig.

• Für die Zweitliniensystemtherapie können nach Krankenkassenantrag spezifische Inhibitoren gegen BRAF, RET oder NTRK eingesetzt werden.

• Alternativ, bei fehlenden spezifischen Mutationen, kann eine Behandlung mit Cabozantinib (zugelassen) oder Immuncheckpoint-Inhibitoren (Krankenkassenantrag) erfolgen.

Schlüsselwörter

Schilddrüsenkarzinom - DTC - Immuntherapie - molekulare Diagnostik - Kinaseinhibitor

Publication History

Article published online:
03 August 2022

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