Zusammenfassung
In der Chemotherapie maligner Gliome wurden neue Standards gesetzt. Eine begleitende
und adjuvante Chemotherapie mit Temozolomid zusätzlich zur Bestrahlung nach Operation
eines Glioblastoms verlängerte Gesamt- und progressionsfreie Überlebenszeit in einer
großen prospektiven, randomisierten Phase-III-Studie. Ob eine alleinige Chemotherapie mit Temozolomid oder mit Procarbazin, CCNU und Vincristin (PCV) einer
Strahlentherapie bei Erstdiagnose eines malignen oligodendroglialen Tumors vorzuziehen
ist, bleibt offen. Die diesbezüglichen Ergebnisse der großen NOA-04-Studie werden
erst in einigen Jahren vorliegen. Zwei große prospektive randomisierte Phase-III-Studien
zeigten keine statistisch signifikante Verlängerung der Gesamtüberlebenszeit durch
eine zusätzliche PCV-Chemotherapie nach Operation und Strahlentherapie eines malignen oligodendroglialen
Tumors. Im Gegensatz zu niedriggradigen astrozytären Tumoren bewirkt eine Chemotherapie
mit Temozolomid oder mit PCV bei einem Teil der niedriggradigen oligodendroglialen
Tumoren ein Ansprechen. Klinische Studien mit so genannten small molecules werden derzeit durchgeführt. Substanzen, welche die intrazelluläre Signalkaskade
von Gliomzellen, die Neoangiogenese und andere Proliferations- und invasionsassoziierte
Prozesse beeinflussen, sind derzeit in der klinischen Erprobung. Ob diese Behandlungsansätze
das Therapiearsenal wesentlich erweitern werden, ist zum jetzigen Zeitpunkt offen.
Abstract
Novel standards have been established regarding the chemotherapy of gliomas. Concomitant
and adjuvant chemotherapy with temozolomide in addition to postoperative radiotherapy
has been proven to prolong overall- and progression-free survival of glioblastoma
patients in a large randomised multicenter prospective phase III-trial in comparison
with postoperative radiotherapy alone. If chemotherapy alone either with procarbacine, lomustine and vincristine (PCV) or with temozolomide is
equally effective or superior to radiotherapy in the initial postoperative management
of malignant oligodendroglial tumors is unclear. The German NOA-04 study addressing
this question is closed, however, results will not be available in the near future.
Two large randomised prospective multicenter phase III trials evaluating the efficacy
of an additional PCV chemotherapy after postoperative radiotherapy of malignant oligodendroglial tumours
failed to show a statistically significant improvement in overall survival. In contrast
to low grade astrocytic tumours, a significant proportion of low grade oligodendroglial
tumours responds to chemotherapy either with temozolomide or with PCV. Clinical trials
with so called small molecules are underway. Among others, substances interfering with signal transduction, with
mechanisms of tumour neo-angiogenesis or with other proliferation and invasion associated
mechanisms are currently evaluated in clinical trials. If these new approaches will
improve therapeutic efficacy in the future, remains to be seen.
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Prof. Dr. Uwe Schlegel
Neurologische Universitätsklinik · Knappschaftskrankenhaus
In der Schornau 23 - 25
44892 Bochum
Email: uwe.schlegel@kk-bochum.de
