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Der Onkologe

, Volume 24, Issue 12, pp 1003–1008 | Cite as

Medikamentöse Therapie des metastasierten oder rezidivierten mutationsnegativen NSCLC

  • Achim RittmeyerEmail author
Leitthema
  • 127 Downloads

Zusammenfassung

Hintergrund

Die Behandlung des metastasierten nichtkleinzelligen Lungenkarzinoms (NSCLC) ohne behandelbare Treibermutation hat sich in den vergangenen Jahren insbesondere durch die Einführung der Immuncheckpointinhibitoren (ICI) rasch verändert.

Ziel

Ein kurzer historischer Abriss sowie der aktuelle Stand der Behandlung des NSCLC Stadium IV sollen knapp zusammengefasst werden.

Material und Methoden

Eine selektive Literaturrecherche der Datenbank Pubmed wurde durchgeführt. Suchbegriffe: NSCLC stage IV, checkpointinhibitors, chemotherapy.

Schlussfolgerung

Immuncheckpointinhibitoren wurden zunächst in der Zweitlinientherapie eingeführt, weil sie sich in mehreren großen Phase-III-Studien einer Standard-Docetaxel-Therapie als deutlich überlegen erwiesen hatten. Mittlerweile wird Pembrolizumab als Standard-Erstlinientherapie bei hoher Programmed-death-ligand-1(PD-L1)-Expression (Tumor Proportion Score [TPS] > 50 %) eingesetzt. In mehreren Phase-III-Studien hat sich eine Kombination mit ICI und Chemotherapie in der Erstlinientherapie einer Standardchemotherapie als überlegen erwiesen. Zulassungen für die Kombinationserstlinientherapie liegen für das nichtsquamöse NSCLC (nsNSCLC) bereits vor und weitere Zulassungen sind zu erwarten. Erst seit Einführung der ICI lässt sich bei einem Teil der Patienten mit metastasiertem NSCLC ein Langzeitüberleben von 3 Jahren und mehr erzielen.

Schlüsselwörter

NSCLC Stadium IV Immuncheckpointinhibitoren Chemotherapie Kombinationstherapie Sequenztherapie 

Medicinal treatment of metastatic or recurrent NSCLC without driver mutations

Abstract

Background

The introduction of immune checkpoint inhibitors (ICI) has led to rapid changes in the treatment of metastatic non-small cell lung cancer (NSCLC) without treatable driver mutations over the last few years.

Objective

A brief historical outline of treatment before and a summary of changes after the arrival of ICI is given.

Material and methods

A selective Pubmed search was performed employing the keywords NSCLC stage IV, checkpoint inhibitors and chemotherapy.

Conclusion

The ICIs were initially introduced as second line treatment of metastatic NSCLC as several large phase III trials were able to show a clinically significant improvement compared to the standard docetaxel treatment. Meanwhile, pembrolizumab is the standard first-line treatment of NSCLC with high PD-L1 expression (TPS > 50%). Recently, several phase III trials could show superior efficacy of the combination of an ICI with standard platinum-based doublet chemotherapy compared to chemotherapy alone. Some of the investigated combinations have already been approved for nonsquamous NSCLC and further approvals can be expected. Since the introduction of ICI long-term survival of 3 or more years has been achieved in some patients with metastatic NSCLC.

Keywords

NSCLC stage IV Immune checkpoint inhibitors Chemotherapy Combination therapy Sequential therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Rittmeyer hat Honorare als Sprecher oder Berater folgender Firmen angenommen: AbbVie, Astra Zeneca, BMS, Boehringer Ingelheim, Eli Lilly, MSD, Pfizer, Roche.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.LKI Lungenfachklinik ImmenhausenImmenhausenDeutschland

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