Der Pneumologe

, Volume 9, Issue 2, pp 115–119

Palliativ intendierte First-line-Chemotherapie des metastasierten nichtkleinzelligen Lungenkarzinoms

Sind zielgerichtete Therapeutika den konventionellen Zytostatika überlegen? – Eine evidenzbasierte Beurteilung
Leitthema
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Zusammenfassung

EGF-Rezeptor-Tyrosinkinaseinhibitoren (EGFR-TKI) sind eine etablierte Option in der zweiten und dritten Therapielinie des fortgeschrittenen nichtkleinzelligen Lungenkarzinoms. In der ersten Therapielinie ergab sich durch Kombination mit Chemotherapie bei hinsichtlich ihres EGFR-Mutationsstatus nicht selektierten Patienten kein zusätzlicher Vorteil gegenüber alleiniger Chemotherapie. Die Kombination des EGFR-Antikörpers Cetuximab und des VEGF-Antikörpers Bevacizumab mit Chemotherapie hatte in jeweils einer Phase-III-Studie zu einer moderaten Verbesserung des Gesamtüberlebens geführt. Vergleichende Untersuchungen molekular gezielter Therapien und klassischer Zytostatika in der ersten Therapielinie liegen gegenwärtig nur für die EGFR-TKI Erlotinib und Gefitinib vor. Sie haben eindrucksvoll zeigen können, dass die molekular gezielte Therapie bei Vorliegen einer aktivierenden Mutation des EGF-Rezeptors der konventionellen Chemotherapie hinsichtlich Ansprechrate, progressionsfreiem Überleben, Toxizität und Lebensqualitätsverbesserung überlegen ist. Für Patienten mit unbekanntem EGFR-Mutationsstatus und EGFR-Wildtyp ist eine platinhaltige Chemotherapiekombination nach wie vor die effektivste Behandlungsoption.

Schlüsselwörter

Nichtkleinzelliges Lungenkarzinom (NSCLC) Erstlinientherapie Molekular gezielte Therapie EGFR EGFR-Tyrosinkinaseinhibitoren 

First-line chemotherapy with palliative intent for metastatic non-small cell lung cancer

Are targeted therapeutic agents superior to conventional cytostatic agents? An evidence-based assessment

Abstract

EGFR-TKI are established as an effective option for second- and third-line-treatment of advanced non-small cell lung cancer. The combination with chemotherapy in nonselected patients did not show an additional benefit compared with chemotherapy alone. With a combination of the EGFR antibody cetuximab or the VEGF antibody bevacizumab with chemotherapy a moderate improvement of overall survival was achieved. Results of comparative trials with molecular targeted therapies and classic chemotherapy as first-line treatment are currently only available for the EGFR-TKI erlotinib and gefitinib which showed impressively the superiority in response rate, progression-free survival, toxicity, and improvement of quality of life for EGFR-TKI in patients harboring an activating mutation of EGFR. For patients with unknown EGFR mutation status or wild-type EGFR the platinum-based chemotherapy combination is still the most effective treatment option.

Keywords

Non-small cell lung cancer (NSCLC) First-line therapy Targeted therapy EGFR EGFR tyrosine kinase inhibitors 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Robert-Koch-KlinikKlinikum St. Georg gGmbHLeipzigDeutschland

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