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Immuntherapie des nichtkleinzelligen Lungenkarzinoms (NSCLC)

Immunotherapy for non-small cell lung cancer (NSCLC)

  • Schwerpunkt: Lungenkarzinom
  • Published:
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Zusammenfassung

Die Einführung der Immuncheckpointinhibition hat die Behandlung von Patient*innen mit metastasiertem nicht onkogen alteriertem nichtkleinzelligem Lungenkarzinom (NSCLC) binnen weniger Jahre fundamental verändert und das Überleben für einen relevanten Anteil substanziell verbessert. Bei einer PD-L1-Überexpression auf ≥ 50 % der Tumorzellen kann eine hocheffektive Behandlung als Monotherapie erfolgen, für alle anderen bzw. unabhängig von der PD-L1-Expression stehen verschiedene Kombinationstherapien zur Verfügung. Im kurativen Setting sollte bei allen PD-L1-positiven Patient*innen (≥ 1 %) nach abgeschlossener Radiochemotherapie zur Rezidivreduktion wie auch zur Verbesserung des Überlebens eine Immunkonsolidierung erfolgen. Mittlerweile liegen auf für resektable Patient*innen positive Ergebnisse aus Phase-III-Studien für eine adjuvante Behandlung vor, wobei eine EMA(Europäische Arzneimittel-Agentur)-Zulassung derzeit noch aussteht. Die Behandlung mit Checkpointinhibitoren hat eine neue Klasse immunvermittelter Nebenwirkungen hervorgebracht, die bei etwa einem Drittel der behandelten Patient*innen auftreten und von problemlos substituierbaren Endokrinopathien bis hin zu lebensbedrohlichen Organtoxizitäten reichen können. Einem vorausschauenden Monitoring sowie einer interdisziplinären Behandlung kommt daher eine Schlüsselposition zur Vermeidung einer Progression in höhergradige, potenziell letale Toxizitäten zu.

Abstract

Within a few years the introduction of immune checkpoint inhibitors (ICI) fundamentally changed the treatment landscape of patients with metastatic non-small cell lung cancer (NSCLC) and improved survival for a relevant proportion of patients. Immune monotherapies are highly efficient in cancers showing a PD-L1 overexpression ≥ 50% of tumor cells, all others with a lower level and independent from the PD-L1 expression can be treated with various treatment combinations. In a curative setting all PD-L1 positive patients (≥ 1%) who underwent chemoradiotherapy to reduce disease relapse and subsequently to improve survival should undergo an ICI maintenance treatment. Furthermore, positive results from phase III studies are also available for adjuvant treatment of patients with resectable NSCLC, whereby an EMA approval is currently pending. The treatment with ICIs has given rise to a new class of immune-mediated adverse side effects, which occur in approximately one third of the patients and range from easily substituted endocrinopathies to life-threatening organ toxicity. An anticipatory monitoring as well as interdisciplinary treatment are therefore the keys to avoiding progression of higher grade potentially fatal toxicities.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Nikolaj Frost

  2. Onkologischer Schwerpunkt, Airway Research Center North, Deutschen Zentrum für Lungenforschung, LungenClinic Großhansdorf, Großhansdorf, Deutschland

    Martin Reck

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  1. Nikolaj Frost
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Correspondence to Nikolaj Frost.

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Interessenkonflikt

N. Frost und M. Reck geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Michael Hallek, Köln

Jürgen Wolf, Köln

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Frost, N., Reck, M. Immuntherapie des nichtkleinzelligen Lungenkarzinoms (NSCLC). Innere Medizin 63, 709–716 (2022). https://doi.org/10.1007/s00108-022-01363-3

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