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Therapie früher und lokal fortgeschrittener Stadien des nicht-kleinzelligen Lungenkarzinoms

Treatment of early and locally advanced stages of non-small cell lung cancer

  • Schwerpunkt: Lungenkarzinom
  • Published:
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Zusammenfassung

Therapiekonzepte für Patienten mit lokalisierten und lokal fortgeschrittenen nicht-kleinzelligen Lungenkarzinomen („non-small cell lung cancer“ [NSCLC]) basieren auf einer Lokaltherapie (Operation oder Strahlentherapie) in kurativer Intention. Nach primärer Resektion eines operablen NSCLC soll durch eine adjuvante Systemtherapie in erster Linie das systemische Rezidivrisiko gesenkt werden. Lokal fortgeschrittene Stadien mit mediastinaler Lymphknotenbeteiligung weisen ein erhebliches lokales und systemisches Rezidivrisiko auf. Hier ist die interdisziplinäre Umsetzung multimodaler Therapiekonzepte gefragt. Eine Immuntherapie mit Programmed-cell-death-1(PD-1)/Programmed-cell-death-1-ligand-1(PD-L1)-Checkpointinhibitoren ergänzt in zunehmendem Maße die neoadjuvanten, adjuvanten oder perioperativen Therapiekonzepte.

Abstract

Treatment concepts for patients with localized and locally advanced non-small cell lung cancer (NSCLC) are based on local treatment, surgery and/or radiotherapy, with curative intent. An adjuvant systemic treatment is added after primary resection of an operable NSCLC primarily to reduce the systemic risk of relapse. Locally advanced stages with mediastinal lymph node involvement carry a substantial risk of local and distant recurrence and require multimodal treatment strategies in an interdisciplinary approach. Recently, immunotherapy with programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) checkpoint inhibitors is increasingly being integrated into adjuvant, neoadjuvant or perioperative treatment concepts.

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Abbreviations

DFS:

„Disease-free survival“ (krankheitsfreies Überleben)

EFS:

„Event-free survival“ (ereignisfreies Überleben)

EGFR:

„Epidermal growth factor receptor“

HR:

Hazard Ratio

MPR:

„Major pathologic response“

NSCLC:

„Non-small cell lung cancer“ (nicht-kleinzelliges Lungenkarzinom)

OS:

„Overall survival“ (Gesamtüberleben)

PD‑1:

„Programmed cell death 1“

PD-L1:

„Programmed cell death 1 ligand 1“

PFS:

„Progression-free survival“ (progressionsfreies Überleben)

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Authors and Affiliations

  1. Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    Marcel Wiesweg, Wilfried E. Eberhardt & Martin Schuler

  2. Thorakale Onkologie, Westdeutsches Tumorzentrum, Ruhrlandklinik – Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland

    Marcel Wiesweg, Wilfried E. Eberhardt & Martin Schuler

  3. Klinik für Thoraxchirurgie und thorakale Endoskopie, Westdeutsches Tumorzentrum, Ruhrlandklinik – Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland

    Till Plönes

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  1. Marcel Wiesweg
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Correspondence to Marcel Wiesweg.

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Interessenkonflikt

M. Wiesweg: Honoraria and Advisory Role: Amgen, Boehringer Ingelheim, Novartis, Roche, Takeda. Research Funding: Bristol-Myers Squibb, Takeda.

W.E. Eberhardt: Research funding to institution: Bristol-Myers Squibb, Astra Zeneca and Eli Lilly. Honoraria: Astra Zeneca, Bristol-Myers Squibb, Merck, Roche, Pfizer, Novartis, Boehringer Ingelheim, Takeda, Abbvie, Bayer, Johnson & Johnson, Amgen, Daichi Sankyo, Eli Lilly, Honoraria for educational lectures from Astra Zeneca, Bristol-Myers Squibb, Merck, Roche, Pfizer, Boehringer Ingelheim, Takeda, Amgen, Eli Lilly.

M. Schuler: Consultant (compensated): Amgen, AstraZeneca, BIOCAD, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck Serono, Novartis, Roche, Sanofi, Takeda. Stock ownership: none. Honoraries for CME presentations: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, Novartis. Research funding to institution: AstraZeneca, Bristol Myers-Squibb.

T. Plönes gibt für diesen Beitrag keinen Interessenkonflikt an.

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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Wiesweg, M., Eberhardt, W.E., Schuler, M. et al. Therapie früher und lokal fortgeschrittener Stadien des nicht-kleinzelligen Lungenkarzinoms. Innere Medizin 63, 717–723 (2022). https://doi.org/10.1007/s00108-022-01366-0

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