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Zweitlinientherapie des kleinzelligen Lungenkarzinoms (SCLC)

Second-line therapy for small cell lung cancer (SCLC)

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Zusammenfassung

Bei 70% aller Patienten mit kleinzelligem Lungenkarzinom im Stadium I–III und bei >90% im Stadium IV tritt ein Rezidiv nach der Erstlinientherapie auf, sodass eine Zweitlinientherapie ein medizinisch relevantes Problem darstellt. Im Gegensatz zum nichtkleinzelligen Lungenkarzinom, bei dem es durch Phase-III-Studien abgesicherte Daten und für diese Indikation zugelassene Substanzen gibt, ist die Datenlage beim rezidivierten kleinzelligen Lungenkarzinom unbefriedigend. Prognostisch ist beim SCLC das primär refraktäre (therapiefreie Zeit <90 Tage) vom primär sensiblen Rezidiv (therapiefreie Zeit >90 Tage) zu differenzieren. Bei sensiblen Rezidiven ist eine Wiederholung (Rechallenge) der Erstlinientherapie prinzipiell möglich. In dieser Situation kommen auch Monotherapien mit Topotecan oder Kombinationstherapien wie bei refraktären Rezidiven in Betracht. Bei refraktären Rezidiven sollten nichtkreuzresistente Substanzen eingesetzt werden. Eine Platinhaltige Therapie führt zu höheren Remissionsraten als eine Anthrazyklinhaltige Zweitlinientherapie. Neuere, überwiegend Phase-II-Studien belegen eine hohe Aktivität — auch bei refraktären Rezidiven — für CPT11-, Topotecan- und Paclitaxel-Kombinationstherapien. Problematisch bei den Empfehlungen ist die fehlende Absicherung unterschiedlicher Therapiestrategien durch Phase-III-Studien, sodass die definitive Therapieentscheidung immer eine Einzelfallentscheidung bleibt, die die Toxizität der Vortherapie, den Allgemeinzustand, Komorbiditäten und das Therapieziel berücksichtigen muss.

Abstract

After first-line therapy, 70% of all patients with stage I-III and >90% with stage IV relapse; therefore, second-line therapy is a clinically relevant problem. In contrast to NSCLC, where indications for second-line therapy have been confirmed by phase III studies and several agents have been licensed for this indication, data are sparse for SCLC. Prognostically, primary refractory SCLC relapse (therapy-free interval <90 days) has to be distinguished from primary sensitive relapse (therapy-free interval >90 days). For sensitive relapses, rechallenge with the first-line therapy is an option, as well as on-label use of topotecan monotherapy or other combination therapies. In refractory relapse, non-cross-resistant drugs should be administered, and platinum-containing regimens result in higher remission rates than anthracycline-containing regimens. Newer predominantly phase II trials confirm the high activity, even in refractory patients, of CPT11-, paclitaxel-, and topotecan-based combinations therapies. Due to the lack of systematic phase III trials for relapsed SCLC patients, recommendations should be individualized for each patient based on the first-line toxicity, performance status, therapeutic aim, and comorbidity.

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Authors and Affiliations

  1. Abtl. Hämatologie und Onkologie, Universität Göttingen

    F. Griesinger & T. Overbeck

  2. Medizinische Klinik III, Onkologie, Hämatologie, Klinikum Leverkusen

    N. Niederle

  3. Abtl. Hämatologie und Onkologie, Universität Göttingen, Robert-Koch-Straße 40, 37099, Göttingen

    F. Griesinger

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  1. F. Griesinger
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  2. T. Overbeck
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  3. N. Niederle
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Correspondence to F. Griesinger.

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Griesinger, F., Overbeck, T. & Niederle, N. Zweitlinientherapie des kleinzelligen Lungenkarzinoms (SCLC). Onkologe 11, 730–740 (2005). https://doi.org/10.1007/s00761-005-0886-5

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  • DOI: https://doi.org/10.1007/s00761-005-0886-5

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