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Erstlinientherapie des kleinzelligen Lungenkarzinoms (SCLC)

First-line treatment in small cell lung cancer

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Die Kombinationschemotherapie stellt den Behandlungsstandard des kleinzelligen Lungenkarzinoms dar. Etablierte Chemotherapieschemata sind Cisplatin/Etoposid (PE), Carboplatin/Etoposid/Vincristin (CEV), Cyclophosphamid/Adriamycin/Vincristin (CAV, ACO) sowie Adriamycin, Cyclophosphamid, Etoposid (ACE). Im Stadium I–III der Erkrankung wird die Chemotherapie durch die thorakale Radiotherapie ergänzt, die möglichst frühzeitig (simultan zur Chemotherapie) eingeleitet werden sollte. In diesem Fall wird simultan zur Radiotherapie die Kombination aus Cisplatin/Etoposid (PE) eingesetzt. Für die Effektivität der Kombinationschemotherapie ist das Einhalten des therapeutischen Intervalls bedeutsam. Die Eskalation der Zytostatika im konventionellen Dosisbereich bzw. bis hin zur Hochdosischemotherapie führte in den bisherigen Studien zu keinem Überlebensvorteil. Aktive neue Substanzen, die die therapeutische Bandbreite beim kleinzelligen Lungenkarzinom erweitern und derzeit überprüft werden, sind die Topoisomerase-I-Inhibitoren Topotecan und Irinotecan. Eine kontinuierliche systemische Erhaltungstherapie — sei es in Form von Zytostatika, von Metalloproteinaseinhibitoren oder immunologischen Therapiemaßnahmen — war bisher ohne erkennbaren Vorteil.

Abstract

Combination chemotherapy forms the basis of therapy in small cell lung cancer. Cisplatin/etoposide (PE), carboplatin/etoposide/vincristine (CEV), cyclophosphamide/adriamycin/vincristine (CAV, ACO), and adriamycin/cyclophosphamide/etoposide (ACE) are established schedules in the treatment of this disease. The approach for stage I-III disease comprises combination chemotherapy and radiotherapy. For concurrent chemoradiotherapy, which is advantageous compared to sequential treatment, the combination of cisplatin/etoposide should be employed. Whilst no survival benefit could be demonstrated by dose escalation up to high-dose chemotherapy, randomized studies emphasize the importance of a tight therapeutic interval. New agents which have shown efficacy in SCLC and which are currently under further investigation are the topoisomerase-I inhibitors topotecan and irinotecan. Concepts of maintenance therapy with metalloproteinase inhibitors or vaccination strategies did not have any impact on survival in randomized trials.

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Authors and Affiliations

  1. Zentrum für Pneumologie und Thoraxchirurgie, Krankenhaus Großhansdorf

    M. Reck & U. Gatzemeier

  2. Medizinische Klinik III, Klinikum Leverkusen

    N. Niederle

  3. Thoraxklinik am Universitätsklinikum Heidelberg

    M. Thomas

  4. Onkologischer Schwerpunkt, Krankenhaus Großhansdorf, 22927, Großhansdorf

    M. Reck

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  1. M. Reck
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  4. U. Gatzemeier
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Correspondence to M. Reck.

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Reck, M., Niederle, N., Thomas, M. et al. Erstlinientherapie des kleinzelligen Lungenkarzinoms (SCLC). Onkologe 11, 722–729 (2005). https://doi.org/10.1007/s00761-005-0887-4

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  • DOI: https://doi.org/10.1007/s00761-005-0887-4

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