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Neue Therapieformen beim Schilddrüsenkarzinom

New forms of therapy for thyroid carcinoma

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Zusammenfassung

Bei Radiojodtherapieversagen differenzierter Schilddrüsenkarzinome, primär schlecht differenzierten sowie anaplastischen Schilddrüsenkarzinomen und fortgeschrittenen, medullären Schilddrüsenkarzinomen kommen palliative Therapieoptionen zum Einsatz. Die Progression des Tumorleidens und damit die Indikation zur systemischen Therapie sollte anhand der „response evaluation criteria in solid tumors“ (RECIST) oder beim medullären Schilddrüsenkarzinom auch mithilfe der Calcitonin- und CEA-Verdopplungszeit bestimmt werden. Die Monotherapie mit Doxorubicin stellt die Standardtherapie des fortgeschrittenen, differenzierten Schilddrüsenkarzinoms mit fehlender Radiojodspeicherung dar und ist für diese Indikation zugelassen. Zur Therapie des fortgeschrittenen, metastasierten, medullären Schilddrüsenkarzinoms stehen keine zugelassen Chemotherapien zur Verfügung. Im „off-label use“ wurden verschiedene Chemotherapieprotokolle vorgeschlagen. Bevorzugtes Chemotherapieschema ist das sog. Averbuch-Schema (Cyclophosphamid, Vincristin, Dacarbazin). Allerdings betragen die nur partiellen Remissionsraten nicht mehr als 30% und eine lebensverlängernde Wirkung ist nicht gesichert. Multikinasehemmer stellen einen Hauptfokus auf der Suche nach effektiveren, palliativen Therapieoptionen dar und werden in weltweiten Multizenterstudien mit z. T vielversprechendem Erfolg eingesetzt.

Abstract

The treatment options for progressive radioiodine-resistant thyroid carcinoma of the follicular epithelium, progressive medullary and anaplastic thyroid carcinoma are palliative. The progression of disease and therefore the indication for a systemic treatment can be established by the response evaluation criteria in solid tumors (RECIST) or the calcitonin and carcinoembryonic antigen (CEA) doubling times in medullary thyroid carcinoma. Doxorubicin (adriamycin) is the standard treatment in progressive thyroid carcinoma of the follicular epithelium. Clinical trials of chemotherapeutic regimes in patients with persistent or recurrent medullary thyroid carcinoma (MTC) have shown limited efficacy with best responses of partial remission in no more than 30% of cass. There are no data that they enhance disease-free survival. Common chemotherapeutic drugs in the treatment of medullary thyroid carcinoma are cyclophosphamide, vincristine and dacarbazine. Multi-targeted therapy is a promising new treatment option, which is under investigation in multi-centre, world-wide clinical trials.

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  1. Klinik für Endokrinologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    A. Matuszczyk & K. Mann

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  1. A. Matuszczyk
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  2. K. Mann
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Correspondence to A. Matuszczyk.

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Matuszczyk, A., Mann, K. Neue Therapieformen beim Schilddrüsenkarzinom. Onkologe 16, 690–694 (2010). https://doi.org/10.1007/s00761-010-1870-2

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