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Gliome und ihre medikamentöse Behandlung

Drug treatment of gliomas

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Gliome stellen in Bezug auf Diagnostik, Einteilung und Therapie eine Besonderheit im Vergleich zu anderen soliden Tumoren dar. Insbesondere die Vulnerabilität des betroffenen Organs Gehirn erfordert eine sorgfältige Planung von operativer, strahlentherapeutischer und medikamentöser Therapie sowie die sorgsame Begleitung und Therapieberatung der Betroffenen.

Methode

Eine selektive Literaturrecherche wurde durchgeführt.

Ergebnisse

Ohne integrierte Diagnose von histomorphologischen und molekularen Kriterien ist eine differenzierte Therapie nicht möglich. Aufgrund des meist diffus infiltrierenden Charakters kommt der medikamentösen Therapie ein entscheidender Stellenwert sowohl in der Erstbehandlung als auch beim Rezidiv oder Progress zu. Der rasante Zuwachs der Kenntnis von zugrunde liegenden molekularen und genetischen Veränderungen, die zur Tumorentstehung führen, lässt für die Zukunft eine weitere Diversifizierung in verschiedene Entitäten erwarten, welche die Therapiemöglichkeiten erweitern kann.

Schlussfolgerungen

Dogmen, wie eine immunprivilegierte Stellung des ZNS und fehlende ZNS-Gängigkeit von Medikamenten aufgrund der Besonderheit der Bluthirnschranke rücken im Zusammenhang mit modernen Therapiemöglichkeiten wie „small molecules“, Antikörpern sowie immunonkologischen Therapieverfahren in den Hintergrund. Weitere sowohl klinische als auch präklinische Forschung ist dringend erforderlich, um die für viele Gliome immer noch schlechte Prognose zu verbessern.

Abstract

Background

Gliomas have specific features in terms of diagnosis, classification and treatment compared to other solid tumors that need to be considered. In particular, the vulnerability of the affected organ “the brain” requires careful planning of surgical, radiotherapeutic and systemic treatment as well as careful support and treatment counseling of affected patients.

Method

A selective literature search was carried out.

Results

Without an integrated diagnosis of histomorphological and molecular criteria, a stratified treatment is not possible. Due to the mostly diffuse infiltrating character of the disease, systemic therapy is of crucial importance both in the initial treatment as well as in recurrence and progression. Due to a rapid increase in the knowledge of underlying molecular and genetic changes leading to tumorigenesis, a further diversification into different entities can be expected in the future, which could expand the treatment options.

Conclusion

Dogmas, such as an immune privilege of the central nervous system (CNS) and a lack of CNS accessibility of drugs due to the blood-brain barrier, lose importance in the context of modern treatment options, such as small molecules, antibodies or immuno-oncological therapeutics. Further clinical and preclinical research is urgently needed to improve the still poor prognosis for many glioma patients.

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Authors and Affiliations

  1. Pius-Hospital Oldenburg, Klinik für Hämatologie und Onkologie, Medizinischer Campus, Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland

    Johannes Hoffmann

  2. Wilhelm Sander-Therapieeinheit NeuroOnkologie, Klinik und Poliklinik für Neurologie, Universität Regensburg, Franz Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Peter Hau

  3. Interdisziplinäres Centrum für medikamentöse Tumortherapie (ICT), Universität Regensburg, Franz Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Tobias Pukrop

  4. Tumorzentrum München Süd, Kliniken Neuperlach und Harlaching, Oskar-Maria Graf Ring 51, 81737, München, Deutschland

    Meinolf Karthaus

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Correspondence to Johannes Hoffmann.

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Interessenkonflikt

P. Hau gibt folgende mögliche Interessenkonflikte an: Referententätigkeit und Advisory Board für NovoCure und Optune. T. Pukrop gibt folgende mögliche Interessenkonflikte an: Referenten-Honorare oder Kongressunterstützung in den letzten 24 Monate von: Astellas Pharma GmbH, Amgen GmbH, GWT-TUD GmbH, Lilly Deutschland GmbH, Roche Pharma AG, Boehringer Ingelheim Pharma, Daiichi Sankyo Europe GmbH, Sirtex Medical Europe GmbH, Bristol-Myers Squibb GmbH & Co. und Celgene GmbH. J. Hoffmann, und M. Karthaus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hoffmann, J., Hau, P., Pukrop, T. et al. Gliome und ihre medikamentöse Behandlung. Onkologe 25, 53–59 (2019). https://doi.org/10.1007/s00761-018-0478-9

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