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Aktueller Stand der Diagnostik und Therapie des nichtkleinzelligen Lungenkarzinoms (NSCLC) im Stadium III

Current status of diagnostic procedures and treatment in stage III non-small-cell lung cancer (NSCLC)

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Zusammenfassung

Basierend auf der ausgeprägten Heterogenität der Patientengruppen im Stadium III des nichtkleinzelligen Lungenkarzinoms („non-small-cell lung cancer“, NSCLC) – trotz der etwas differenzierteren neuen 8. Stadieneinteilung der Union Internationale Contre le Cancer (UICC)/International Association for the Study of Lung Cancer (IASLC) – wird eine zunehmend individualisierte Therapie dieser Patienten notwendig. Die initiale interdisziplinäre Einschätzung der Operabilität ist ein wesentlicher Faktor für die Therapieselektion. Die kombinierte simultane Chemostrahlentherapie bleibt für die Mehrzahl der Patienten im Stadium III die Standardbehandlung. Dieser Behandlung sollte sich aber – basierend auf den eindeutig und klinisch relevant positiven Ergebnissen der PACIFIC-Studie – eine konsolidierende Behandlung mit Durvalumab über 12 Monate bei positiver PD-L1-Expression im Tumor anschließen. Für die interdisziplinär als potenziell operabel eingeschätzten Patienten werden weiter multimodale Behandlungsprotokolle unter Einschluss der Operation den Standard darstellen. Aufgrund der positiven Datenlage für die Immuntherapie beim NSCLC in der Gruppe der inoperablen Patienten ergeben sich nun zwangsläufig auch in den lokal begrenzten Stadien hochrelevante Chancen für eine Integration der Checkpointinhibition in den Therapiealgorithmus, welche zukünftig detailliert im Rahmen von prospektiven klinischen Studien analysiert werden sollten.

Abstract

Based on the considerable heterogeneity of patient subgroups in stage III non-small-cell lung cancer (NSCLC)—despite the slightly more differentiated 8th edition of the Union Internationale Contre le Cancer (UICC)/International Association for the Study of Lung Cancer (IASLC) staging classification—increasingly individualized treatment of these patients has become necessary. Initial interdisciplinary assessment of potential operability is a key factor for treatment selection. Standard treatment for the majority of stage III NSCLC patients is still concurrent chemoradiotherapy. However, based on the equivocal and clinically relevant positive results of the phase III PACIFIC trial, this treatment should be followed by consolidation therapy with durvalumab for 12 months in patients with proven PD-L1 expression in the tumor. In patients who are evaluated as potentially operable in interdisciplinary consensus, multimodality treatment protocols including definitive surgical resection of the tumor are still standard. Based on the positive data on immunotherapy in inoperable patients, there are now multiple interesting scenarios for integration of this new modality into the treatment of patients with localized disease, which should be carefully analyzed in well-designed prospective clinical trials.

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Authors and Affiliations

  1. Innere Klinik (Tumorforschung) und Ruhrlandklinik, Westdeutsches Tumorzentrum, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    Wilfried E. E. Eberhardt & Michael Pogorzelski

  2. Klinik für Strahlentherapie, Universitätsmedizin Essen, Essen, Deutschland

    Martin Stuschke

  3. Klinik für Thoraxchirurgie und Thorakale Endoskopie, Universitätsmedizin Essen, Essen, Deutschland

    Clemens Aigner

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  1. Wilfried E. E. Eberhardt
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  4. Michael Pogorzelski
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Correspondence to Wilfried E. E. Eberhardt.

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Interessenkonflikt

W.E.E. Eberhardt weist auf folgende Beziehungen hin: Fortbildungsvorträge: BMS, MSD, Roche, Astra Zeneca, Novartis, Pfizer, Boehringer Ingelheim, Celgene, Hexal, Amgen, Lilly; Advisory Board Funktion: BMS, MSD, Roche, Astra Zeneca, Novartis, Pfizer, Boehringer Ingelheim, Celgene, Abbie, Bayer, Daichi Sankyo, Guardant Health, Lilly; Research Funding: Eli Lilly, BMS; Reisefinanzierung: Boehringer Ingelheim. M. Pogorzelski weist auf folgende Beziehungen hin: Fortbildungsvorträge: Boehringer Ingelheim, Merck Serono, MSD; Advisory Board Funktion: Boehringer Ingelheim, Merck Serono, MSD; Reisefinanzierung: Boehringer Ingelheim, BMS, MSD, Roche, Astra Zeneca, Novartis, Pfizer, Lilly, Teva. M. Stuschke und C. Aigner geben an, dass kein Interessenkonflikt besteht.

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Eberhardt, W.E.E., Stuschke, M., Aigner, C. et al. Aktueller Stand der Diagnostik und Therapie des nichtkleinzelligen Lungenkarzinoms (NSCLC) im Stadium III. Onkologe 24, 974–982 (2018). https://doi.org/10.1007/s00761-018-0488-7

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