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Systemische Therapie von Osteosarkomen

Wege aus der prognostischen Stagnation?

Systemic treatment of osteosarcoma

How to improve stagnating prognosis rates?

  • Leitthema
  • Published:
Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Osteosarkome sind die häufigsten primär malignen Knochentumorerkrankungen. Ihre gut etablierte Standardtherapie besteht aus einer kompletten Tumoroperation, die in eine intensive prä- und postoperative Chemotherapie eingebettet wird.

Ziel

Es erfolgt die Beschreibung des Ist-Standards und aktueller Entwicklungen und Perspektiven der medikamentösen Tumortherapie in Abhängigkeit vom Patientenalter.

Material und Methoden

Dabei handelt es sich um einen nichtsystematischen Literaturreview.

Ergebnisse

Der Epidemiologie folgend, wurden fast alle Therapiestudien bei Kindern, Jugendlichen und jungen Erwachsenen durchgeführt. In den letzten Jahrzehnten ist in diesen allerdings eine Stagnation der Heilungsraten zu beobachten. Die Kombination der Chemotherapie mit einem Tyrosinkinasehemmer gilt als eine Möglichkeit, die diese Stagnation durchbrechen könnte. Noch stehen entsprechende Studien allerdings aus. Betroffene Erwachsene mittleren Alters profitieren ebenfalls von einer zusätzlich zur Lokaltherapie eingesetzten (neo)adjuvanten Chemotherapie. Die Auswahl der Medikamente und Dosierungen muss dabei an das Alter angepasst werden. Kaum etwas ist über noch ältere Patienten im Rentenalter bekannt, die konventionelle Chemotherapie i. d. R. schlecht tolerieren. Hier müssen, mangels aussagekräftiger Studien, individuelle Therapieangebote gefunden werden.

Schlussfolgerung

Es ist zu hoffen, dass die raschen Erkenntnisgewinne zur Tumorbiologie auch bei Osteosarkompatienten jeden Alters zu relevanten therapeutischen Fortschritten führen werden.

Abstract

Background

Osteosarcomas are the most frequent primary bone malignancies. Standard treatment consists of complete surgical excision and a period of intensive pre- and postoperative chemotherapy.

Objective

Description of standard medical treatment and current developments regarding perspectives of drug-based cancer treatment that is based on the age of the patients.

Materials and methods

We performed a nonsystematic review of the literature.

Results

As mandated by epidemiology, most therapeutic trials were performed in children, adolescents, and young adults. However, recent decades have witnessed a stagnation in prognosis rates. Combining existing chemotherapeutic treatments with novel tyrosine kinase inhibitors may offer a strategy to end this stagnation. Studies demonstrating any benefit of this combination are, however, still pending. Adults of intermediate age also benefit from adding systemic to local therapies. The choice and doses of agents must be adapted to the age of the patient. Almost nothing is known about treating patients of retirement age, who often tolerate conventional systemic therapy poorly. Due to the lack of trials in this age group, individualized decisions have to be made.

Conclusion

It is hoped that the rapid gains in knowledge about tumor biology will also lead to therapeutic progress in osteosarcoma patients of all ages.

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  1. Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder‑, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart – Olgahospital, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland

    Stefan S. Bielack & Stefanie Hecker-Nolting

  2. Abteilung für Pädiatrische Hämatologie und Onkologie, Klinik für Kinder- und Jugendmedizin – Pädiatrische Hämatologie und Onkologie, Münster, Deutschland

    Stefan S. Bielack

  3. HELIOS Klinikum Berlin-Buch, Berlin, Deutschland

    Peter Reichardt

  4. Medizinische Klinik III, SarKUM, LMU Klinikum, München, Deutschland

    Lars H. Lindner

Authors
  1. Stefan S. Bielack
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  2. Peter Reichardt
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  3. Lars H. Lindner
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  4. Stefanie Hecker-Nolting
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Corresponding author

Correspondence to Stefan S. Bielack.

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Interessenkonflikt

S.S. Bielack berichtet über Honorare von Eli Lilly Ipsen, Hoffmann-La Roche, Bayer Healthcare, Boehringer-Ingelheim und EISAI. P. Reichardt berichtet über Honorare von Bayer, Novartis; Roche, Merck Sharp und Dome, Deciphera, Mundibiopharma, Pharm Mar, Blueprint Medicines und Glaxo Smith Kline sowie Vortragshonorare von Clinigen, Deciphera, Eli Lilly und PharmaMar. L.H. Lindner und S. Hecker-Nolting geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bielack, S.S., Reichardt, P., Lindner, L.H. et al. Systemische Therapie von Osteosarkomen. Onkologie 28, 555–562 (2022). https://doi.org/10.1007/s00761-022-01119-6

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  • DOI: https://doi.org/10.1007/s00761-022-01119-6

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