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Palliative Chemotherapie des fortgeschrittenen NSCLC

Palliative chemotherapy for advanced NSCLC

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Für Patienten mit fortgeschrittenem NSCLC im guten Allgemeinzustand ist die palliative Chemotherapie Standard. In der First-line-Behandlung ist eine Zweifachkombination von Cisplatin oder Carboplatin mit einer der neuen Substanzen Docetaxel, Gemcitabine, Paclitaxel oder Vinorelben indiziert. Eine Monotherapie der neuen Substanzen geht mit einer schwächeren Wirkung einher, kann aber eine empfehlenswerte Alternative für ältere Patienten mit Nebenkrankheiten darstellen. Eine Dreifachkombination bewirkt keine Lebensverlängerung, sondern nur eine Zunahme der Toxizität. Die Therapiedauer sollte 4 bis maximal 6 Zyklen betragen. Prognoseparameter für die Effektivität einer Chemotherapie sind Allgemeinzustand, Serum-LDH und Gewichtsabnahme. Für Patienten im guten Allgemeinzustand mit ECOG 0–2 ist eine Second-line-Chemotherapie mit Docetaxel, 3-wöchentlich appliziert, Standard. Alternativen sind die wöchentliche Gabe von Docetaxel oder Pemetrexed. Mit dieser Therapie erhalten Patienten die Möglichkeit, eine Lebensverlängerung sowie eine Verbesserung der Symptomatik und Lebensqualität zu erfahren.

Abstract

Palliative chemotherapy is the standard of care for patients in good general condition with advanced NSCLC. Double combination of cisplatin or carboplatin with one of the new substances such as docetaxel, gemcitabine, paclitaxel, or vinorelbine is indicated for first-line treatment. Monotherapy with one of the new substances is associated with decreased effect but can represent an advisable alternative for older patients with comorbidities. A triple combination does not prolong life but instead increases toxicity. The duration of therapy should be four to a maximum of six cycles. Prognostic parameters for the efficacy of chemotherapy are general condition, serum LDH level, and extent of weight loss. For patients in good general condition with ECOG 0–2, second-line chemotherapy with docetaxel administered every 3 weeks is standard. Alternatives are docetaxel or pemetrexed given weekly. These treatment regimens offer patients the possibility for prolonged life and improved symptomatology and quality of life.

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  1. Städtisches Krankenhaus Martha-Maria Halle-Dölau

    W. Schütte

  2. Klinik für Innere Medizin, Städtisches Krankenhaus Martha-Maria Halle-Dölau, Röntgenstraße 1, 06120, Halle

    W. Schütte

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Schütte, W. Palliative Chemotherapie des fortgeschrittenen NSCLC. Pneumologe 2, 260–267 (2005). https://doi.org/10.1007/s10405-005-0048-x

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