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Therapie des metastasierten kleinzelligen Lungenkarzinoms

Treatment of metastatic small cell lung cancer

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

In der First-line-Therapie des metastasierten Lungenkarzinoms stehen platinhaltige Kombinationen wie Cisplatin- oder Carboplatin/Etoposid im Vordergrund, die einen Vorteil gegenüber den älteren Kombinationen aus Epirubicin/Cyclophosphamid/Vincristin nachweisen konnten. Das Gesamtansprechen bei metastasierter Erkrankung liegt bei 60–80%, das 2-Jahres-Überleben bei 10–20%. Die beiden neueren Regime TEC (Paclitaxel/Etoposid/Carboplatin) und CI (Cisplatin/Irinotecan) werden kontrovers diskutiert. Die optimale Therapiedauer liegt zwischen 4 und 6 Zyklen, eine alternierende Gabe oder Dosisintensivierung steigert die Effektivität nicht. In klinischer Prüfung zur First-line-Behandlung befindet sich zurzeit das Topotecan. Der Benefit einer Second-line-Therapie ist im Wesentlichen abhängig von dem Ansprechen bzw. dem rezidivfreien Intervall nach First-line-Therapie. Hinsichtlich der neuen biologisch wirksamen Substanzen gibt es zum jetzigen Zeitpunkt noch keinen Effektivitätshinweis. Eine prophylaktische Hirnbestrahlung sollte auch bei Patienten mit einem Ansprechen auf die Chemotherapie durchgeführt werden.

Abstract

Platinum combinations like cisplatin or carboplatin/etoposide are the mainstay of treatment in patients with metastatic SCLC and have an advantage over epirubicin/cyclophosphamide/vincristine. The overall response is 60–80% and 2-year survival 10–20%. The two new regimens TEC (paclitaxel/etoposide/carboplatin) and CI (cisplatin/irinotecan) are discussed controversially. Optimal duration of treatment is 4–6 months. There is no further benefit gained by alternating the regimen or intensifying the dose. Topotecan is a new drug under clinical investigation. The benefit of second-line treatment depends on response or recurrence-free survival after first-line therapy. At the present time, there is no evidence that the new biologically active drugs are effective. Prophylactic brain irradiation is a new standard in metastatic patients who have responded to first-line treatment.

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Referententätigkeit für GlaxoSmithKline, Bristol-Myers Squibb.

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  1. 1. Medizinische Klinik, Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Helios Klinikum Erfurt GmbH, Nordhäuser Straße 74, 99089, Erfurt, Deutschland

    K.-M. Deppermann

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Deppermann, KM. Therapie des metastasierten kleinzelligen Lungenkarzinoms. Pneumologe 4, 343–350 (2007). https://doi.org/10.1007/s10405-007-0168-6

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