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Therapie des malignen Pleuramesothelioms

Medikamentöse und palliative Optionen

Treatment of malignant pleural mesothelioma

Medicinal and palliative options

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Die Chemotherapie ist essenzieller Bestandteil sowohl kurativer als auch palliativer Behandlungskonzepte beim malignen Pleuramesotheliom (MPM). Bei der Mehrzahl der Patienten sind aufgrund des Ausbreitungsgrads der Erkrankung, ihres Alters bzw. vorhandener Komorbiditäten nur palliative Behandlungsoptionen möglich. Standard in der Erstlinientherapie ist die Kombination von Pemetrexed und Cisplatin, die zu einer signifikanten Verlängerung des Überlebens sowie zur Verbesserung der Lebensqualität bei gebesserter Lungenfunktion und tumorbedingter Symptome führt.

Mit zunehmender Detektion molekularer Besonderheiten des MPM wächst die Zahl zielgerichteter Substanzen, die erfolgversprechend in Studien geprüft werden. Die Strahlentherapie spielt in der palliativen Behandlung des MPM eine untergeordnete Rolle. Der Stellenwert einer prophylaktischen Stich- oder Drainagekanalbestrahlung ist nicht geklärt. Die Talkumpleurodese zur Beseitigung ausgedehnter, rezidivierender Pleuraergüsse und eine kombinierte analgetische Behandlung sind feste Bestandteile des palliativen Managements beim MPM.

Dieser Artikel gibt einen Überblick über Standards in der medikamentösen, insbesondere der palliativen systemischen Therapie des MPM, neue Substanzen und symptomorientierte Behandlungsoptionen.

Abstract

Chemotherapy is an essential part not only for curative but also for palliative treatment concepts for malignant pleural mesothelioma (MPM). For the majority of patients with MPM palliative forms of treatment are the only option due to the extent of the disease, their age or the presence of comorbidities. The standard first line chemotherapy is the combination of pemetrexed and cisplatin which not only leads to a significant extension of survival but also to an improvement of quality of life with better lung function and reduction of tumor-linked symptoms.

With increasing detection of molecular characteristics of MPM the number of targeted agents increases which show promising results in trials. Radiotherapy plays a subordinate role in the palliative treatment of MPM. The significance of prophylactic radiation of puncture or drainage canals has not been clarified. Talc pleurodesis for the elimination of extensive, relapsing pleural effusion and a combined analgetic treatment are integral components of the palliative management of MPM.

This article provides an overview of standards in medicinal, especially palliative systematic therapy of MPM, new substances and symptom-oriented treatment options.

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  1. Robert-Koch-Klinik, Klinikum St. Georg gGmbH, Nikolai-Rumjanzew-Str. 100, 04207, Leipzig, Deutschland

    S. Gütz

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Gütz, S. Therapie des malignen Pleuramesothelioms. Pneumologe 7, 36–42 (2010). https://doi.org/10.1007/s10405-009-0351-z

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