Besonderheiten in der Therapie des TTF-1-negativen Adenokarzinoms der Lunge

Zusammenfassung

Die Identifikation Biomarker-stratifizierter Behandlungen hat das Überleben eines relevanten Anteils an Patient*innen mit metastasiertem Lungenkrebs in den letzten Jahren teils erheblich verbessert. Hierzu zählen Treibermutationen und bei Treiber-negativen Tumoren die Expression des „programmed death ligand 1“ (PD-L1) hinsichtlich des Ansprechens auf eine Therapie mit Checkpoint-Inhibitoren. Aufgrund der beim Lungenkarzinom bestehenden Korrelation zwischen PD-L1-Expression und Behandlungseffektivität kommt insbesondere bei geringer oder fehlender Expression der zusätzlich applizierten Chemotherapie eine wichtige Rolle zu. Derzeitig erhalten Patient*innen im Stadium IV mit einer PD-L1-Expression <50% auf den Tumorzellen eine Chemoimmuntherapie zur Erstlinienbehandlung. Hierzu stehen Pemetrexed- und Taxan-basierte Regime zur Auswahl. In retrospektiven Analysen zeigte sich bei für den thyroidalen Transkriptionsfaktor 1 (TTF-1)-negativen Patient*in ein im Vergleich zu Pemetrexed-basierter Therapie verbessertes Überleben bei Verwendung Taxan-haltiger Regime. Diese Beobachtung wird aktuell prospektiv randomisiert untersucht.

Abstract

The identification of biomarker-adjusted treatments has revolutionized the treatment landscape of metastatic lung cancer and improved survival for a relevant share of patients with actionable genomic alterations and those benefiting from checkpoint inhibitors (CPI). Given a clear correlation between the expression of “programmed death ligand 1” (PD-L1) and treatment efficacy of CPI, immunochemotherapy is used in patients with a PD-L1 expression <50%. The lower the PD-L1 expression, the more important is the chemotherapy backbone. For lung adenocarcinoma, there is currently a choice between pemetrexed- and taxane-based regimens. Retrospective data suggested superior survival using taxane-based treatment for patients negative for “thyroid transcription factor 1”. A prospective randomized clinical trial is underway to verify this hypothesis.

Schlüsselwörter

TTF-1 - Pemetrexed - Paclitaxel - Lungenkarzinom

Keywords

TTF-1 - pemetrexed - paclitaxel - lung cancer

Publication History

Received: 26 January 2023

Accepted: 14 March 2023

Article published online:
24 April 2023

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