Perioperative Immuntherapie beim operablen Lungenkarzinom: aktuelle Studienlage und neue Therapiestandards

Zusammenfassung

Die Einführung der Immuntherapie hat die Behandlung des Lungenkarzinoms drastisch verändert, wobei auch die perioperative Applikation bei lokal fortgeschrittenen nicht kleinzelligen Lungenkarzinomen ermutigende Ergebnisse gezeigt hat. Die neoadjuvanten und perioperativen Therapieregime der CheckMate-816- und KEYNOTE-671-Studie sowie die adjuvanten Therapien nach dem IMPower010- und dem PEARLS/KEYNOTE-091-Protokoll wurden bereits von der Europäischen Arzneimittel-Agentur (EMA) für die Behandlung ausgewählter Fälle zugelassen. Weitere Therapieregime und Kombinationstherapien mit unterschiedlichen Wirkstoffgruppen und Therapiemodalitäten werden derzeit auf ihre Wirksamkeit und Verträglichkeit überprüft. Aus der veränderten Therapielandschaft ergeben sich neue Möglichkeiten, aber auch Herausforderungen für die behandelnden Disziplinen. Die aktuelle Studienlage zur perioperativen Immuntherapie des resektablen Lungenkarzinoms und die sich daraus ergebenden Handlungsempfehlungen, insbesondere bez. der Patientenselektion sowohl für eine neoadjuvante als auch adjuvante Immuntherapie sowie die derzeitigen Forschungsbemühungen werden in diesem Artikel beleuchtet.

Abstract

Immunotherapy has drastically changed the treatment of lung cancer not only in systemic disease but also in the perioperative setting in locally advanced non-small cell lung cancer. In particular, the neoadjuvant and perioperative therapy regimes of the CheckMate 816 and KEYNOTE-671 studies as well as the adjuvant therapy according to the IMPower010 and the PEARLS/KEYNOTE-091 protocols have already been approved by the European Medicines Agency (EMA) for the treatment of selected cases. Other therapy protocols and combination therapies with varying drug classes and therapy modalities are currently being examined for their effectiveness and tolerance. The new treatment landscape creates new opportunities but also challenges for the treating disciplines. This article will focus on the current evidence for perioperative immunotherapy for resectable lung cancer and the resulting therapy standards, especially with regard to patient selection for both neoadjuvant and adjuvant immunotherapy, as well as current research efforts.

Schlüsselwörter

Lungenkarzinom - Immuntherapie - neoadjuvante Therapie - adjuvante Therapie

Keywords

lung cancer - immunotherapy - neoadjuvant therapy - adjuvant therapy

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