Therapie des fernmetastasierten nichtkleinzelligen Lungenkarzinoms (NSCLC) – Standards und Innovationen

Nach den epidemiologischen Daten des Robert–Koch–Institutes und der Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. ist Lungenkrebs in Deutschland sowohl bei Männern als auch bei Frauen die dritthäufigste Krebserkrankung. Wegen der eingeschränkten Prognose ist der Anteil der Lungenkrebserkrankungen an allen Krebstodesfällen noch höher; bei Männern ist Lungenkrebs die häufigste maligne Erkrankung, die zum Tod führt, bei Frauen die dritthäufigste.

Da die überwiegende Mehrzahl der Patienten erst im fernmetastasierten und damit nicht mehr kurativ therapierbaren Stadium diagnostiziert wird, spielt die palliative Therapie mit dem Ziel der Lebensverlängerung und der Kontrolle krankheitsbedingter Symptome wie Schmerzen, Dyspnoe, Husten oder Hämoptysen und damit der Verbesserung der Lebensqualität eine wichtige Rolle im Therapiekonzept der Lungenkrebserkrankung. Aktuelle Therapiekonzepte und neue Entwicklungen werden in diesem Artikel dargestellt.

Lung cancer incidence ranks third in Germany according to the epidemiological data of the Robert Koch Institute and the Society of German Epidemiological Cancer Registry. This applies to both males and females. The rate of lung cancer deaths is even higher on account of the limited prognostic rate. In males, this is the most frequently occurring malignant disease with fatal outcome while ranking third in females.

An important constituent of the therapy concept in lung cancer aims at the prolongation of life and the alleviation of associated symptoms such as pain, dyspnoea, coughing and hemoptyses, since in the majority of cases diagnosis is established only after distant metastasis has occurred and hence cannot be cured. The present article describes update therapeutic concepts and novel developments in this regard.

Key words

Lung cancer - non–small cell lung cancer (NSCLC) - palliative therapy - chemotherapy

Literatur

• 1 Ademuyiwa FO, Hanna N.. Cetuximab in non–small cell lung cancer.  Expert Opin Biol Ther. 2008;  8 107-113
• 2 Bunn Jr. PA, Thatcher N.. Systemic treatment for advanced (stage IIIb/IV) non–small cell lung cancer: more treatment options; more things to consider. Conclusion.  Oncologist. 2008;  13 37-46
• 3 Ganz PA, Haskell CM, Figlin RA. et al. . Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky performance status and the Functional Living Index – Cancer.  Cancer. 1988;  61 849-856
• 4 Gridelli C, Aapro M, Ardizzoni A. et al. . Treatment of advanced non–small–cell lung cancer in the elderly: results of an international expert panel.  J Clin Oncol. 2005;  23 3125-3137
• 5 Gridelli C, Ardizzoni A, Ciardiello F. et al. . Second–line treatment of advanced non–small cell lung cancer.  J Thorac Oncol. 2008;  3 430-440
• 6 Gridelli C, Perrone F, Gallo C. et al. . Chemotherapy for elderly patients with advanced non–small–cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial.  J Natl Cancer Inst. 2003;  95 362-372
• 7 Gutierrez M, Giaccone G.. Antiangiogenic therapy in nonsmall cell lung cancer.  Curr Opin Oncol. 2008;  20 176-182
• 8 Hanna N, Lilenbaum R, Ansari R. et al. . Phase II trial of cetuximab in patients with previously treated non–small–cell lung cancer.  J Clin Oncol. 2006;  24 5253-5258
• 9 Herbst RS, Giaccone G, Schiller C JH. et al. . Gefitinib in combination with paclitaxel and carboplatin in advanced non–small–cell lung cancer: a phase III trial – INTACT 2.  J Clin Oncol. 2004;  22 785-794
• 10 Molina JR, Yang P, Cassivi SD. et al. . Non–small cell lung cancer: epidemiology, risk factors, treatment, and survivorship.  Mayo Clin Proc. 2008;  83 584-594
• 11 O'Connell JP, Kris MG, Gralla RJ. et al. . Frequency and prognostic importance of pretreatment clinical characteristics in patients with advanced non–small–cell lung cancer treated with combination chemotherapy.  J Clin Oncol. 1986;  4 1604-1614
• 12 Owonikoko TK, Ragin CC, Belani CP. et al. . Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database.  J Clin Oncol. 2007;  25 5570-5577
• 13 Pfister DG, Johnson DH, Azzoli CG. et al. . American Society of Clinical Oncology treatment of unresectable non–small–cell lung cancer guideline: update 2003.  J Clin Oncol. 2004;  22 330-353
• 14 Sandler A, Gray R, Perry MC. et al. . Paclitaxel–carboplatin alone or with bevacizumab for non–small–cell lung cancer.  N Engl J Med. 2006;  355 2542-2550
• 15 Scagliotti GV, Parikh P, Von J Pawel. et al. . Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy–naive patients with advanced–stage non–small–cell lung cancer.  J Clin Oncol. 2008;  26 3543-3551
• 16 Schiller JH, Harrington D, Belani J CP. et al. . Comparison of four chemotherapy regimens for advanced non–small–cell lung cancer.  N Engl J Med. 2002;  346 92-98
• 17 Sculier JP, Lafitte JJ, Paesmans M. et al. . Chemotherapy improves low performance status lung cancer patients.  Eur Respir J. 2007;  30 1186-1192
• 18 Shepherd FA.. Molecular selection of patients for first–line treatment of advanced non–small–cell lung cancer with epidermal growth factor inhibitors: not quite ready for prime time.  J Clin Oncol. 2008;  26 2426-2427
• 19 Shepherd FA, Dancey J, Ramlau R. et al. . Prospective randomized trial of docetaxel versus best supportive care in patients with non–small–cell lung cancer previously treated with platinum–based chemotherapy.  J Clin Oncol. 2000;  18 2095-2103
• 20 Shepherd FA, Rodrigues PJ, Ciuleanu T. et al. . Erlotinib in previously treated non–small–cell lung cancer.  N Engl J Med. 2005;  353 123-132
• 21 Tsao MS, Sakurada A, Cutz JC. et al. . Erlotinib in lung cancer – molecular and clinical predictors of outcome.  N Engl J Med. 2005;  353 133-144
• 22 Wheatley–Price P, Ding K, Seymour L. et al. . Erlotinib for advanced non–small–cell lung cancer in the elderly: an analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21.  J Clin Oncol. 2008;  26 2350-2357

Korrespondenz