Zusammenfassung
Die Chemotherapie des malignen Pleuramesothelioms ist von großer Bedeutung, da die
meisten Patienten in einem fortgeschrittenen, inoperablem Stadium diagnostiziert werden.
Die Validierung der Effektivität der Chemotherapie war aufgrund geringer Fallzahlen
und unscharfer Bewertungskriterien in den letzten 20 Jahren nur eingeschränkt möglich,
wobei schon früh eine symptomatische palliative Wirksamkeit gezeigt werden konnte.
Nach Einführung der modernen Antifolate in die Therapie des Pleuramesothelioms und
nach Etablierung von standardisierten Ansprechkriterien, konnte in randomisierten
Phase-III-Studien eine signifikante Verlängerung der Überlebenszeit durch eine kombinierte
Chemotherapie belegt werden, wobei die Kombination von Cisplatin und Pemetrexed der
derzeitige Standard in der Chemotherapie ist. Neben der Erstlinientherapie gibt es
auch Hinweise auf eine Aktivität der Chemotherapie beim vorbehandelten Patienten.
Trotz wiederholter präklinischer Hinweise auf eine relevante prognostische Bedeutung
verschiedener Zielstrukturen in der intra- und interzellulären Signaltransduktion
wurde bisher keine signifikante Aktivität von zielgerichteten Therapien beim Pleuramesotheliom
beobachtet.
Abstract
Chemotherapy of malignant mesothelioma is of great importance because most patients
with malignant pleural mesothelioma are diagnosed for the first time with widespread
or advanced disease. Due to the small number of patients in clinical trials and due
to difficulties in tumour assessment in the last 20 years, validation criteria for
efficacy could only be defined with major limitations. After the introduction of modern
antifolates in the chemotherapy for malignant mesothelioma and after the establishment
of standardised response criteria, a significant prolongation of survival time by
combination chemotherapy was shown in two randomised phase III trials. The combination
of pemetrexed and cisplatin is the current standard of chemotherapy in malignant mesothelioma.
Besides first-line therapy, there are also data to support the efficacy of chemotherapy
in pretreated patients. In spite of the various results of preclinical trials which
support the prognostic significance of certain targeted structures of intra- and intercellular
signal transduction, no relevant efficacy could be shown for targeted therapies in
mesothelioma up to now.
Schlüsselwörter
malignes Pleuramesotheliom - Chemotherapie - Pemetrexed - prognostische Gruppen -
Zweitlinientherapie
Key words
malignant pleural mesothelioma - chemotherapy - pemetrexed - prognostic groups - second-line
therapy
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Dr. M. Reck
Onkologischer Schwerpunkt · Krankenhaus Grosshansdorf
Wöhrendamm 80
22927 Grosshansdorf
Phone: 0 41 02 / 60 11 88
Email: dr.martin.reck@web.de
