Systemtherapie des malignen Pleuramesothelioms: Gibt es Fortschritte?

 

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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.

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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