Fischer Berthold, Buhl Roland
III. Medizinische Klinik und Poliklinik, Schwerpunkt Pneumologie, Klinikum der Johannes Gutenberg-Universität, Langenbeckstrasse 1, 55131 Mainz.
Med Klin (Munich). 2008 May 15;103(5):311-20. doi: 10.1007/s00063-008-1038-7.
Since the late 1980s, lung cancer incidence in men has declined in Germany whereas in women there is still a rise. There is no approved screening program for lung cancer up to now and results from randomized trials like the National Lung Screening Trial are eagerly awaited. In stage II and IIIA non-small cell lung cancer (NSCLC), several positive trials have demonstrated the advantage of adjuvant chemotherapy which is now an established modality to improve cure rates. Epidermal growth factor receptor (EGFR) is commonly overexpressed in NSCLC. Erlotinib, an EGFR tyrosine kinase inhibitor, has been approved for relapsed advanced-stage NSCLC. Bevacizumab is a monoclonal antibody against vascular endothelial growth factor, a primary mediator of angiogenesis that is commonly overexpressed in solid tumors including lung cancer. Bevacizumab, in combination with chemotherapy, has demonstrated improved outcomes in advanced NSCLC and is now approved for selected patients with advanced-stage NSCLC. Patient selection for therapeutic use of bevacizumab is crucial to optimize safety. Ongoing trials explore multitargeted agents such as sorafenib, sunitinib, and vandetanib.
自20世纪80年代末以来,德国男性肺癌发病率呈下降趋势,而女性肺癌发病率仍在上升。目前尚无获批的肺癌筛查项目,人们急切期待着像国家肺癌筛查试验这样的随机试验结果。在II期和IIIA期非小细胞肺癌(NSCLC)中,多项阳性试验已证明辅助化疗的优势,辅助化疗现已成为提高治愈率的既定治疗方式。表皮生长因子受体(EGFR)在NSCLC中通常过度表达。厄洛替尼是一种EGFR酪氨酸激酶抑制剂,已获批用于复发性晚期NSCLC。贝伐单抗是一种针对血管内皮生长因子的单克隆抗体,血管内皮生长因子是血管生成的主要介质,在包括肺癌在内的实体瘤中通常过度表达。贝伐单抗与化疗联合使用,已证明可改善晚期NSCLC的治疗效果,现已获批用于特定的晚期NSCLC患者。选择合适的患者使用贝伐单抗对于优化安全性至关重要。正在进行的试验探索多靶点药物,如索拉非尼、舒尼替尼和凡德他尼。