Neuentwicklungen in der Neuro-Onkologie

Zusammenfassung

Die Standardtherapie des Glioblastoms im Erwachsenenalter besteht aus operativer Resektion, Bestrahlung der erweiterten Tumorregion begleitet von einer kontinuierlichen Temozolomidtherapie, gefolgt von sechs Zyklen einer adjuvanten Temozolomidtherapie. Therapiestudien mit dem Ziel, diese Standardtherapie zu verbessern, werden mit dem Integrinantagonisten Cilengitide, mit Tyrosinkinaseinhibitoren, mit dem PKC-β-Hemmer Enzastaurin, mit Neoangiogenesehemmern und mit anderen Substanzen durchgeführt. In der Rezidivtherapie werden unter anderem intensivierte Chemotherapieprotokolle und der Neoangiogenesehemmer Bevacizumab eingesetzt. In der Primärtherapie und im Rezidiv enttäuscht haben targeted therapies mit „small molecules“. Für die anaplastischen Gliome, WHO Grad III, hat die NOA-04-Studie einen neuen Therapiestandard definiert. Obwohl es keine „Standardtherapie“ der primären ZNS-Lymphome (PZNSL) gibt, soll primär eine Methotrexat-(MTX)-basierte systemische Chemotherapie eingesetzt werden. Eine primäre Strahlentherapie der PZNSL allein wird nicht empfohlen und ihr Einsatz als konsolidierende Maßnahme nach einer MTX-basierten Chemotherapie bringt nach neuesten Daten keinen Überlebensvorteil. Die Therapie der Wahl bei PZNSL besteht in einer MTX-basierten Polychemotherapie. Bei Patienten unter 60 werden damit kurative Therapieansätze verfolgt. In Deutschland gibt es gut organisierte Studiengruppen. Die Patienten sollten möglichst alle innerhalb dieser Studien behandelt werden.

Summary

The standard of care in adult glioblastoma is tumour resection followed by concomitant radio-/chemotherapy with temozolomide and 6 cycles of adjuvant temozolomide. To improve this standard, clinical trials have evaluated/evaluate efficacy and toxicity of cilengitide, an integrin antagonist, inhibitors of tyrosine kinases, of PKC-β and of neo-angiogenesis among other substances. In the recurrent situation intensified chemotherapy regimens are applied as well as bevacizumab, an antibody to the vascular endothelial growth factor. For recurrent glioblastoma, results with small molecules have been disappointing. For anaplastic glioma, WHO grade III, results of the NOA04-trial, have established a new standard. There is no “standard” therapy for primary CNS lymphoma. Methotrexate (MTX)-based chemotherapy should be considered first. A primary radiotherapy is not recommended, its usefulness as “consolidating” therapy after chemo could not be shown by a large prospective randomized trial. Today’s therapy of choice is a MTX-based polychemotherapy. In patients at age 60 years or younger this therapy is given in a curative approach. In Germany there are well-organized study groups. If possible, all patients should be treated within clinical trials.

Schlüsselwörter

Chemotherapie - Strahlentherapie - Gliome - primäre ZNS-Lymphome

Keywords

Chemotherapy - radiotherapy - glioma - primary CNS lymphoma

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