SpringerLink
Log in

Nichtkleinzelliges Lungenkarzinom

Palliative Chemotherapie im Stadium IV und bei Patienten mit Komorbidität

Non-small cell lung cancer

Palliative chemotherapy in stage IV non-small cell lung cancer and in patients with comorbidity

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Aufgrund der hohen Inzidenz des nichtkleinzelligen Lungenkarzinoms in fortgeschrittenen Stadien stellt die systemische Therapie eine wichtige Behandlungsmaßnahme dieser Erkrankung dar. Durch Einführung neuer Medikamente konnte die Effektivität und die Verträglichkeit der Chemotherapie verbessert werden. Standard in der Erstlinientherapie ist eine platinbasierte Zweierkombination mit einem Drittgenerationszytostatikum über 4–6 Zyklen je nach Ansprechen. Weder eine Erweiterung der Kombination noch eine Verlängerung der Therapie führen zu einer Verbesserung der Ergebnisse. Eine Alternative in der Erstlinientherapie sind platinfreie Kombinationen von Drittgenerationszytostatika. Für Patienten in schlechtem Allgemeinzustand und alte Patienten mit Komorbidität ist eine Monotherapie mit Gemcitabin, Vinorelbin oder einem Taxan angezeigt. Eine modifizierte Kombinationstherapie sollte bei alten Patienten in gutem Allgemeinzustand geprüft werden. Als Therapieoptionen in der Zweitlinientherapie bieten sich Pemetrexed, Docetaxel oder der EGFR-Tyrosinkinaseinhibitor Erlotinib an.

Abstract

Chemotherapy is a cornerstone in the treatment of metastatic non-small cell lung cancer due to the high frequency of metastatic stages at diagnosis. By introducing new drugs, the efficacy and tolerability of chemotherapy could be improved. Chemotherapy with a platinum based doublet containing a third generation drug for four to six cycles is standard in first-line treatment. Neither a three or four drug schedule, nor the application of more cycles could demonstrate any increase in efficacy. Patients with reduced performance status and elderly patients with comorbidity should receive monotherapy with gemcitabine, vinorelbine or taxanes. Elderly patients with a good performance status, however, might be candidates for a modified combination therapy. Pemetrexed, docetaxel and the EGFR inhibitor erlotinib are options as second-line treatment following progression or relapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Krebs in Deutschland (2004) 4. Überarbeitete und aktualisierte Ausgabe, Arbeitsgemeinschaft Bevölkerungsbezogener Krebsregister in Deutschland, Saarbrücken

  2. Mountain CF (1997) Revision in the the international system for staging of Lung Cancer. Chest 111: 1710–1717

    PubMed  Google Scholar 

  3. Non-small Cell Lung Cancer Collaborative Group (1995) A meta-analysis using updated data on individual patients from 52 randomised clinical trials. Br Med J 311: 899–909

    Google Scholar 

  4. Spiro SG, Rudd RM, Souhami RL et al (2004) Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life. Thorax 59: 828–836

    Article  PubMed  Google Scholar 

  5. Rudd RM, Gower NH, Spiro SG et al. (2005) Gemcitabine plus carboplatin versus mitomycin, ifosfamide, and cisplatin in patients with stage IIIb or IV non-small cell lung cancer: a phase III randomized study of the London Lung Cancer Group. J Clin Oncol 23: 142–153

    Article  PubMed  Google Scholar 

  6. Crino L, Scagliotti GV, Ricci F et al. (1999) Gemcitabine and Cisplatin versus Mitomycin, Ifosfamide and Cisplatin in advanced non-small cell lung cancer: a randomized phase III study of the Italian Lung Cancer Project. J Clin Oncol 17: 3522–30.

    PubMed  Google Scholar 

  7. Cardenal F, Lopez-Cabrerizo MP, Anton A et al. (1999) Randomized phase III study of Gemcitabine-Cisplatin versus Etoposide-Cisplatin in the treatment of locally advanced or metastatic non-small cell lung cancer. J Clin Oncol 17: 12–18

    PubMed  Google Scholar 

  8. Le Chevalier T, Brisgand D, Douillard JY et al (1996) Randomized study of vinorelbine and cisplatin versus vindesine and cisplatin versus vinorelbine alone in advanced non-small cell lung cancer : results of an European multicenter trial including 612 patients. J Clin Oncol 14: 687–688

    PubMed  Google Scholar 

  9. Le Chevalier T, Brisgand D, Soria JC et al. (2001) Long term analysis of survival in the European randomized trial comparing Vinorelbine to Vindesine/Cisplatin and Vinorelbine alone in advanced non-small cell lung cancer. Oncologist 6 (Suppl 1): 8–11

    Google Scholar 

  10. Kubota K, Watanabe K, Kunitoh H et al. (2004) Phase III randomized trial of docetaxel plus cisplatin versus Vindesine plus cisplatin in patients with stage IV non-small cell lung cancer: the Japanese Taxotere Lung Cancer Study Group. J Clin Oncol 22: 254–261

    Article  PubMed  Google Scholar 

  11. Belani CP, Lee JS, Socinski MA (2005) Randomized phase III trial comparin cisplatin-etoposide to carboplatin-paclitaxel in advanced or metastatic non-small cell lung cancer. Ann Oncol 16: 1069–1075

    Article  PubMed  Google Scholar 

  12. Grigorescu AC, Draghici IN, Nitipir C et al. (2002) Gemcitabine and Carboplatin versus Cisplatin and Vinblastine in advanced non-small cell lung cancer stages III and IV: a phase III randomised trial. Lung Cancer 37: 9–14

    Article  PubMed  Google Scholar 

  13. Bonomi P, Kim K, Fairclough D et al. (2000) Comparison of survival and quality of life in advanced non-small cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial. J Clin Oncol 18: 623–631

    PubMed  Google Scholar 

  14. Giaccone G, Splinter TA, Debruyne C et al. (1998) Randomized study of paclitaxel-cisplatin versus cisplatin-teniposide in patients with advanced non-small cell lung cancer. The European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol 16: 2133–2141

    PubMed  Google Scholar 

  15. Schiller JH, Harrington D, Belani CP et al. (2002) Comparison of four chemotherapy regimens for advanced non-small cell lung cancer. N Engl J Med 346: 92–98

    Article  PubMed  Google Scholar 

  16. Kelly K, Crowley J, Bunn PA Jr et al. (2001) Randomized phase III trial of Paclitaxel plus Carboplatin versus Vinorelbine plus Cisplatin in the treatment of patients with advanced non-small cell lung cancer: a Southwest Oncology group trial. J Clin Oncol 19: 3210–3218

    PubMed  Google Scholar 

  17. Scagliotti GV, De Marinis F, Rimaldi M et al. (2002) Phase III randomised trial comparing three platinum-based doublets in advanced non-small cell lung cancer. J Clin Oncol 20: 4285–4291

    Article  PubMed  Google Scholar 

  18. Fosella F, Pereira JR, von Pawel J et al. (2003) Randomized, multinational, phase III study of Docetaxel plus platinum combinations versus Vinorelbine plus Cisplatin for advanced non-small cell lung cancer: the TAX 326 study group. J Clin Oncol 21: 3016–3024

    PubMed  Google Scholar 

  19. Alberola V, Camps C, Provencio M et al. (2003) Cisplatin plus Gemcitabine versus a Cisplatin-triplet versus nonplatinum sequential doublets in advanced non-small cell lung cancer: a Spanish Lung Cancer Group phase III randomized trial. J Clin Oncol 21: 3207–3213

    Article  PubMed  Google Scholar 

  20. Greco FA, Gray JR Jr, Thompson DS et al. (2002) Prospective randomized study of four novel chemotherapy regimens in patients with advanced non-small cell lung carcinoma: a minnie pearl cancer research network trial. Cancer 95: 1279–1285

    Article  PubMed  Google Scholar 

  21. Laack E, Dickgreber N, Muller T et al. (2004) Randomized phase III study of gemcitabine and vinorelbine versus gemcitabine, vinorelbine and cisplatin in the treatment of advanced non-small cell lung cancer: from the German and Swiss Lung Cancer Study Group. J Clin Oncol 22: 2348–2356

    Article  PubMed  Google Scholar 

  22. Delbaldo C, Michiels S, Syz N et al. (2004) Benefits of adding a drug to a single-agent or a 2-agent chemotherapy regimen in advanced non-small cell lung cancer: a meta-analysis. JAMA 292: 499–500

    Article  PubMed  Google Scholar 

  23. Smith IE, O‘Brien ME, Talbot DC et al. (2001) Duration of chemotherapy in advanced non-small cell lung cancer: a randomized trial of three versus six courses of mitomycin, vinblastine and cisplatin. J Clin Oncol 19: 1336–1343

    PubMed  Google Scholar 

  24. Socinski MA, Schell MJ, Peterman A et al. (2002) Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIb/IV non-small cell lung cancer. J Clin Oncol 20: 1335–1343

    PubMed  Google Scholar 

  25. Pfister DG, Johnson DH, Azzoli CG et al. (2004) American Society of Clinical Oncology Treatment of unresectable non-small cell lung cancer guideline: update 2003. J Clin Oncol 22: 330–353

    Article  PubMed  Google Scholar 

  26. Georgoulias V, Samonis G, Papadakis E et al. (2001) Comparison of docetaxel/cisplatin to docetaxel/gemcitabine as first-line treatment of advanced non-small cell lung cancer: early results of a randomized trial. Lung Cancer 34 (Suppl 4): 47–51

    Article  PubMed  Google Scholar 

  27. Kosmidis P, Mylonakis N, Nicolaides C et al. (2002) Paclitaxel plus carboplatin versus gemcitabine plus paclitaxel in advanced non-small cell lung cancer: a phase III randomized trial. J Clin Oncol 20: 3578–3585

    Article  PubMed  Google Scholar 

  28. Stathopoulos GP, Veslemes M, Georgatou N et al. (2004) Front-line paclitaxel-vinorelbine versus paclitaxel-carboplatin in patients with advanced non-small cell lung cancer: a randomized phase III trial. Ann Oncol 15: 1048–1055

    Article  PubMed  Google Scholar 

  29. Tan EH, Szszesna A, Krzakowski M et al. (2005) Randomized study of vinorelbine – gemcitabine versus vinorelbine carboplatin in patients with advanced non-small cell lung cancer. Lung Cancer 49: 233–240

    Article  PubMed  Google Scholar 

  30. Georgoulias V, Ardavanis A, Tsiafaki X et al. (2005) Vinorelbine plus cisplatin versus docetaxel plus gemcitabine in advanced non-small cell lung cancer: a phase III randomized trial. J Clin Oncol 23: 2937–2945

    Article  PubMed  Google Scholar 

  31. Pujl JL, Breton JL, Gervais R et al. (2005) Gemcitabine-docetaxel versus cisplatin-vinorelbine in advanced or metastatic non-small cell lung cancer: a phase III study addressing the case for cisplatin. Ann Oncol 16: 602–610

    Article  PubMed  Google Scholar 

  32. Kosmidis P, Kalofonos C, Syrigos K et al. (2005) Paclitaxel and gemcitabine vs carboplatin and gemcitabine. A multicenter, phase III randomized trial in patients with advanced inoperable non-small cell lung cancer. Lung Cancer 49 (Suppl 2): 34 (O-094)

    Article  Google Scholar 

  33. D’Addario G, Pintilie M, Leighl NB et al. (2005) Platinum-based versus non-platinum based chemotherapy in advanced non-small cell lung cancer: a meta-analysis of the published literature. J Clin Oncol 23: 2926–2936

    Article  PubMed  Google Scholar 

  34. Deppermann K-M (2001) Influence of age and comorbidities on the chemotherapeutic management of lung cancer. Lung Cancer 33 (Suppl): 115–120

    Article  PubMed  Google Scholar 

  35. Balducci L (2000) Geriatic oncology: challenges for the new century. Eur J Cancer 36: 1741–1754

    Article  PubMed  Google Scholar 

  36. Charlson ME, Popmpei P, Ales KL et al. (1987) A new method for classifying prognostic comorbidity in longitudinal studies. J Chronic Disease 40: 373–383

    Article  Google Scholar 

  37. Elder Lung Cancer Vinorelbine Italian Study (ELVIS) Group (1999) Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small cell lung cancer. J Natl Cancer Inst 91: 66–72

    Article  PubMed  Google Scholar 

  38. Gridelli C, Shepherd FA (2005) Chemotherapy for elderly patients with non-small cell lung cancer: a review of the evidence. Chest 128: 947–57

    Article  PubMed  Google Scholar 

  39. Frasci G, Lorusso V, Panza N et al. (2000) Gemcitabine plus vinorelbine versus Vinorelbine alone in elderly patients with advanced non-small cell lung cancer. J Clin Oncol 18: 2529–2536

    PubMed  Google Scholar 

  40. Gridelli C, Perrone F, Gallo C et al. (2003) 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 95: 362–372

    PubMed  Google Scholar 

  41. Jackman DM, Lucca J, Fidias P et al. (2005) Phase II study of the EGFR tyrosine kinase inhibitor Erlotinib in patients >70 years of age with previously untreated advanced non-small cell lung cancer. Lung Cancer 49 (Suppl 2): 62 (O-188)

    Article  Google Scholar 

  42. Kelly K, Giarritta S, Akerley W et al. (2001) Should older patient receive combination chemotherapy for advanced stage non-small cell lung cancer? An analysis of Southwest Oncology Trials 9505 and 9308. Proc Am Soc Clin Oncol 20: 329a

    Google Scholar 

  43. Langer CJ, Vangel J, Schiller DP et al. (2003) Age-specific subanalysis of ECOG 1594: fit elderly patients (70–80 yrs) with NSCLC do as well as younger patients (<70). Proc Am Soc Clin Oncol 22: 639

    Google Scholar 

  44. Langer CJ, Manola J, Bernado P et al. (2002) Cisplatin-based therapy for elderly patients with advanced non-small cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst 94: 173–181

    PubMed  Google Scholar 

  45. Fossella FV, Belani CP (2003) Phase III study of docetaxel-cisplatin and docetaxel-carboplatin versus vinorelbine-cisplatin fort he first-line treatment of advanced/metastatic non-small cell lung cancer: analysis in elderly patients. Proc Am Soc Clin Oncol 22: 629

    Google Scholar 

  46. Deppermann KM, Ukena D, von Pawel J et al. (2004) Vinorelbine and carboplatin in elderly patients with metastatic non-small cell lung cancer: a multicentre phase II study. Ann Oncol 15 (Suppl 3): iii183 (691P)

    Google Scholar 

  47. Stanley KE (1980) Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 65: 25–32

    PubMed  Google Scholar 

  48. Ranson M, Davidson N, Nicolson M et al. (2000) Randomized trial of paclitaxel plus supportive care versus supportive care for patients with advanced non-small cell lung cancer. J Natl Cancer Inst 92: 1074–1080

    Article  PubMed  Google Scholar 

  49. Soria JC, Brisgand D, Le Chevalier T (2001) Do all patients with advanced non-small cell lung cancer benefit from cisplatin-based combination therapy? Ann Oncol 12: 1667–1670

    Article  PubMed  Google Scholar 

  50. Shepherd FA, Dancey J, Ramlau R et al. (2001) 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 18: 2095–2103

    Google Scholar 

  51. Fossella FV, DeVore R, Kerr RN et al. (2000) Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 non-small cell lung cancer study group. J Clin Oncol 18: 2354–2362

    PubMed  Google Scholar 

  52. Hanna N, Shepherd FA, Fossella FV (2004) Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small cell lung cancer previously treated with chemotherapy. J Clin Oncol 22: 1589–1597

    Article  PubMed  Google Scholar 

  53. Danson S, Middleton MR, O’Byrne KJ et al. (2003) Phase III trial of gemcitabine and carboplatin versus mitomycin, ifosfamide and cisplatin or mitomycin, vinblastine, and cisplatin in patients with advanced non-small cell lung cancer. Cancer 98: 542–553

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Klinik für Pneumologie, Ruppiner Kliniken

    K.M. Deppermann

  2. Medizinische Klinik III, Klinikum Leverkusen

    N. Niederle

  3. Onkologischer Schwerpunkt, Krankenhaus Großhansdorf, Wöhrendamm 80, 22927 , Großhansdorf

    M. Reck & U. Gatzemeier

Authors
  1. M. Reck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K.M. Deppermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Gatzemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Niederle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Reck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reck, M., Deppermann, K., Gatzemeier, U. et al. Nichtkleinzelliges Lungenkarzinom. Onkologe 12, 761–768 (2006). https://doi.org/10.1007/s00761-006-1081-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-006-1081-z

Schlüsselwörter

Keywords

Search

Navigation