Zusammenfassung
Nach einer Durststrecke von mehreren Jahrzehnten konnte in der Therapie des Glioblastoma multiforme, des häufigsten und bösartigsten primären Hirntumors bei Erwachsenen, endlich eine Verbesserung der Prognose erreicht werden. Durch die konkomitante und adjuvante Therapie mit Temozolomide, einer oralen alkylierenden Substanz, konnte eine signifikante Verlängerung der Überlebenszeit der Patienten erzielt werden (Studie EORTC 26981/22981, NCIC CE3). Diese Therapie wird von den meisten Patienten gut vertragen. Während der konkomitanten Phase sind wöchentliche Blutbildkontrollen dringend angezeigt. Die häufigste und schwerwiegendste beobachtete Toxizität waren Grad III und IV Thrombozytopenien und Lymphozytopenien bei etwa 5 % der Patienten. In der EORTC-Studie war eine Prophylaxe gegen Pneumocystis carinii Pneumonie vorgeschrieben. Eines der wichtigsten Ergebnisse der Studie war auch, dass die Lebensqualität der Patienten durch die ganze Therapiephase hindurch stabil gehalten werden konnte. Wieweit sich dieses Therapiekonzept auf andere Hirntumore übertragen lässt oder welche Dosismodifikationen von Temozolomide oder Kombinationen mit anderen Substanzen, insbesondere mit "small molecules", die Effektivität der Therapie steigern können, sollte in weiteren Studien untersucht werden.
Summary
Concomitant and adjuvant treatment with Temozolomide, an oral alkylating agent, has significantly improved the survival of patients with newly diagnosed glioblastoma multiforme (study EORTC 26981/22981, NCIC CE3). When given with the appropriate cautiousness including weekly clinical and laboratory controls during the concomitant phase, this therapy is generally well tolerated. The observed toxicity is mainly haematological. Grade III and IV toxicities mainly thrombocytopenia or lymphocytopenia occur in around 5 % of patients. A prophylaxis against pneumocystis carinii pneumonia was mandatory in the EORTC study. Most importantly, the quality of life of the patients was maintained throughout the therapy. This success has boosted the whole field of neurooncology, after a dry spell of more than thirty years for glioblastoma multiforme. Whether this concept will be applicable to other brain tumours and which schedule modifications or combinations with biologicals will improve the effectivity of therapy in brain tumours should be explored in further studies.
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Marosi, C. Chemotherapy for malignant gliomas. Wien Med Wochenschr 156, 346–350 (2006). https://doi.org/10.1007/s10354-006-0307-4
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DOI: https://doi.org/10.1007/s10354-006-0307-4