Zusammenfassung
Hirnmetastasen sind häufig, v. a. bei PatientInnen mit Lungenkarzinomen, Mammakarzinomen und Melanomen, und stellen eine therapeutische Herausforderung dar. Neben den etablierten lokalen Therapieverfahren wie neurochirurgischer Entfernung, stereotaktischer Bestrahlung und Ganzhirnbestrahlung stehen zunehmend für selektierte PatientInnen auch zielgerichtete Medikamente mit Aktivität gegen zerebrale Metastasen zur Verfügung. Dazu gehören „v-raf murine sarcoma viral oncogene homolog B“ (BRAF)-Inhibitoren und der „anti-cytotoxic T lymphocyte-associated protein 4“ (CTL4A)-Antikörper Ipilimumab bei Melanomen, HER2-Antagonisten bei Brustkrebs, und „epidermal growth factor receptor“ (EGFR)- und „anaplastic lymphoma kinase“ (ALK)-Inhibitoren bei nichtkleinzelligem Lungenkrebs. Das moderne Management von PatientInnen mit Hirnmetastasen sollte daher im interdisziplinären Setting und unter Berücksichtigung therapierelevanter molekularer Marker erfolgen, um optimale Ergebnisse zu ermöglichen.
Summary
Brain metastases are common in cancer patients, especially in lung cancer, breast cancer and melanoma and represent a therapeutic challenge. Established local therapeutic procedures include neurosurgical resection, stereotactic irradiation and whole brain radiotherapy; however, for selected patients novel targeted therapies with documented activity against brain metastases are emerging. These include v-raf murine sarcoma viral oncogene homolog B (BRAF) inhibitors, the anticytotoxic T lymphocyte-associated protein 4 (CTL4A) antibodies ipilimumab in melanoma, HER2 antagonists in breast cancer and epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors in non-small cell lung cancer. Therefore, the modern management of patients with brain metastases should be performed in an interdisciplinary setting and under consideration of relevant molecular markers to facilitate optimal patient outcome.
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Interessenkonflikt. M. Preusser: Research Grants, Honoraria Tralec, Support by Roche, Asic, MSD, BMS, Boehringer-Ingelheim. F. Winkler: Research Grant: Roche, Genentech; Honoraria: Roche, UCB, Sanofi, Abbvie.
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Preusser, M., Winkler, F. Optionen für die Behandlung von Hirnmetastasen. Nervenarzt 86, 716–718 (2015). https://doi.org/10.1007/s00115-015-4278-9
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DOI: https://doi.org/10.1007/s00115-015-4278-9