[Updated Recommendation for Treatment of Metastatic Non-Small Cell Lung Cancer]. / Aktualisierte Therapieempfehlung metastasiertes nicht kleinzelliges Lungenkarzinom.

Lung cancer accounts for the leading cause of cancer deaths in Germany and is characterized by early metastasis formation. The majority of patients with non-small cell lung cancer (NSCLC) will receive systemic therapy for treatment of their disease. Importantly together with the identification of targetable oncogenic alterations, systemic treatment of NSCLC has dramatically changed in recent years with the implementation of various new agents such as tyrosine kinase inhibitors and immune modulating drugs. However, these new therapeutic options also challenge the treating physician since molecular, histologic, and clinical factors need to be considered for the clinical decisionmaking. Moreover, supportive therapy including bronchoscopic therapy has evolved. The following therapy recommendations will summarize the up-to date treatment strategies for metastatic NSCLC.

[Therapy of Metastatic Non-small Cell Lung Cancer]. / Therapieempfehlung für das metastasierte nicht-kleinzellige Lungenkarzinom.

Lung cancer accounts for the leading cause of cancer deaths in Germany and is characterized by early metastasis formation. The majority of patients with non-small cell lung cancer (NSCLC) will receive systemic therapy for treatment of their disease. Importantly together with the identification of targetable oncogenic alterations, systemic treatment of NSCLC has dramatically changed in recent years with the implementation of various new agents such as tyrosine kinase inhibitors, anti angiogenic agents, and immune modulating drugs. However, these new therapeutic options also challenge the treating physician since molecular, histologic, and clinical factors need to be considered for the clinical decision-making. Moreover, supportive therapy including bronchoscopic therapy has evolved. The following therapy recommendations will summarize the up-to date treatment strategies for metastatic NSCLC.

[New developments in treatment of non-small cell lung cancer]. / Aktuelle Entwicklungen in der Therapie des nicht-kleinzelligen Lungenkarzinoms.

In early June the annual meeting of the American Society of Clinical Oncology (ASCO) took place. Several new hypotheses, therapy approaches and clinical studies were presented and intensively discussed. Some new developments in treatment of non-small cell lung cancer will be briefly discussed in this article.

[Crizotinib - molecular therapy for lung cancer]. / Crizotinib - Molekulare Therapie des Lungenkarzinoms.

The anaplastic lymphoma kinase (ALK) can act as a key oncogenic driver after activation by means of processes such as gene rearrangement. In approximately 5 % of patients with advanced non-small cell lung cancer (NSCLC), an oncogenic fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and ALK has been detected using fluorescence in situ hybridisation (FISH). Moreover, various methods including immunohistochemistry and PCR-based assays can be used for analysing ALK expression. Clinical data have been generated for crizotinib, a small molecule inhibitor of the ALK receptor tyrosine kinase, demonstrating a substantial improvement of objective response rate and prolonged progression-free survival (PFS) compared to standard chemotherapy in pretreated NSCLC patients harbouring EML4-ALK fusion genes. In the current review, recent data on the detection and inhibition of ALK in advanced NSCLC are summarised.

[Accuracy of positron emission tomography with fluorine-18-fluoro-deoxyglucose]. / Aussagekraft der Positronen-Emissions-Tomographie mit F-18-Fluordesoxyglukose (FDG-PET) beim Bronchioloalveolarzellkarzinom (BAC).

BACKGROUND: : FDG-PET is a powerful tool for the diagnostic workup of patients with lung cancer. A reduced sensitivity of FDG-PET for the evaluation of lung lesions was reported for bronchioloalveolar carcinoma (BAC). No literature exists about the diagnostic efficacy of FDG-PET in the staging of BAC. METHODS: : Out of a series of subsequent 630 untreated patients with the final diagnosis of lung cancer, who underwent FDG-PET, all patients with BAC were evaluated with respect to tumour detection, N-staging, and M-staging. RESULTS: : 35 patients (5.6 %) had BAC, 22 in a localized form (8 x pT1, 14 x pT2), 13 in a disseminated stage. FDG-PET correctly identified 19/22 cases with localized forms. Two of the missed one were classified as pT1. All disseminated forms of BAC were detected. Standardized uptake values (SUV) ranged from 0.9 to 23.3 (mean +/- SD: 11.6 +/- 5.1). Accuracy of N-staging was comparable to known results in lung cancer (FDG-PET 80 %, CT 64 %). With respect to M-staging, sensitivity of FDG-PET was as follows: M1(HEP): 2/3 (67 %), M1(PUL): 7/8 (88 %), M1(OSS): 1/1 (100 %). CONCLUSIONS: : With some limitations in small localized tumours FDG-PET can detect and stage BAC with an accuracy which is identical to that for other histological types of non-small cell lung cancer.