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20.06.2024 | Schilddrüsenkarzinome | Schwerpunkt: Endokrine Onkologie

Schilddrüsenkarzinome – Rolle internistischer Systemtherapien

verfasst von: Dr. med. Tim Brandenburg, Prof. Dr. Dr. med. Matthias Kroiß

Erschienen in: Die Innere Medizin | Ausgabe 7/2024

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Zusammenfassung

Schilddrüsenkarzinome sind die häufigsten endokrinen Malignome. Ihre molekulare Pathogenese ist gut untersucht und hat für die Therapie fortgeschrittener Stadien große Bedeutung. Differenzierte, gering differenzierte und anaplastische Karzinome haben ihren Ursprung in der Follikelepithelzelle der Schilddrüse, während medulläre Karzinome von den C‑Zellen der Schilddrüse ausgehen. In den meisten Fällen ist die Prognose des differenzierten Schilddrüsenkarzinoms nach Operation und Radiojodtherapie sehr günstig. Verlieren Tumoren in fortgeschrittenen Stadien die Fähigkeit der Jodaufnahme, ist eine kurative Behandlung meist nicht möglich. Das oft weiterhin relativ langsame Fortschreiten der Erkrankung erlaubt eine abwartend-beobachtende Strategie. Aktivierende Mutationen in BRAF oder Genfusionen von RET und NTRK erlauben zielgerichtete Therapien, die allein oder mit dem Ziel einer Wiederherstellung der Jodaufnahme (Redifferenzierung) erfolgen können. Fehlen solche therapeutisch angehbaren Veränderungen, ist der Einsatz von Multityrosinkinaseinhibitoren (MKI) Therapie der Wahl. Der Verdacht auf ein anaplastisches Schilddrüsenkarzinom erfordert eine rasche Diagnostik einschließlich molekularpathologischer Analysen. Wo technisch möglich sind die Operation und eine anschließende Radiochemotherapie wesentliche Therapiebestandteile. Bei Vorliegen einer BRAF-Mutation ist eine zielgerichtete Therapie mit Inhibition von BRAF und MEK effektiv, wenn auch in Deutschland nicht zugelassen. Wo molekulare Zielmoleküle fehlen, kommt neuerdings die Kombinationstherapie mit dem MKI Lenvatinib und einer Immuncheckpointinhibition mit großem Erfolg zum Einsatz. Mutationen in RET liegen bei der großen Mehrzahl der Fälle von medullärem Schilddrüsenkarzinom vor. Bei aggressiven Verläufen mit Metastasierung ist die selektive RET-Inhibition seit Kurzem als Erstlinientherapie zugelassen und führt häufig zu objektivem Ansprechen und lang anhaltender Krankheitsstabilisierung. Zusammenfassend gehören Schilddrüsenkarzinome zu den Tumorentitäten, bei denen molekular zielgerichtete Therapien am häufigsten eingesetzt werden können. Eine Mitbehandlung in spezialisierten Zentren ist sinnvoll.
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Metadaten
Titel
Schilddrüsenkarzinome – Rolle internistischer Systemtherapien
verfasst von
Dr. med. Tim Brandenburg
Prof. Dr. Dr. med. Matthias Kroiß
Publikationsdatum
20.06.2024
Verlag
Springer Medizin
Erschienen in
Die Innere Medizin / Ausgabe 7/2024
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-024-01728-w

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