Pneumologie meets Onkologie

Abstract

Lung cancer is common and associated with a high mortality. After major therapeutic advances in the palliative situation of non-small cell lung cancer (NSCLC), new therapeutic concepts including immunotherapy and targeted tumor therapy have now also reached the curative stages. Osimertinib and atezolizumab have recently been approved under certain conditions in adjuvant therapy after complete tumor resection. In addition, the first approval of a neoadjuvant immunochemotherapy in Germany is expected soon. In the palliative therapy setting, comprehensive molecular pathological diagnostics on oncogenic mutations are required. Many drugs addressing these targets are now available predominantly for first line therapy but also although less for second line therapy. If there are no possibilities to address driver mutations, immunotherapy and immunochemotherapy are available depending on the programmed death ligand 1 (PD-L1) status. Overall, these new therapeutic options have already significantly improved therapy tolerability and the prognosis of lung cancer. Specific side effects must be considered. For small cell lung cancer (SCLC), palliative immunochemotherapy provides a moderate improvement in the prognosis. The introduction of lung cancer screening by low-dose computed tomography (CT) in Germany is to be expected in the coming years. The advantages are a relative reduction in lung cancer mortality of approximately 20% with a number needed to screen of 250. The disadvantage is particularly the expected number of false positive findings. A screening program must be established as a structured and quality assured procedure.