{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:00:58Z","timestamp":1787320858539,"version":"build-2736575974"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Was ist neu?<\/jats:title>\n                  <jats:p>Erhebliche prognostische Verbesserungen f\u00fcr Fr\u00fch- und Sp\u00e4tstadien der Endometrium-Karzinome zeichnen sich durch neue diagnostische und therapeutische Entwicklungen ab. So hat die Molekularpathologie sowohl die Klassifikation als auch die adjuvante und palliative Therapie dieser Tumoren revolutioniert. Neuerdings werden 4 Hauptgruppen unterschieden: POLE-mutierte Tumoren machen etwa 7% aller Karzinome aus und werden als \u201eultramutiert\u201c klassifiziert. Sie weisen eine exzellente Prognose auf. Mismatch-Repair-defiziente Tumoren (MMRd) sind mit etwa 25% h\u00e4ufig und gelten als \u201ehypermutiert\u201c. Sie sind ausgesprochen empfindlich gegen Immun-Checkpoint-Inhibitoren. Die gr\u00f6\u00dfte Gruppe, Tumoren ohne spezifische molekulare Signatur (No specific molecular Profile, NSMP), sind prognostisch etwa den MMRd-Tumoren vergleichbar. Schlie\u00dflich werden TP53-mutierte Endometrium-Karzinome unterschieden, die eine ung\u00fcnstige Prognose aufweisen.<\/jats:p>\n                  <jats:p>Diese molekularpathologischen Grundlagen wurden k\u00fcrzlich in die neue FIGO-Klassifikation von 2023 integriert. Dadurch ver\u00e4ndert sich die adjuvante Therapie-Indikation erheblich: W\u00e4hrend ohne Molekularpathologie fr\u00fcher 60% der POLE-mutierten Tumoren adjuvant radio\/(chemo)therapiert wurden, bleiben sie heutzutage aufgrund ihrer exzellenten Prognose therapiefrei. FIGO 2023 erkennt u.a. auch neue g\u00fcnstige Subgruppen wie das synchrone Endometrium- und Ovarial-Karzinom an.<\/jats:p>\n                  <jats:p>Niedrigrisiko-Patientinnen ben\u00f6tigen keine adjuvante Therapie. Intermedi\u00e4rstadien (z.B. Stadium IIB) profitieren von adjuvanter Radiotherapie. Molekulare Marker entscheiden \u00fcber den zus\u00e4tzlichen Therapiebedarf: POLE-mutierte Tumoren werden therapiefrei belassen, G3-endometrioide Tumoren ohne TP53-Mutation erhalten meist nur eine adjuvante Strahlentherapie, w\u00e4hrend TP53-mutierte Tumoren intensiv radiochemotherapiert werden. Hochrisiko-Patientinnen (ab Stadium IIC) erhalten \u00fcblicherweise eine Kombination aus Radiochemotherapie, gefolgt von Chemotherapie, oder eine alleinige Chemotherapie.<\/jats:p>\n                  <jats:p>In der Therapie der fortgeschrittenen und metastasierten Stadien haben sowohl die Immun-Checkpoint-Inhibitoren als auch der PARP-Inhibitor Olaparib einen festen Stellenwert. Bei Patientinnen ohne Mismatch-Repair-Defizienz ist in der Erstlinien-Therapie der Immun-Checkpoint-Inhibitor Durvalumab plus Chemotherapie, gefolgt von Durvalumab und Olaparib, neu zugelassen. Bei Mismatch-Repair-defizienten Tumoren ist die vorgenannte Therapie ohne Olaparib \u2013 ebenso wie Dostarlimab und Carboplatin\/Paclitaxel \u2013 als Erstlinien-Behandlung zugelassen. Aufgrund des mannigfachen immunologischen Nebenwirkungspotenzials und m\u00f6glicher Interaktionen ist auch f\u00fcr den allgemeinmedizinisch und internistisch t\u00e4tigen Hausarzt die Auseinandersetzung mit den neuen Therapieoptionen von Vorteil.<\/jats:p>","DOI":"10.1055\/a-2481-0958","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:12:46Z","timestamp":1740165166000},"page":"266-272","source":"Crossref","is-referenced-by-count":3,"title":["Endometrium-Karzinom"],"prefix":"10.1055","volume":"150","author":[{"given":"Aristoteles","family":"Giagounidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1016\/s0140-6736(05)66455-0","article-title":"Endometrial cancer and hormone-replacement therapy in the Million Women Study","volume":"365","author":"V 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