Therapielinienkonzepte in der Onkologie

The concept of lines of therapy (LoT) is frequently used term in oncology which is of critical importance when decisions in tumor boards are discussed for further treatment. However, there is no uniform, interdisciplinary definition. The complexity and heterogeneity of malignant diseases and treatment modalities contribute to an inconsistent understanding of LoT. In a qualitative study, the understanding of the concept from the perspective of physicians from various oncological disciplines was examined by means of expert interviews. Most respondents agreed that there is no uniform definition of LoT and stated that they had already encountered misunderstandings. There was notable disagreement about the role of maintenance therapy, treatment intent, change of drug regimen, and treatment breaks. The majority of respondents considered the same criteria to be decisive for the definition as for a change in treatment lines (e.g., the occurrence of progression or tumor recurrence). Based on the findings of the qualitative study, a quantitative survey was conducted to examine the understanding, relevance, and potential events and measures for a change in LoT in a larger sample of physicians. Sixty physicians responded to the survey, with most respondents indicating that they were permanent members of a tumor board. Progression, recurrence, the occurrence of metastases, or severe side effects were considered indicators for a change in treatment line. The consideration of local therapeutic interventions, such as surgery, as an independent treatment line was controversial among the respondents.