Deutsche Medizinische Wochenschrift最新文献

Considerable efforts concerning the molecular characterization and targeted treatment of cancer have significantly improved treatment options and prognosis of tumor patients. Nevertheless, in tumor entities without recurrent genetic alterations the application of molecular testing for potentially targetable lesions remains heterogeneous and, in most cases, the approval of targeted therapies is still restricted to defined tumor entities harboring corresponding predictive biomarkers.The broad genomic analysis of different tumor entities including rare cancers within several genome sequencing initiatives and precision oncology programs has revealed the occurrence of addressable molecular alterations across many tumor entities, although their incidence may differ significantly in the context of the underlying cancer type. The treatment of molecularly defined patient cohorts demonstrated an impressive tumor-agnostic efficacy of certain therapeutics such as NTRK inhibitors, while the outcome of other targeted therapies, such as ERBB or BRAF inhibitors, varied in the context of the underlying disease.In the meantime, a handful targeted therapeutics addressing NRTK and RET fusions, the BRAF V600E mutation or different features of defective DNA mismatch repair and high tumor mutational burden has been approved for histology-agnostic treatment of tumors harboring these target lesions. Ongoing molecularly stratified basket trials will further investigate the tumor-agnostic efficacy of different targeted treatment approaches.

In recent years, clinical scientific data on LDL cholesterol and atherosclerosis has led to lowering of LDL-C targets and the expansion of the indication for lipid drug therapy to larger populations or patients. The calculators SCORE2 and SCORE-OP were newly developed to calculate the cardiovascular risk in primary prevention. When assessing the cardiovascular risk of patients, in addition to e.g., pre-existing cardiovascular disease, familial hypercholesterolaemia and type II diabetes, type I diabetes, diabetic complications, renal insufficiency and subclinical arteriosclerosis are also considered. Statins are the basic therapy for hypercholesterolemia. Alternative medication are ACL inhibitors e.g., Bempedoic acid and Inclisiran which represent new drug therapy options for statin intolerance. Nevertheless, a dietary intervention belongs at the beginning of every lipid-lowering therapy.

In August 2022, the European Society of Cardiology (ESC) published new guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. In order to cope with the complexity of the patients and the multidisciplinary, representatives of the European Society of Anesthesia and Intensive Care Medicine as well as 2 patient representatives were involved in the development of the published document in addition to authors from the European Society of Cardiology. As a result, the document contains 147 recommendations on this complex topic, with more than half of them being grade I recommendations.The interdisciplinarity and the need for interdisciplinary cooperation in this context is particularly emphasized. Particular attention was also paid to recommendations for action for a structured preoperative risk stratification. The new guidelines also focus on increasing vigilance for perioperative myocardial damage and identifying it at an early stage.In the following article, some of the essential innovations and revisions will be highlighted using practical clinical case studies.

Actively avoiding fever is the only possibility to improve neurological outcome after cardiac arrest. It is uncertain if and which patients benefit from a lower target temperature. The ERC Guidelines in 2021 recommended targeted temperature management (TTM) for all patients after in- and out-of-hospital cardiac arrest with a target temperature of 32-36 °C for at least 24 hours. These recommendations were updated in 2022 by the ERC/ESICM Guidelines suggesting to avoid fever only within the first 72 hours after the event. Divergent results of recent trials lead to these guideline changes. The large TTM2 Trial in 2021 did not show a benefit neither in survival nor in neurological outcome in the group of hypothermia at 33°C compared to normothermia. Although leading to the updated guidelines, applying these study results to the German population is restricted as the rate of bystander cardiopulmonary resuscitation (CPR) or shockable rhythms is much lower in Germany. Further studies are needed to allow a better differentiation of subpopulations and to implement a more individual classification und therapy.