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Tumorassessment bei Immun-Checkpoint-Inhibitor-Therapie

Tumoransprechen, Progression und Pseudoprogression

Tumor assessment in immune checkpoint inhibitor therapy

Tumor response, progression and pseudoprogression

Zusammenfassung

Anders als bei der Chemotherapie wird unter Immun-Checkpoint-Inhibition (ICI) gelegentlich ein unkonventionelles Tumoransprechen beobachtet. Hier können sich neben rascher partieller oder kompletter Response oder einem Tumorprogress auch eine sog. Pseudoprogression, eine „mixed response“ bzw. ein verzögertes Ansprechen zeigen. Eine Behandlung über einen in der Bildgebung nachgewiesenen Progress hinaus kann daher sinnvoll sein. Die klinische Beurteilung des Patienten (Performance-Status, Symptome etc.), die „Dynamik“ der Tumorerkrankung und die Verfügbarkeit von Therapiealternativen gewinnen bei dieser Entscheidung enorme Bedeutung. Andererseits sollte der Zeitpunkt nicht verpasst werden, bei dem ein rapider Progress eine mögliche Folgetherapie verhindert. Beim Urothelkarzinom nach Platin-basierter Vortherapie zeigen sich Ansprechen oder Progress unter PD-1-ICI („programmed cell death protein 1“) meist bereits nach 8 Wochen. In der Zweitlinientherapie des Nierenzellkarzinoms werden dagegen noch etwa ein Viertel aller Remissionen spät, d. h. in Woche 24 oder später (teils erst nach 1 Jahr), beobachtet. Insofern sollte die Therapie bei stabiler Erkrankung fortgesetzt werden. Ob bzw. wie lange die Therapie bei partieller oder kompletter Remission fortgesetzt werden muss, ist bislang unklar.

Abstract

In contrast to chemotherapy, treatment with immune checkpoint inhibitors occasionally results in an unconventional pattern of response. Besides an early partial or complete response or tumor progression, a so-called pseudoprogression, a “mixed response” or late responses can also be observed. Treatment beyond radiographically defined progression may therefore be appropriate in selected cases. For these treatment decisions, the clinical evaluation of the patient (performance status, symptoms, etc.), the “dynamics” of the underlying malignancy, and the availability of other treatment options are of paramount importance. However, the time to initiate another treatment should not be missed by rapid progression. In PD-1 (programmed cell death protein 1) immune checkpoint inhibition in urothelial cancer after platinum-based chemotherapy, response or progression can be observed early at week 8 in the vast majority of the cases. In contrast, in second-line treatment of renal cell carcinoma around 25% of responses are seen late, at week 24 or later (occasionally after 1 year). Therefore, immune checkpoint inhibition should be continued for stable disease. At present, it remains unclear how long to continue therapy in cases with partial or complete remission.

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Author information

Correspondence to Dr. med. S. Foller.

Ethics declarations

Interessenkonflikt

S. Foller ist als Referent/Berater für folgende Firmen tätig gewesen: Bayer Health Care, Bristol-Myers Squibb, GlaxoSmithKline, Novartis, Pfizer, Roche. H. Oppel-Heuchel ist als Referent für die Firmen Pfizer, Bristol-Myers Squibb und Novartis tätig gewesen. M.-O. Grimm ist als Referent und Berater für folgende Firmen tätig gewesen: AstraZeneca, Bayer Health Care, Bristol-Myers Squibb, GlaxoSmithKline, Ipsen, MSD, Novartis, Ono Pharma, Pfizer; Forschungsunterstützung wurde von Novartis und Bristol-Myers Squibb gewährt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Foller, S., Oppel-Heuchel, H. & Grimm, M. Tumorassessment bei Immun-Checkpoint-Inhibitor-Therapie. Urologe 57, 1316–1325 (2018). https://doi.org/10.1007/s00120-018-0788-y

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Schlüsselwörter

  • Progression
  • RECIST
  • PD-1
  • PD-L1
  • Metastasen

Keywords

  • Progression
  • RECIST
  • PD-1
  • PD-L1
  • Neoplasm metastasis