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Einfluss von Immunmodulatoren auf die urologische Bildgebung

  • F. Peisen
  • W. Thaiss
  • N. Tietze
  • S. Rausch
  • B. Amend
  • K. Nikolaou
  • J. Bedke
  • A. StenzlEmail author
  • S. Kaufmann
Leitthema
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Zusammenfassung

Hintergrund

Die Einführung der sog. „Immun-Checkpoint-Inhibitoren“ (ICI) hat zu einer deutlichen Verbesserung der Prognose sowohl in der Therapie des Nierenzellkarzinoms als auch des Urothelkarzinoms geführt. Aktuell sind die ICI in der Erstlinientherapie beim Cisplatin-ungeeigneten Patienten (Atezolizumab, Pembrolizumab) und in der Zweitlinientherapie (Atezolizumab, Nivolumab, Pembrolizumab) bei metastasierten Urothelkarzinompatienten zugelassen. In der Therapie des metastasierten Nierenzellkarzinoms ist für die Zweitlinienbehandlung der ICI Nivolumab zugelassen, in der Erstlinientherapie ist die Kombination des PD‑1 Antikörpers Nivolumab mit dem CTLA‑4 Antikörper Ipilimumab zugelassen.

Fragestellung

Wie erfolgt eine optimale radiologische Verlaufsbeurteilung unter den neuen ICI, die sich in ihrem Ansprechmuster von den herkömmlichen Chemotherapien und antiangiogenetischen Medikamenten unterscheiden? Was sind Lösungsstrategien, den neu auftretenden Herausforderungen zu begegnen?

Material und Methoden

Es wurde eine systematische Literaturrecherche zum Nierenzell- und Urothelkarzinom durchgeführt.

Ergebnisse

Während sich die Überwachung der Tumorantwort auf eine Immuntherapie immer noch an den RECIST-Kriterien („response evaluation criteria in solid tumors“) orientiert, haben sich jüngst immun-bezogene Kriterien etabliert, um die Tumorantwort auf ICI in der Bildgebung besser zu charakterisieren.

Schlussfolgerung

Weitere Studien mit längeren Nachsorgezeiträumen sind erforderlich, um die Tumorantwort auf ICI umfassend zu identifizieren und das Ansprechverhalten auf die Therapie, über den Progress hinaus, genauer zu definieren. Aufgrund des zunehmenden Einzugs der ICI in den klinischen Alltag sollten Urologen und Radiologen mit den allgemeinen Befunden und Befundmöglichkeiten (u. a. Pseudoprogress) dieser Therapie vertraut sein, um diese im klinischen Alltag interdisziplinär deuten zu können.

Schlüsselwörter

Nierenzellkarzinom Urothelkarzinom Bildgebung Immuntherapie „Programmed cell death protein 1“ 

Influence of immunomodulators on urological imaging

Abstract

Background

Immune checkpoint inhibitors (ICI) have led to great advances in the therapy of metastatic renal cell and urothelial carcinoma. Currently ICI are approved for the first-line therapy of cisplatin-unfit patients (Atezolizumab, Pembrolizumab) and second-line therapy in patients with metastasized urothelial cancer (Atezolizumab, Nivolumab, Pembrolizumab). For the therapy of metastasized RCC, Nivolumab is approved as a second-line therapy and in combination with the CTLA‑4 antibody Ipilimumab as a first-line therapy.

Objectives

What does the optimized radiological follow-up and therapy response assessment for ICI, which differ in their pathways from common chemotherapeutics and anti-angiogenetic drugs, look like? What strategies are needed to meet the upcoming challenges concerning interpretation of the acquired images?

Methods

A systematic literature search was carried out for urothelial and renal cell carcinoma.

Results

Immune-related response criteria have been introduced to better characterize the imaging changes occurring under ICI, as monitoring response to immunotherapy still relies on RECIST.

Conclusions

To properly identify and predict response after treatment with ICI, additional studies with long-term follow-ups are needed. Because of the growing use of ICI, radiologists and urologist should be familiar with common imaging findings (such as pseudo progress) under immunotherapy to correctly interpret these findings in daily routine.

Keywords

Renal cell carcinoma Urothelial carcinoma Imaging Immunotherapy Programmed cell death protein 1 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Bedke reports Consultancies and Speaker’s Bureau: BMS; Eisai, EUSA, Ipsen, Novartis, MSD, Pfizer, Roche and study participation with institutional funding: Bayer, BMS; Eisai, Ipsen, Novartis, MSD, Pfizer, Roche; A. Stenzl Current: Ad Board/Consultant, Ipsen Pharma, Roche; Ad Board/Consultant, Janssen; Ad Board/Constultant, Alere; Ad Board/Bristol-Myers Squibb; Ad Board/Stebabiotech; Ad Board/Synergo; Ad Board/Ferring; Speaker, Janssen; Speaker, Ipsen Pharma; Speaker, Sanofi Aventis; Speaker, CureVac; Speaker, Astellas; Speaker, Amgen; Institution: clinical study, Johnson & Johnson, Roche; clinical study, Cepheid; clinical study, Roche; Research grant, Amgen Inc; clinical study, Bayer AG; clinical study, CureVac; clinical study, immatics biotechnologies GmbH; clinical study, GemeDx Biosciences; Research grant, immatics biotechnologies GmbH; Research grant, Novartis AG; Research grant, Karl Storz AG. F. Peisen, W. Thaiss, N. Tietze, S. Rausch, B. Amend, K. Nikolaou und S. Kaufmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • F. Peisen
    • 1
  • W. Thaiss
    • 1
  • N. Tietze
    • 1
  • S. Rausch
    • 2
  • B. Amend
    • 2
  • K. Nikolaou
    • 1
  • J. Bedke
    • 2
  • A. Stenzl
    • 2
    Email author
  • S. Kaufmann
    • 1
  1. 1.Klinik für Diagnostische und Interventionelle RadiologieUniversitätsklinikum TübingenTübingenDeutschland
  2. 2.Klinik für UrologieUniversitätsklinikum TübingenTübingenDeutschland

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