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Highlights der ASCO- und ESMO-Jahrestagungen 2021 zur Strahlentherapie von Kopf-Hals-Tumoren

Highlights from the 2021 ASCO and ESMO annual meetings on radiotherapy of head and neck cancer

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Zusammenfassung

Auf den diesjährigen Jahreskongressen der American Society for Clinical Oncology (ASCO) und der European Society for Medical Oncology (ESMO) wurden mehrere Studien zur Strahlentherapie lokal fortgeschrittener Kopf-Hals-Tumoren vorgestellt. In der Indikation der nichtchirurgischen kurativen Therapie wurde insbesondere der Einsatz von Immuncheckpointinhibitoren simultan zur Strahlentherapie untersucht. In der Phase-III-GORTEC-REACH-Studie war die kombinierte Inhibition von EGFR („epidermal growth factor receptor“) und PD-L1 („programmed death ligand 1“) simultan zur Strahlentherapie lokal fortgeschrittener Kopf-Hals-Tumoren einer platinbasierten Radiochemotherapie unterlegen. Allerdings könnte dieses Therapiekonzept effektiver als eine alleinige Bestrahlung mit simultaner EGFR-Inhibition sein. Auch das Konzept der Phase-II-CheckRad-CD8-Studie mit einer Induktions-Chemoimmuntherapie und anschließender chemotherapiefreier Radioimmuntherapie nach entsprechender Patientenselektion erwies sich als hoch effektiv. In ersten Phase-II-Studien erscheint bei HPV-positiven Oropharynxkarzinomen eine Dosis-Deeskalation der Strahlentherapie nach entsprechender Patientenselektion sowohl postoperativ (ECOG-ACRIN E3311-Studie) als auch nach Induktionstherapie (Optima-II-Studie) möglich. Eine Dosis-Deeskalation sollte aber außerhalb von klinischen Studien noch nicht durchgeführt werden. Zudem weisen erste Studien auf einen Nutzen der funktionellen Bildgebung (diffusionsgewichtete Magnetresonanztomographie [MRT] oder 18Fluor-Misonidazol-Positronenemissionstomographie [FMISO-PET]) zur Etablierung personalisierter Dosiskonzepte in der Strahlentherapie hin.

Abstract

At this year’s annual meetings of the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), several studies on radiotherapy of locally advanced head and neck cancer were presented. For the indication of definitive radiochemotherapy, particularly the administration of immune checkpoint inhibitors concomitant to radiotherapy was investigated. In the phase III GORTEC-REACH trial, combined inhibition of epidermal growth factor receptor (EGFR) and programmed death-ligand (PD-L1) concomitant to radiotherapy of locally advanced head and neck cancer was inferior to platinum-based chemoradiotherapy. However, this therapeutic approach may be more efficient than radiotherapy with simultaneous EGFR inhibition alone. The concept of the phase II CheckRad-CD8 trial with induction chemoimmunotherapy followed by chemotherapy-free radioimmunotherapy after appropriate patient selection also proved to be highly efficient. In initial phase II trials, dose de-escalation of radiotherapy seems feasible for HPV-positive oropharyngeal cancer after appropriate patient selection both postoperatively (ECOG-ACRIN E3311 trial) and after induction therapy (Optima II trial). However, dose de-escalation should currently not be performed outside of clinical trials. In addition, first studies indicate a benefit of functional imaging (diffusion-weighted magnetic resonance imaging [MRI] or F‑fluoromisonidazole positron-emission tomography [FMISO-PET]) to establish personalized dose concepts in radiotherapy.

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Authors and Affiliations

  1. Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91056, Erlangen, Deutschland

    Markus Hecht, Sabine Semrau, Thomas Weissmann, Udo S. Gaipl & Rainer Fietkau

  2. Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland

    Jens von der Grün

  3. Hals-Nasen-Ohren-Klinik – Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen, Erlangen, Deutschland

    Sarina Müller, Heinrich Iro & Antoniu-Oreste Gostian

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  1. Markus Hecht
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  2. Jens von der Grün
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  9. Antoniu-Oreste Gostian
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Correspondence to Markus Hecht.

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Interessenkonflikt

M. Hecht: Merck Serono (Advisory Boards, Vorträge, Reisemittel, Forschungsfinanzierung); MSD (Advisory Boards, Vorträge, Reisemittel, Forschungsfinanzierung); AstraZeneca (Forschungsfinanzierung, Vorträge); Novartis (Forschungsfinanzierung); BMS (Advisory Boards, Vorträge, Forschungsfinanzierung); Sanofi Genzyme (Advisory Boards, Forschungsfinanzierung); Teva (Reisemittel). R. Fietkau: MSD (Advisory Boards, Reisemittel, Forschungsfinanzierung); Fresenius (sonstige); BrainLab (sonstige); AstraZeneca (Advisory Boards, Reisemittel, Forschungsfinanzierung); Merck Serono (Advisory Boards, Reisemittel, Forschungsfinanzierung); Novocure (Advisory Boards, Vorträge, Forschungsfinanzierung); Sennewald (Vorträge, Reisemittel). U.S. Gaipl: Astra-Zeneca (Advisory Boards, Forschungsfinanzierung); BMS (Advisory Boards); MSD (Forschungsfinanzierung); Sennewald Medizintechnik (Reisemittel, Advisory Boards). J. von der Grün, S. Semrau, S. Müller, T. Weissmann, H. Iro und A.-O. Gostian 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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Hecht, M., von der Grün, J., Semrau, S. et al. Highlights der ASCO- und ESMO-Jahrestagungen 2021 zur Strahlentherapie von Kopf-Hals-Tumoren. HNO 70, 258–264 (2022). https://doi.org/10.1007/s00106-022-01150-4

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