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Immunonkologie

Kein Bedarf mehr für interventionelle Radiologie?

Immuno-oncology

No longer a need for interventional radiology?

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Zusammenfassung

Klinisches Problem

Das hepatozelluläre Karzinom (HCC) zeichnet sich durch eine hohe Mortalität aus.

Therapeutische Standardverfahren

Über viele Jahre stand mit Sorafenib nur eine einzelne systemische, nicht gut verträgliche Behandlungsoption zur Verfügung, was zu einem teilweise unkritischen Einsatz von Lokaltherapien wie der transarteriellen Chemoembolisaton (TACE) geführt hat.

Neue Therapieverfahren

Seit Kurzem liegen positive Phase-III-Daten für jeweils drei systemische Therapieoptionen in der Erst- sowie auch in der Zweitlinie vor, die eine effektive sequenzielle Systemtherapie mit hoher Wirksamkeit beim HCC erlauben.

Diagnostik

Neben einer exakten Dokumentation der Tumorlast ist beim HCC auch eine longitudinale Erfassung der Leberfunktion essenziell.

Leistungsfähigkeit

Durch den Einsatz auf Immunonkologie basierender Kombinationstherapien können hohe Ansprechraten, einschließlich Komplettremissionen, beim HCC erreicht werden. Durch den sequenziellen Einsatz der Therapien kann schon heute in den Phase-II-Studien ein mittleres Gesamtüberleben (mOS) von deutlich über 20 Monaten bei Patienten mit fortgeschrittenem HCC und erhaltener Leberfunktion erreicht werden.

Bewertung

Lokale Therapien werden auch in Zukunft ihren Stellenwert in der Behandlung des fortgeschrittenen HCC behalten die neuen medikamentösen Optionen werden jedoch zunehmend zu einer Neuausrichtung zugunsten der Systemtherapien bei HCC-Patienten im intermediären Erkrankungsstadien führen.

Empfehlung für die Praxis

Die Anwendung validierter Scoringsysteme kann dazu beitragen, die Indikation für interventionelle Verfahren zu prüfen und zu vermeiden, dass der Beginn und der geeignete Zeitpunkt für einen Wechsel auf die Systemtherapien verpasst wird.

Abstract

Clinical issue

Hepatocellular carcinoma (HCC) is associated with a high mortality rate.

Standard treatment

For many years, sorafenib was the only, and frequently poorly tolerated systemic treatment option, which lead to the unreflected recurrent use of locoregional treatment modalities, such as transarterial chemoembolization (TACE).

Innovations

Based on recent positive phase III trial results, we now have three systemic therapeutic options available in the first and second line of treatment, respectively. This development enables us to design sequential treatments concepts for patients with advanced HCC.

Diagnostic work-up

Beyond the assessment of tumor burden, the liver function of HCC patients needs to be closely monitored under therapy.

Performance

High response rates, including complete remissions have been documented for immuno-oncology-based combination regimens in HCC patients. Already today, a median overall survival (mOS) above 20 months can been achieved through the sequential application of systemic therapies in phase II studies in patients with advanced HCC and preserved liver function.

Achievements

Local therapies will remain an integral component of HCC therapy. However, recent advancements will shift the focus towards systemic treatment concepts.

Practical recommendations

The rigorous implementation of validated scoring systems can contribute towards an improved selection of patients that are suited to locoregional therapies. Longitudinal monitoring of liver function is fundamental to ensure that the optimal point in time for a switch towards systemic therapies is not missed.

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Deutschland

    Anna Saborowski &  Arndt Vogel

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  1. Anna Saborowski
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  2. Arndt Vogel
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Correspondence to Arndt Vogel.

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Interessenkonflikt

A. Vogel: Erhielt Honoraria von Bayer, Roche, Lilly, EISAI, Ipsen, BMS, und MSD. A. Saborowski: Erhielt Reisekostenzuschüsse von Ipsen, Roche und Novartis.

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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Saborowski, A., Vogel, A. Immunonkologie. Radiologe 60, 687–692 (2020). https://doi.org/10.1007/s00117-020-00722-1

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