Zusammenfassung
Interleukin-2 (IL-2) und/oder Interferon-α (IFN-α) induzieren Remissionen und können bei selektionierten Patienten mit metastasiertem Nierenzellkarzinom zur Lebensverlängerung führen. Gerade bei alten Patienten und solchen mit Begleiterkrankungen besteht jedoch ein Bedarf an besser verträglichen und effektiveren Therapien. Die jüngsten Ansätze in der Behandlung des fortgeschrittenen Nierenzellkarzinoms unterstreichen mögliche signifikante Verbesserungen.
Immunzellen im Tumor korrelieren mit der Reaktion auf die Therapie und dem Überleben und weisen so auf die Bedeutung der lokalen Immunmodulation hin. Durch sie wurden gut verträgliche Behandlungen wie die Inhalation von IL-2 zur Beherrschung von Lungenmetastasen möglich, welche zu einem signifikanten Überlebensvorteil bei Hochrisikopatienten führte, wie in einer aktuellen Kohortenstudie an 200 Patienten gezeigt wurde. Tumor-Targeting mit Antikörpern gegen cG250, mit spezifischer Expression beim Nierenzellkarzinom, scheint zur Stabilisierung bei Metastasierung zu führen und induziert keine Toxizität. Vakzinierungen werden ebenfalls gut vertragen, haben aber bisher keine überzeugenden Ergebnisse bei fortgeschrittener Erkrankung erbracht. Andere Ansätze haben die Erwartungen nicht erfüllt. Die Stammzelltransplantation weist noch eine signifikante Toxizität auf und kann nicht bei älteren Patienten empfohlen werden.
Abstract
Interleukin-2 (IL-2) and/or interferon-α (IFN-α) induce remissions and prolong life in patients with metastatic renal cell carcinoma when carefully selected for a possibly toxic treatment. However, better-tolerated and more effective therapies are needed, especially in the elderly and patients with comorbidities. Recent achievements in the treatment of advanced renal cell carcinoma highlight potentially significant improvements.
Immune cells within the tumor correlate with response and survival indicating the importance of local immune modulation. Such modulation has allowed introducing well-tolerated treatments such as inhalation of IL-2 to control lung metastases, which results in a significant survival benefit for high-risk patients as suggested by a recent cohort study in 200 patients. Antibody-based tumor targeting against cG250, specifically expressed on RCC, seems to stabilize progressive metastatic disease and does not induce toxicity. Vaccination strategies are also well tolerated, but have not shown convincing results in advanced disease so far. Other approaches have not fulfilled expectations. Stem cell transplantation still has significant toxicity and cannot be recommended for the elderly.
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Heinzer, H., Huland, E. & Huland, H. Immuntherapie des Nierenzellkarzinoms. Urologe [A] 42, 1450–1452 (2003). https://doi.org/10.1007/s00120-003-0444-y
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DOI: https://doi.org/10.1007/s00120-003-0444-y