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Immuntherapie beim Ovarialkarzinom

Immunotherapy for ovarian cancer

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die immunologischen Therapien bei soliden Tumoren haben in den letzten Jahren eine enorme Entwicklung erfahren. Mehrere Substanzen wurden bereits für die Behandlung des Melanoms, Urothelkarzinoms, Lungenkarzinoms und vor kurzem auch des Mammakarzinoms zugelassen.

Fragestellung

Wirksamkeit der Immuncheckpointinhibitoren (ICPi) und anderen Immuntherapien beim Ovarialkarzinom.

Material und Methoden

Analyse der publizierten Ergebnisse von klinischen Studien einschließlich Kongressbeiträge.

Ergebnisse

Die Wirksamkeit von ICPi beim Ovarialkarzinom wurde bis dato vor allem im Rahmen von Phase-I/II-Studien überprüft. In den ersten Phase-III-Studien zum Einsatz des PD-L1(„programmed cell death ligand 1“)-Inhibitors Avelumab konnte allerdings weder in der primären noch in der Rezidivsituation eine Verbesserung des Outcome durch Hinzunahme des ICPi gezeigt werden. Weitere ICPi in Kombination mit Chemotherapie, Bevacizumab und/oder einem der PARP(Poly[ADP-ribose]-Polymerase)-Inhibitoren werden derzeit in Phase-III-Studien untersucht, deren Ergebnisse noch ausstehen. In den meisten dieser Analysen erfolgt die Stratifizierung der Patientinnen nach PD-L1-Status. Um die Immuntherapieresistenz im epithelialen Ovarialkarzinom (EOC) zu überwinden, werden weitere Therapiekonzepte, wie der adoptive Zelltransfer oder die Vakzinierung, verfolgt.

Diskussion

Die Immuntherapie stellt einen neuen Behandlungsansatz beim EOC dar. Ob und welche Patientinnengruppe von der Behandlung mit ICPi profitiert, muss im Rahmen der aktuell laufenden Phase-III-Studien evaluiert werden.

Abstract

Background

Immunotherapeutic strategies for the treatment of solid tumors have gained increasing interest in recent years. Several immune checkpoint inhibitors (ICPi) have been approved for the treatment of melanoma, urothelial carcinoma, lung cancer and recently breast cancer.

Objectives

The aim of the study was to investigate the efficacy and toxicity profile of ICPi in ovarian cancer treatment.

Materials and methods

An analysis of published results of clinical trials, including conference abstracts, was performed.

Results

The use of ICPi in ovarian cancer has been investigated mostly in phase‑I and phase-II studies. In the first phase-III trials on the use of the programmed cell death receptor ligand 1 (PD-L1) inhibitor avelumab in the primary and recurrent setting, the primary endpoints were not been reached. Further ICPi in combination with chemotherapy, bevacizumab and/or poly (ADP-ribose) polymerase (PARP) inhibitors are currently under investigation in numerous phase-III trials. In the majority of these studies patients are stratified according to their PD-L1 status. In addition, innovative therapy concepts such as vaccination and adoptive cell transfer aimed at overcoming resistance mechanisms are being examined.

Conclusions

Immunotherapy is a promising new treatment option for oncological patients. Whether women with ovarian cancer benefit from ICPi therapy, and which subgroup is particularly likely to derive a long-term benefit, remains to be clarified in the ongoing phase-III trials.

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Authors and Affiliations

  1. Universitäts-Frauenklinik Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    Natalia Krawczyk,  Werner Meier,  Anne-Kathrin Volkmer &  Tanja Fehm

  2. Frauenklinik, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland

    Malgorzata Banys-Paluchowski

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  1. Natalia Krawczyk
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  2. Malgorzata Banys-Paluchowski
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  3. Werner Meier
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  4. Anne-Kathrin Volkmer
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Corresponding author

Correspondence to Natalia Krawczyk.

Ethics declarations

Interessenkonflikt

N. Krawczyk hat keine Interessenkonflikte im Zusammenhang mit den genannten Medikamenten. M. Banys-Paluchowski hat Honorare für Vorträge bzw. Beratungstätigkeiten von Lilly, Novartis, Pfizer und Roche erhalten. W. Meier hat Honorare für Vorträge bzw. Beratungstätigkeiten von Roche, Tesaro und AstraZeneca erhalten. A.-K. Volkmer gibt an, dass kein Interessenkonflikt besteht. T. Fehm hat Honorare für Vorträge bzw. Beratungstätigkeiten von Novartis, Roche, Pfizer, Tesaro, Lilly, Esai, Celgene, Daichii Sankyo erhalten.

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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W. Janni, Ulm

T. Fehm, Düsseldorf

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Krawczyk, N., Banys-Paluchowski, M., Meier, W. et al. Immuntherapie beim Ovarialkarzinom. Gynäkologe 53, 229–237 (2020). https://doi.org/10.1007/s00129-020-04579-2

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  • DOI: https://doi.org/10.1007/s00129-020-04579-2

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