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Therapie ösophagogastraler Tumoren: Magenkarzinom

Treatment of esophagogastric junction cancers: gastric cancer

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best practice onkologie Aims and scope

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Zusammenfassung

Hintergrund

Die Zulassung verschiedenster PD-1/PD-L1- und CTLA-4-Inhibitoren haben die Behandlungsmöglichkeiten bei diversen Tumorentitäten nachhaltig beeinflusst und die Immuntherapie als neue onkologische Behandlungsstrategie etabliert.

Ziel der Arbeit

In der vorliegenden Arbeit wurden der derzeitige klinische Stand der Therapie des lokal fortgeschrittenen und metastasierten Magenkarzinoms zusammengefasst und die laufenden und zukünftigen Entwicklungsprogramme sowie ihre Umsetzung im klinischen Alltag bewertet.

Material und Methoden

Publikationen aus der Datenbank MEDLINE sowie von den Fachgesellschaften American Society of Clinical Oncology (ASCO) und European Society for Medical Oncology (ESMO) wurden systematisch gesammelt und ausgewertet.

Ergebnisse

Viele Immuntherapiestudien der Phase I–III wurden in den letzten Jahren bei oberen gastrointestinalen Tumoren durchgeführt, allerdings ohne vergleichbare Erfolge zu anderen Tumorentitäten – mit lediglich moderaten Ansprechraten zwischen 10 und 25 % in der Monotherapie. Subgruppen wie u. a. Patienten mit mikrosatelliteninstabilen (MSI) und mit dem Epstein-Barr-Virus (EBV) assoziierten Tumoren scheinen in besonderem Maße von der Behandlung mit Immuncheckpointinhibitoren zu profitieren. Erste vielversprechende Ansätze zur Kombination von Chemo- und Immuntherapie wurden kürzlich veröffentlicht und könnten zur Etablierung neuer Therapiestandards beim Magenkarzinomen führen.

Schlussfolgerung

Aufgrund des Überlebensvorteils beim progressionsfreien und Gesamtüberleben durch die Kombination von Chemo- und Immuntherapie bei fortgeschrittenen, nicht vorbehandelten Magenkarzinomen ist zu erwarten, dass, eine Zulassung vorausgesetzt, sich diese Therapie rasch als neuer Standard etablieren wird.

Abstract

Background

The approval of several PD-1/PD-L1 and CTLA‑4 inhibitors radically changed the treatment landscape in many cancer types and established immuno-oncology as a new treatment strategy for cancer.

Objective

This article addresses the current use of and evidence for innovative treatment strategies for locally advanced and metastatic gastric cancer and evaluates future trends in this area for clinical practice.

Materials and methods

Publications from Medline, the American Society of Clinical Oncology (ASCO), and the European Society for Medical Oncology (ESMO) were systematically collected and evaluated.

Results

Various phase I–III trials focusing on immunotherapies for gastrointestinal tumors have found only moderate to unsatisfactory objective response rates (ORR) ranging between 10 and 25% with immune monotherapy. Nevertheless, small subsets of cancers, such as microsatellite instable (MSI) cancers and Epstein–Barr Virus (EBV)-associated tumors, seem to benefit from treatment with immune checkpoint inhibition in particular. First promising data have been reported for the combination of chemo-immunotherapy and these approaches might become new treatment standards for gastric cancer.

Conclusion

Due to the survival advantage in terms of prolonged progression-free and overall survival by chemo-immune combinations in untreated advanced-stage gastric cancer, it seems likely that the combination of chemo-immunotherapy will become a new standard of care for selected subgroups provided approval is obtained.

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  1. Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland

    Michael Masetti & Sylvie Lorenzen

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  1. Michael Masetti
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  2. Sylvie Lorenzen
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Correspondence to Michael Masetti.

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M. Masetti und S. Lorenzen 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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Stefan Kasper-Virchow, Essen

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Masetti, M., Lorenzen, S. Therapie ösophagogastraler Tumoren: Magenkarzinom. best practice onkologie 16, 438–448 (2021). https://doi.org/10.1007/s11654-021-00335-7

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  • DOI: https://doi.org/10.1007/s11654-021-00335-7

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