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Immuntherapeutische Studien bei Kopf-Hals-Tumoren

Highlights der ASCO-Jahrestagung 2016

Immunotherapeutic studies of head and neck tumors

Highlights of the 2016 ASCO Annual Meeting

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Zusammenfassung

Die Immuntherapie erfährt durch den Einsatz sog. Immuncheckpointinhibitoren aktuell auch eine Renaissance in der medikamentösen Kopf-Hals-Onkologie. Auf der aktuellen Jahrestagung der American Society of Clinical Oncology (ASCO) wurden zum Thema Immuntherapie bei Kopf-Hals-Tumoren verschiedene Innovationen präsentiert, die in Kürze einen Paradigmenwechsel zunächst in der palliativen, später möglicherweise auch in der kurativ intendierten Kopf-Hals-Onkologie einleiten werden. Der verbreitetste Ansatz besteht in der Inhibition des Programmed-cell-death-1(PD-1)-Rezeptors oder seiner Liganden durch therapeutische Antikörper. Diese Form der Immuntherapie scheint bei einem relevanten Anteil der Patienten (unabhängig vom humanen Papillomvirus) wirksam zu sein und bei diesen zu einem langanhaltenden Therapieansprechen zu führen.

In einer Phase-III-Studie zur palliativen Zweitlinientherapie nach Platinversagen hat der PD-1-Antikörper Nivolumab im Vergleich zur eingesetzten Standardtherapie eine signifikante Verbesserung des Gesamtüberlebens ergeben, was hinsichtlich einer beschleunigten Zulassungsmöglichkeit aktuell geprüft wird. Weitere Studien beispielsweise zum Erstlinieneinsatz der Immuncheckpointinhibitoren (vgl. EXTREME-Schema) aber auch in der Neoadjuvanz laufen derzeit. Um zukünftig die hohen Kosten der Immuntherapie besser zu kontrollieren und v. a. um eine personalisierte Therapie anbieten zu können, um Patienten vor unnötigen potenziell schweren Nebenwirkungen zu schützen, ist die Entwicklung valider Testsysteme (z. B. PD-L1-Bestimmung) wie auch die Identifikation prädiktiver Marker notwendig.

Abstract

Immunotherapeutic drugs in the form of novel immune checkpoint inhibitors have had a significant impact on and revival of the treatment standards for head and neck tumors. Recently, at the annual meeting of the American Society of Clinical Oncology (ASCO) several innovative immunotherapies in head and neck cancer were presented, which might lead to a paradigm shift in the palliative as well as curative setting in the near future.

The most common approaches are antibodies targeting the programmed cell death 1 (PD-1) axis. These therapies seem to be effective in a significant proportion of patients (independent of human papillomavirus) and show an extended duration of response.

In a phase III trial for palliative second-line therapy, the PD-1 antibody nivolumab demonstrated a significant improvement in survival in patients with head and neck squamous cell carcinoma (HNSCC) who were experiencing disease progression after platinum-based therapy; therefore, the Food and Drug Administration gave it a breakthrough therapy designation.

Further clinical trials focusing on first-line palliative treatment (compared with the EXTREME protocol) as well as neoadjuvant therapies using immune checkpoint-inhibitors are ongoing. However, valid testing systems (e. g., PD-L1 testing) as well as reliable predictive markers for patient selection are necessary to avoid increasing public health costs and to protect patients from potentially serious adverse events.

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Authors and Affiliations

  1. Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie und Onkologie, Kopf-Hals-Tumorzentrum des UCCH, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    C.-J. Busch & R. Knecht

  2. Kopf-Hals-Tumorzentrum Ulm, Klinik für Hals-Nasen-Ohren-Heilkunde und Kopf-Hals-Chirurgie, Universitätsklinik Ulm, Ulm, Deutschland

    S. Laban & T. K. Hoffmann

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  1. C.-J. Busch
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  2. S. Laban
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  3. R. Knecht
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  4. T. K. Hoffmann
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Correspondence to C.-J. Busch.

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Interessenkonflikt

C.-J. Busch, S. Laban, und T. K. Hoffmann geben an, dass kein Interessenkonflikt besteht. R. Knecht: Advisory Board BMS, AstraZeneca, Aventis und Merck Serono.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Busch, CJ., Laban, S., Knecht, R. et al. Immuntherapeutische Studien bei Kopf-Hals-Tumoren. HNO 64, 708–716 (2016). https://doi.org/10.1007/s00106-016-0238-3

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  • DOI: https://doi.org/10.1007/s00106-016-0238-3

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