Zusammenfassung
Die Prognose von fortgeschrittenen Nierenzellkarzinomen ist nach wie
vor infaust. Die mediane Überlebenszeit für das metastasierte Stadium
liegt unter einem Jahr. Da bei Nierenzellkarzinomen im Vergleich zu anderen
Tumoren häufiger Spontanremissionen beobachtet werden, liegt die Vermutung
nahe, dass das Nierenzellkarzinom prinzipiell auf eine immunologische Therapie
anspricht. Dabei zeigten sich die Standardtherapieverfahren der unspezifischen
Immuntherapie mit Interferonen und Interleukin-2 als nicht besonders
erfolgversprechend hinsichtlich der Verlängerung der
Gesamtüberlebenszeit bei gleichzeitig nicht zu unterschätzenden
Nebenwirkungen. Daher ist die Entwicklung innovativer Strategien auf der Basis
zellulärer spezifischer Immuntherapien, insbesondere für das
fortgeschrittene Stadium, von eminent wichtiger Bedeutung. Dies gilt
insbesondere unter Berücksichtigung der Verbesserung oder wenigstens
Beibehaltung der Lebensqualität. Mittlerweile liegen für das
Nierenzellkarzinom eindeutige Hinweise vor, dass es in besonderem Maße
durch eine T-Zell-vermittelte Immunantwort behandelbar ist. In mehreren
klinischen Phase-I/II-Studien sowie Einzelfallbeschreibungen konnte gezeigt
werden, dass die Behandlung von Nierenzellkarzinomen mit einer spezifischen,
zellbasierten Immuntherapie erfolgreich sein kann. Dabei wurden autologe
Tumorvakzinen, Peptidvakzinen sowie autologe dendritische Zellen zur Behandlung
eingesetzt. Die Therapien wurden allgemein gut vertragen, schwerwiegende
Nebenwirkungen wurden für keine der Vakzinierungsstrategien
beschrieben.
Summary
Advanced renal cell carcinomas belong to the tumors with up to now
unfavorable prognosis. Once metastasized the median survivals are less than one
year. Because of observed spontaneous remissions of metastases it is likely
that an immunotherapy can be a successful treatment option. However, the
treatment with an unspecific immunotherapy with Interferon or Interleukine-2
failed to have a significant impact on the survival and the side effects are
high. Thus the development of a specific immunotherapy is required. Meanwhile,
several groups have shown that a specific immunotherapy based on cellular
vaccines can induce a clinical antitumor response in patients with renal cell
carcinoma, especially in advanced metastatic disease stages.
Schlüsselwörter
Nierenzellkarzinom - dendritische Zelle - Immuntherapie - Tumorzell-Lysat - regulatorische
T-Zellen (T-reg) - TLR
Keywords
Renal cell carcinoma - dendritic cell - immunotherapy - cellular vaccines - regulatoric
T-Cells
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Korrespondenzadresse
Dr. Thomas Neßelhut
Institut für Tumortherapie
Hinterstrasse 53
37115 Duderstadt
Email: thomas.nesselhut@dr-nesselhut.de
