Concerto grosso der Immunologie

Zusammenfassung

In der vorliegenden Kasuistik wird die erfolgreiche Kombination einer neuartigen, sich schnell etablierenden Immuntherapie mit monoklonalen Antikörpern und einer unterstützenden, synergistisch ausgerichteten komplementären Begleittherapie bei einer Patientin mit weit fortgeschrittenem, lokal, pulmonal, lymphogen sowie zerebral metastasierendem Adenokarzinom der Lunge vorgestellt. Zum Diagnosezeitpunkt wurden keine aktivierenden Treibermutationen und keine PD-L1-Expression des Tumors festgestellt. Deshalb wurde die Patientin vor der hier vorgestellten Immuntherapie bei initial weit fortgeschrittener Erkrankung, dem aktuellen Standard entsprechend, systemisch mit einer Polychemotherapie und bzgl. der frontalen, okzipitalen und parietalen Hirnmetastasierung mit einer stereotaktischen Strahlentherapie behandelt. Nach einem initialen Ansprechen dieses Therapiekonzeptes kam es dann schon nach 5 Monaten zu einer erneuten pulmonalen und zerebralen Progression. Es erfolgte eine erneute stereotaktische Radiatio der neu aufgetretenen Hirnmetastasen sowie eine systemische Therapie mit dem antiangiogen wirkenden Antikörper Ramucirumab und einer Chemotherapie. Als in einer späteren Nachuntersuchung doch eine signifikante PD-L1-Expression (programmed death ligand 1) im Tumorgewebe festgestellt wurde, kam es zum Einsatz des gerade für diese Indikation und Therapielinie zugelassenen Antikörpers Pembrolizumab, einem innovativen Checkpoint-Inhibitor. Nach 6 Zyklen Immuntherapie wurde in einer Restaging-CT-Untersuchung ein deutlicher Rückgang der Tumormanifestationen festgestellt.

ABSTRACT

In the present case history we will describe the effective and successful combination of innovative immunotherapy with synergistic, accompanying complementary therapy in a patient with far advanced, locally, lymphogenic and cerebral metastasized adenocarcinoma of the lung.

At that point no activating mutations were known and there was no proof for PD-L1 expression of the tumor tissue. In this situation the patient was treated, according to the topical guidelines, with polychemotherapy and radiation therapy. After initial response to the treatment, we observed a deterioration of the clinical situation already five month after start of the treatment, with pulmonary and cerebral progression. Another radiation therapy was initiated, as well as a systemic therapy with the antiangiogenic monoclonal antibody ramucirumab in combination with chemotherapy.

The PD-L1 expression in the tumor tissue was re-evaluated and now a significant PD-L1 expression was found. Therefore we applied a new immunotherapy with monoclonal antibody pembrolizumab which was recently admitted for this situation and indication. After six cycles of three weekly treatments with pembrolizumab a CT scan showed an impressive remission of the tumor manifestations.

Schlüsselwörter

Bronchialkarzinom - Checkpoint-Inhibitoren - Immunmodulation - Thymuspeptide - Komplementärmedizin

Key words

lung cancer - checkpoint-inhibitors - immunomodulation - thymic peptides - complementary medicine

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