Status quo: Immuntherapie in der Uroonkologie

Zusammenfassung

Das Jahr 2016 markiert das Jahr der Immunonkologie bei urologischen Tumoren. Es wurde als erster Vertreter der Immuncheckpoint-Inhibitoren bei uroonkologischen Tumoren der PD-1-Antikörper Nivolumab beim fortgeschrittenen Nierenzellkarzinom in der zweiten Therapielinie (nach „Vortherapie“) zugelassen. Grundlage für die Zulassung von Nivolumab waren Daten der Phase-III-Studie CheckMate-025, in der Nivolumab im Vergleich zu Everolimus bei Patienten mit fortgeschrittenem klarzelligen Nierenzellkarzinom (RCC) nach Vortherapie mit einem Angiogeneseinhibitor untersucht wurde. Für den PD-1-Antikörper wurden eine höhere Remissionsrate (25 % vs. 5 %) und eine Verlängerung des Gesamtüberlebens um 5,4 Monate im Vergleich zu Everolimus analysiert.

In den USA wurde zudem der Anti-PD-1-Antikörper Atezolizumab beim metastasierten Urothelkarzinom nach platinbasierter Chemotherapie zugelassen. Ausschlaggebend dafür waren Phase-II-Daten der IMvigor-210-Studie, die eine Gesamtansprechrate von 15 % belegt. Das mediane Gesamtüberleben (mOS) betrug 7,9 Monate in der Gesamtpopulation.

Die Substanzgruppe der Immuncheckpoint-Inhibitoren zeichnet sich durch geringe Nebenwirkungen aus. Derzeit werden in zahlreichen Phase-III-Studien Immuncheckpoint-Inhibitoren geprüft, um bisherige Erstlinien-Standardtherapien bei metastasierten urologischen Tumoren abzulösen.

Abstract

The year 2016 marks the year of the immune therapy in urological cancers. The anti-PD-1 antibody Nivolumab has been approved as the first immune checkpoint inhibitor for the treatment of urological cancer, namely for advanced, previously treated renal cell carcinoma. This approval was based on CheckMate-025, a phase-III-trail analysing Nivolumab compared with Everolimus in patients previously treated with angiogenetic drugs. Nivolumab has achieved a higher rate of remission (25 vs. 5%) and a 5,4-month increase in overall survival (25,0 vs. 19,6 months).

Moreover in the US Atezolizomab has been approved by the FDA for metastatic urothelial carcinoma after platinum-based chemotherapy. Data of a phase-II-trail (IMvigor 210) demonstrated an overall response rate of 15 %. Median survival was 7.9 months for all patients with advanced urothelial cancer after platinum-based chemotherapy treated with Atezulizumab.

The side-effects resulting from immune checkpoint therapy are comparatively low. Immune checkpoint inhibitors are beeing tested in a large number of clinical trails. It is expected that this new class of drugs have the potential to replace current first-line treatment options for metastatic urological tumors such as renal cell carcinoma or urothelial carcinoma.

Key words

immune therapy - renal cell carcinoma - urothelial carcinoma - PDL1

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