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Lokal fortgeschrittenes nichtkleinzelliges Lungenkarzinom: Radioimmuntherapie als neuer Standard?

Locally advanced non-small cell lung cancer: radioimmunotherapy as new standard of care?

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Hintergrund

Seit den 1990er-Jahren ist die simultane Radiochemotherapie als Standardtherapie für Patienten mit inoperablem nichtkleinzelligem Lungenkarzinom („non-small cell lung cancer“, NSCLC) im Stadium III fest etabliert. Zwischen der Radiochemotherapie und Immuntherapie bestehen potenziell synergistische Effekte. Immuncheckpointinhibitoren werden zunehmend in der Behandlung metastasierter Tumorerkrankungen eingesetzt.

Fragestellung

Welchen Stellenwert hat die Radioimmuntherapie für Patienten mit NSCLC im Stadium III?

Material und Methode

Es handelt sich um eine halbstrukturierte Literaturrecherche.

Ergebnisse

In dieser Übersichtsarbeit werden die Etablierung der Radiochemotherapie und die aktuelle Datenlage zu potenziellen Synergismen zwischen Radiotherapie und Immuntherapie dargelegt. So zeigte die PACIFIC-Studie einen signifikanten Überlebensvorteil beim Einsatz einer Immunerhaltungstherapie mit Durvalumab nach simultaner Radiochemotherapie.

Schlussfolgerung

Die Immunerhaltungstherapie nach simultaner Radiochemotherapie im Stadium III stellt einen neuen Therapiestandard dar und könnte den Stellenwert der Radiochemotherapie im Vergleich zur Operation im Stadium III neu gewichten. Während Langzeitdaten aktuell noch ausstehen, wird in weiteren klinischen Studien der Stellenwert der Immuntherapie in diesem Kontext untersucht.

Abstract

Background

Concurrent radiochemotherapy has been established as a treatment standard for patients with inoperable non-small cell lung cancer (NSCLC) since the 1990s. There are potential synergistic effects between radiochemotherapy and immunotherapy. Thus, immune checkpoint inhibitors are increasingly used in patients with metastatic tumors.

Objectives

What is the role of radioimmuntherapy in patients with stage III NSCLC?

Materials and methods

A semistructured literature search was performed.

Results

In this review, the established radiochemotherapy and the current data regarding potential synergisms between radiotherapy and immunotherapy are summarized. In this context, consolidation immunotherapy with durvalumab after chemoradiation offers a significant overall survival benefit as shown by the PACIFIC trial.

Conclusion

Immunotherapy with durvalumab as consolidation therapy after concurrent radiochemotherapy represents a new paradigm for patients with stage III NSCLC. This could lead to a rearrangement of the current treatment algorithms for patients with stage III NSCLC, also with respect to surgery. While long-term data are still pending, further clinical studies are currently testing the role of immunotherapy in patients with stage III NSCLC.

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Abbreviations

CTLA4:

„Cytotoxic T-lymphocyte-associated protein 4“

GM-CSF:

Granulozyten-Monozyten-Kolonie-stimulierender Faktor

ICI:

Immuncheckpointinhibitor

IMRT:

Intensitätsmodulierte Strahlentherapie

NSCLC:

Nichtkleinzelliges Lungenkarzinom

PD1/PDL1:

„Programmed cell death protein/ligand 1“

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Authors and Affiliations

  1. Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland

    Alexander Fabian, Justus Domschikowski, Jürgen Dunst &  David Krug

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  1. Alexander Fabian
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  2. Justus Domschikowski
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  3. Jürgen Dunst
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  4. David Krug
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Correspondence to David Krug.

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Interessenkonflikt

J. Domschikowski erhielt Reisekostenerstattung von Bristol Myers Squibb und Roche. D. Krug erhielt Vortragshonorare von Merck Sharp & Dome. A. Fabian und J. Dunst 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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D. Ukena, Bremen

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Fabian, A., Domschikowski, J., Dunst, J. et al. Lokal fortgeschrittenes nichtkleinzelliges Lungenkarzinom: Radioimmuntherapie als neuer Standard?. Pneumologe 16, 366–372 (2019). https://doi.org/10.1007/s10405-019-0265-3

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