Busch C-J, Laban S, Knecht R, Hoffmann T K
Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie und Onkologie, Kopf-Hals-Tumorzentrum des UCCH, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Kopf-Hals-Tumorzentrum Ulm, Klinik für Hals-Nasen-Ohren-Heilkunde und Kopf-Hals-Chirurgie, Universitätsklinik Ulm, Ulm, Deutschland.
HNO. 2016 Oct;64(10):708-16. doi: 10.1007/s00106-016-0238-3.
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.
新型免疫检查点抑制剂形式的免疫治疗药物对头颈部肿瘤的治疗标准产生了重大影响并使其得以复兴。最近，在美国临床肿瘤学会（ASCO）年会上展示了几种用于头颈癌的创新性免疫疗法，这可能在不久的将来导致姑息治疗和根治性治疗模式的转变。最常见的方法是靶向程序性细胞死亡1（PD-1）轴的抗体。这些疗法似乎在很大一部分患者中有效（与人类乳头瘤病毒无关），并且显示出延长的反应持续时间。在一项用于姑息性二线治疗的III期试验中，PD-1抗体纳武单抗在铂类治疗后疾病进展的头颈部鳞状细胞癌（HNSCC）患者中显示出显著的生存改善；因此，美国食品药品监督管理局给予其突破性疗法认定。目前正在进行进一步的临床试验，重点是一线姑息治疗（与EXTREME方案相比）以及使用免疫检查点抑制剂的新辅助治疗。然而，为了避免增加公共卫生成本并保护患者免受潜在的严重不良事件影响，有效的检测系统（例如，PD-L1检测）以及用于患者选择的可靠预测标志物是必要的。
