Verkarre Virginie, Roussel Hélène, Granier Clémence, Tartour Eric, Allory Yves
Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; Unité Inserm U970, Paris Cardiovascular Research Center, PARCC, 56, rue Leblanc, 75015 Paris, France.
Ann Pathol. 2017 Feb;37(1):90-100. doi: 10.1016/j.annpat.2016.12.015. Epub 2017 Jan 19.
The algorithms for treatment of metastatic cancers are evolving due to positive results obtained with immunotherapy. Therapeutics approaches to stimulate the immune system have already been used in the treatment of kidney and bladder cancer, such as the administration of cytokines and BCG therapy, confirming the immunogenicity of these tumors. The aim of immunotherapies is not only to activate the immune system against tumor cells, but also to take into account the tumor-induced suppressive microenvironment, in particular by removing the anergy of T-cell lymphocytes, and by targeting the co-stimulation inhibitors molecules. Among the genito-urinary cancers, second-line clinical trials have clearly shown that kidney and bladder cancers are sensitive to the inhibition of PD-1/PD-L1 axis and have already achieved FDA approvals for some molecules. Numerous other clinical trials are underway, particularly in first-line treatment in bladder and renal cancers. Refractory testicular cancer could also benefit from these treatments. Other approaches using vaccine therapy especially in castration-resistant prostate cancer are also of interest. We will see, in this chapter dedicated to the urogenital cancers, the benefit of the immunotherapy by resituating it in the genetic and immunological context of each organ. We will also present briefly the therapeutic outlines and the place of biomarkers.
由于免疫疗法取得了积极成果，转移性癌症的治疗算法正在不断发展。刺激免疫系统的治疗方法已被用于治疗肾癌和膀胱癌，如细胞因子的给药和卡介苗疗法，证实了这些肿瘤的免疫原性。免疫疗法的目的不仅是激活针对肿瘤细胞的免疫系统，还需要考虑肿瘤诱导的抑制性微环境，特别是通过消除T淋巴细胞的无反应性，以及靶向共刺激抑制剂分子。在泌尿生殖系统癌症中，二线临床试验清楚地表明，肾癌和膀胱癌对PD-1/PD-L1轴的抑制敏感，并且一些分子已经获得了美国食品药品监督管理局（FDA）的批准。许多其他临床试验正在进行中，特别是在膀胱癌和肾癌的一线治疗中。难治性睾丸癌也可能从这些治疗中获益。其他使用疫苗疗法的方法，特别是在去势抵抗性前列腺癌中，也很有意义。在本章专门讨论泌尿生殖系统癌症时，我们将通过将免疫疗法置于每个器官的遗传和免疫背景中来了解其益处。我们还将简要介绍治疗概述和生物标志物的作用。
