Immuntherapie von Tumoren im oberen Gastrointestinaltrakt

Background: The approval of several programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) and cytotoxic T‑lymphocyte-associated protein 4 (CTLA-4) inhibitors radically changed the treatment landscape in many cancer types and established immune oncology as a new treatment strategy against cancer. Objectives: This article will address the use and evidence for immunotherapy in gastrointestinal (GI) malignancies and current trends in this area for clinical practice. Materials and methods: Publications from MEDLINE® (U.S. National Library of Medicine®, Bethesda, MD, USA), the American Society of Clinical Oncology (ASCO), and the European Society for Medical Oncology (ESMO) were collected and evaluated. Results: Many phase I–III trials focusing on immunotherapies for GI tumors have found only moderate to unsatisfactory objective response rates (ORR). Nevertheless, subsets of cancers, such as microsatellite instable cancers and Ebstein–Barr virus-associated tumors, seem in particular to benefit from treatment with immune checkpoint inhibition. Testing for rare molecular features that can predict response should be implemented in clinical routine. Preliminary data have been reported for the combination of chemotherapy and immunotherapy and might become new treatment standards for esophageal and gastric cancer. GI tumors and large scale clinical trials to identify predictive biomarkers are needed. Conclusion: Due to the survival advantage in terms of progression-free and overall survival by combining chemotherapy and immunotherapy in untreated advanced stage esophageal and gastric cancer, it seems likely that this treatment strategy will establish itself as new standard of care. Immunotherapy might also become treatment standard in the adjuvant treatment of esophageal cancer.