Therapie ösophagogastraler Tumoren: Magenkarzinom

Background: The approval of several PD-1/PD-L1 and CTLA‑4 inhibitors radically changed the treatment landscape in many cancer types and established immuno-oncology as a new treatment strategy for cancer. Objective: This article addresses the current use of and evidence for innovative treatment strategies for locally advanced and metastatic gastric cancer and evaluates future trends in this area for clinical practice. Materials and methods: Publications from Medline, the American Society of Clinical Oncology (ASCO), and the European Society for Medical Oncology (ESMO) were systematically collected and evaluated. Results: Various phase I–III trials focusing on immunotherapies for gastrointestinal tumors have found only moderate to unsatisfactory objective response rates (ORR) ranging between 10 and 25% with immune monotherapy. Nevertheless, small subsets of cancers, such as microsatellite instable (MSI) cancers and Epstein–Barr Virus (EBV)-associated tumors, seem to benefit from treatment with immune checkpoint inhibition in particular. First promising data have been reported for the combination of chemo-immunotherapy and these approaches might become new treatment standards for gastric cancer. Conclusion: Due to the survival advantage in terms of prolonged progression-free and overall survival by chemo-immune combinations in untreated advanced-stage gastric cancer, it seems likely that the combination of chemo-immunotherapy will become a new standard of care for selected subgroups provided approval is obtained.