Supervisors info:
Σακελλαρίου Στρατηγούλα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Θυμαρά Ειρήνη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Λακιωτάκη Ελευθερία, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Immunotherapy in modern Medicine is a doctor’s significant ally, in the direction of choosing the most suitable therapeutic line for cancer of the digestive system namely (esophagogastric junction, gastric, colorectal and liver carcinoma) patients. For each of these four gastrointestinal cancer types, the patient’s response to therapy depends (among other factors) on the stage and the histological type of the disease, as well as the molecular characteristics and the tumor microenvironment. Given these parameters, the medical doctor is asked to draw a therapeutic plan, in the direction of improving the patient’s clinical picture and offering a longer and more qualitative survival. Today, immunotherapy is an important weapon in the quiver of oncologists. Research papers of the latest years discuss a wide variety of immunotherapeutic agents, most of which are still under preclinical or clinical trials. There are, however, certain pharmaceutics -the circulation of which has been officially approved- and that can be administered to the patients with much promising clinical results. Typical examples of those agents are the immune checkpoint inhibitors, the adoptive cell therapies, the monoclonal antibodies, the immunosuppressors and/or the immunomodulators, as well as the various interferons, growth factors, cytokines and their agonists. Specifically, in esophagogastric junction carcinoma, anti-PD-1 immune checkpoint inhibitors (ICIs) (Nivolumab and Pembrolizumab) are used therapeutically based on MSI or MMR screening, PD-L1 immunoexpression, and high tumor mutational burden (TMB- H), as well as the anti-HER-2 monoclonal antibody (Trastuzumab). In gastric cancer, the anti-PD1 agent Nivolumab is used in combination with chemotherapy for patients with HER2-negative tumors and PD-L1 CPS ≥5 and Pembrolizumab as 2nd-line treatment for MSI-H/dMMR or TMB-H tumors. In the case of colon cancer, anti-PD-1 antibodies (Nivolumab and Pembrolizumab) alone or in combination with the anti-CTLA-4 antibody Ipilimumab are used as 1st or next-line treatment for MSI-H/dMMR carcinomas as well as the anti-HER-2 antibodies (Trastuzumab), anti-EGFR (Cetuximab και Panitumumab), anti-VEGF (Bevacizumab). Finally, in hepatocellular carcinoma, anti-PDL1 Atezolizumab and Durvalumab and anti-CTLA4 Tremelimumab are mainly used therapeutically, in combination treatments that include Atezolizumab-Bevacizumab or Tremelimumab-Durvalumab. On condition that the production, distribution and clinical administration of those agents fulfill all the scientific ethics and codes of conduct, the results of their use in the near future can be quite encouraging.
Keywords:
Immunotherapy, Biomarkers, Immunoregulation, Cancer, Survival
