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Immunotherapy: Revolutionizing Oncology

Immunotherapy helps a patient's body produce cancer-fighting immune cells that effectively find and destroy cancer cells.

In recent years, the use of immunotherapies has revolutionized the treatment of solid tumors and hematological neoplasms.

The use of antibodies against negative regulators of T-cell activation (so-called checkpoint inhibitors) has led to patients with metastatic solid tumors being cured in some cases which were previously considered incurable.

Immunotherapy has been successfully applied to multiple tumors such as lung cancer, melanoma, breast cancer, Hodgkin's lymphoma, bladder cancer, kidney cancer, liver cancer (hepatocellular carcinoma), squamous cell cancer of the skin, squamous cell cancer of the cervix, certain types of colorectal cancer (MSI high) and others.

Advantages of the therapy: Fewer side effects than chemotherapy as well as a higher chance of cure for many tumor entities.

Disadvantages of the therapy: Immune-mediated side effects such as inflammation of the thyroid gland, intestines, liver and skin are possible in some patients.

Future developments in the coming years will focus in particular on the combination of immunotherapy with other therapeutic approaches in order to make immunotherapy more effective.

In Freiburg, we are working on this issue in the Collaborative Research Center 1479, which is headed by Prof. Robert Zeiser.

We are working in particular on the improvement of the efficacy of the immunotherapy by combining it with MDM inhibitors for melanoma (Langenbach ... Zeiser R. Mol Cancer Research 2023) and leukemia (Ho .. Zeiser R. Blood 2022), on metabolic modifiers such as bicarbonate (Uhl ... Zeiser R Sci Trans Med 2020) and on improving the treatment of the side effects of immunotherapy (Apostolova ... Zeiser R. NEJM 2020).

A case treated in Freiburg

A 29-year-old man was treated with ipilimumab and nivolumab for metastatic melanoma. After two doses of this combination therapy, symptoms of dermatitis, thyroiditis, hepatitis, and colitis developed. The diagnosis of colitis was based on macroscopic mucosal ulcerations and intraepithelial apoptosis and crypt loss identified in a biopsy sample. After no durable response was noted, the patient received ECP. During the next 8 months, he underwent two cycles of ECP on consecutive days every 2 to 4 weeks, which led to a complete resolution of the colitis. Immunosuppression was tapered without a rebound in the colitis symptoms. The melanoma remained in remission at a follow-up of 3 years. We then tested the effect of ECP in future patients with colitis after ICI therapy in a prospective trial.

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