{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T23:11:28Z","timestamp":1768345888457,"version":"3.49.0"},"reference-count":126,"publisher":"Georg Thieme Verlag KG","issue":"S 01","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Laryngorhinootologie"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Das Konzept der neoadjuvanten Immuntherapie stellt einen bedeutenden\n                    Paradigmenwechsel bei der Behandlung von potenziell heilbaren\n                    Kopf-Hals-Plattenepithelkarzinomen (HNSCC, head and neck squamous cell\n                    carcinoma) dar. Die derzeitigen Therapien sind zwar hochgradig individualisiert\n                    und innovativ, erreichen aber oft keine zufriedenstellenden\n                    Langzeit\u00fcberlebensraten und sind h\u00e4ufig mit einer erheblichen Morbidit\u00e4t\n                    verbunden.<\/jats:p><jats:p>Der Hauptvorteil dieses Ansatzes liegt in dem Potenzial, die Therapie mit einer\n                    spezifischen Behandlungsmodalit\u00e4t zu intensivieren und zu verbessern, die den\n                    bestehenden Dreiklang aus Chirurgie, Strahlentherapie und Chemotherapie erg\u00e4nzt.\n                    Checkpoint-Inhibitoren spielen bei dieser Entwicklung eine Vorreiterrolle. Sie\n                    zeigen einen moderaten, aber signifikanten \u00dcberlebensvorteil bei rezidivierten\n                    oder metastasierten Krebserkrankungen mit einem relativ besseren\n                    Sicherheitsprofil im Vergleich zu konventionellen Behandlungen. Somit sind sie\n                    vielversprechend, wenn sie f\u00fcr fr\u00fchere Stadien des HNSCC in Betracht gezogen\n                    werden.<\/jats:p><jats:p>Ein wesentlicher Vorteil der Einf\u00fchrung einer neoadjuvanten Immuntherapie ist die\n                    M\u00f6glichkeit einer Deeskalation der Behandlung. Durch die Verringerung der\n                    Tumorlast vor der Operation k\u00f6nnte diese Strategie zu weniger invasiven\n                    chirurgischen Eingriffen f\u00fchren. Die Aussicht auf organschonende Protokolle ist\n                    in diesem Zusammenhang ein erstrebenswertes Ziel. Dar\u00fcber hinaus k\u00f6nnte die\n                    fr\u00fchzeitige Anwendung von Immuntherapien eine wirksamere und dauerhaftere\n                    Immunreaktion ausl\u00f6sen. Die Induktion eines Immunged\u00e4chtnisses kann\n                    m\u00f6glicherweise zu einer effektiveren \u00dcberwachung der Krankheit durch das\n                    Immunsystem f\u00fchren, die Raten lokaler, regionaler und Fernmetastasen senken und\n                    so das Gesamt\u00fcberleben und das rezidivfreie \u00dcberleben verbessern.<\/jats:p><jats:p>Die neoadjuvante Immuntherapie ist jedoch nicht risikofrei. Eines der\n                    Hauptprobleme ist das Sicherheits- und Nebenwirkungsprofil. Zwar deuten die\n                    Daten darauf hin, dass unerw\u00fcnschte Ereignisse relativ selten und \u00fcberschaubar\n                    sind, doch ist das langfristige Sicherheitsprofil bei der neoadjuvanten\n                    Behandlung, insbesondere im Kontext der langfristigen, kurativen Absicht,\n                    weiterhin Gegenstand laufender Forschungsarbeiten. Ein weiteres ungel\u00f6stes\n                    Problem liegt in der genauen Bewertung des Ansprechens auf die Behandlung. Es\n                    l\u00e4sst sich eine Diskrepanz zwischen der radiologischen Bewertung anhand der\n                    RECIST-Kriterien und den histologischen Befunden feststellen, was auf eine\n                    mangelnde F\u00e4higkeit der derzeitigen bildgebenden Verfahren hinweist, das\n                    tats\u00e4chliche Ansprechen auf Immuntherapie genau wiederzugeben. Diese Diskrepanz\n                    unterstreicht die Notwendigkeit verbesserter bildgebender Verfahren und der\n                    Entwicklung neuer radiologischer und pathologischer Kriterien, die auf die\n                    genaue Bewertung des Ansprechens auf eine Immuntherapie zugeschnitten sind.<\/jats:p><jats:p>Kombinationsbehandlungen und das Timing der Therapie stellen eine weitere\n                    komplexe Herausforderung dar. Es gibt eine Vielzahl von M\u00f6glichkeiten,\n                    Immuntherapeutika mit konventioneller Chemotherapie, zielgerichtete\n                    Krebstherapie (eng. targeted therapy), Bestrahlung und experimentellen Ans\u00e4tzen\n                    zu kombinieren. Die Bestimmung des optimalen Behandlungsschemas f\u00fcr den\n                    einzelnen Patienten wird zu einer komplizierten Aufgabe, insbesondere wenn\n                    kleine, einarmige, nicht randomisierte Studien mit unterschiedlichen Schemata\n                    und Ergebnismessungen verglichen werden.<\/jats:p><jats:p>Au\u00dferdem muss die Bedeutung der pr\u00e4- und intraoperativen Entscheidungsfindung im\n                    Zusammenhang mit der neoadjuvanten Immuntherapie ber\u00fccksichtigt werden. Mit\n                    zunehmender Erfahrung mit diesem Behandlungsparadigmen besteht das Potenzial f\u00fcr\n                    ma\u00dfgeschneiderte chirurgische Ans\u00e4tze auf der Grundlage der verbleibenden\n                    Tumorlast des Patienten nach der neoadjuvanten Behandlung. Diese \u00dcberlegung ist\n                    besonders bei umfangreichen Operationen von Bedeutung, bei denen organschonende\n                    Protokolle evaluiert werden k\u00f6nnten.<\/jats:p><jats:p>Im klinischen Alltag f\u00fchrt der multimodale Charakter dieser Behandlungsstrategie\n                    zu praktischen Herausforderungen, insbesondere au\u00dferhalb klinischer Studien. Die\n                    Patienten m\u00fcssen sich einer der Behandlungslandschaft zurechtzufinden, die eine\n                    Koordination verschiedener medizinischer Disziplinen erfordert. Dies\n                    unterstreicht die Notwendigkeit eingespielter Behandlungspfade in\n                    spezialisierten Zentren, um ein effektives Behandlungsmanagement zu erm\u00f6glichen,\n                    sollte der neoadjuvante Ansatz in der Praxis eingef\u00fchrt werden.<\/jats:p><jats:p>Diese potenziellen Herausforderungen und offenen Fragen unterstreichen die\n                    dringende Notwendigkeit sorgf\u00e4ltig konzipierter klinischer Studien und\n                    translationaler Untersuchungen, um Sicherheit und Wirksamkeit f\u00fcr die Patienten\n                    zu gew\u00e4hrleisten. Nur so kann sichergestellt werden, dass dieser neue\n                    Behandlungsansatz auf ethische Weise eingef\u00fchrt wird und sein Potential\n                    erf\u00fcllt.<\/jats:p>","DOI":"10.1055\/a-2183-5802","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T22:46:42Z","timestamp":1714690002000},"page":"S167-S187","source":"Crossref","is-referenced-by-count":5,"special_numbering":"S","title":["Neoadjuvante Immuntherapie bei Kopf-Hals-\n                    Plattenepithelkarzinomen"],"prefix":"10.1055","volume":"103","author":[{"given":"Cornelius H. L.","family":"K\u00fcrten","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hals-, Nasen- und Ohrenheilkunde, Universit\u00e4tsklinikum\n                    Essen, Universit\u00e4t Duisburg-Essen, Essen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L.","family":"Ferris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA,\n                    USA"},{"name":"UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA,\n                    USA"},{"name":"Department of Immunology, University of Pittsburgh, Pittsburgh, PA,\n                    USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.radonc.2021.01.013","article-title":"Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on\n      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