Immunotherapy in Urological, Gynecological and Gastrointestinal Cancers - Current Landscape

Immunotherapy is becoming increasingly important in the management of urological, gynecological, and gastrointestinal cancers. Immune checkpoint inhibitor-based combinations have become a standard of care for patients with metastatic renal and liver cancers, as well as for many patients with bladder, cervical, gastric, and esophageal cancers, based on various biomarkers. Some tumor types are less responsive to immunotherapy, such as prostate and colon cancer. In these tumors, however, a subgroup of patients with a microsatellite-instability-high/DNA-mismatch repair deficient molecular phenotype significantly benefits from immunotherapy. Molecular characterization is therefore essential to identify patients who may benefit from these treatments. One of the major challenges is the search for new predictive biomarkers and novel combinations or strategies to further improve patient outcome.

The Future of Cancer Immunotherapy

This article describes three emerging, novel cancer immunotherapies: BITE, TIL and cancer vaccines are therapies that recognize specific targets on cancer cells and trigger a specific immune response. So far, not all tumor types can benefit from these approaches the best results have been observed in hematological malignancies, melanoma, and lung cancer. These novel biological products are currently being tested in several cancer centers in Switzerland, and physicians must be familiar with these procedures, as some of their patients might be treated with such therapies in the near future.

Endocrine and Neurological Toxicities of Immunotherapies

Immunotherapy has revolutionized cancer care but exposes patients to a new spectrum of complications that mimic autoimmune diseases, which are referred to as immune-related adverse events (irAEs). Endocrine complications are among the most common and involve nearly all endocrine tissues. Corticosteroids are not useful in endocrine irAEs, and definitive hormonal substitution is often indicated. Neurological irAEs can involve the central nervous system, the peripheral nervous system or the neuromuscular junction. Neurological irAEs are among the rarer complications but are associated with a higher morbidity and fatality. Therefore, prompt recognition and treatment are crucial. In this article, we discuss incidence, presentation, work-up, management, and common pitfalls in endocrine and neurological irAEs.

Side Effects of Cancer Immunotherapies: Dermatologic and Rheumatologic Toxicities

Dermatologic and rheumatologic toxicities are frequent adverse events during treatment with immune checkpoint inhibitors in oncology. Timely identification of these events and the referral to the oncologist or dermatologist are important in daily practice, such an organ damage involvements can be severe and sometimes life-threatening. The diagnosis and management of cutaneous toxicities, such as maculopapular rash and bullous dermatitis in particular, must be based on the body surface affected by skin lesions. Corticosteroids are basic treatment in moderate to severe cases. Rheumatologic toxicities are rarer and more heterogeneous, and they are often underestimated. They can occur in the absence of autoantibodies, and myositis can be life-threatening.

[Chemotherapy-Free Treatment of Hematological Neoplasias: Dream or Reality?]

Chemotherapy-Free Treatment of Hematological Neoplasias: Dream or Reality? Abstract. Hematologic neoplasias are a heterogeneous group of diseases based on clonal expansion of immature, dysfunctional blood cell populations. Chemotherapy can achieve long-term remission in some patients, but side effects are often severe and recurrences frequent. The fact that the immune system can have the strongest activity against tumor cells is well-known from the field of allogeneic stem cell transplantation. Accordingly, various immunological therapy approaches to combat malignant diseases have been pursued for a long time. New generations of antibody- and cell-based therapies lead to excellent remission rates; the combination of different technologies culminates today in the combination of the targeted specificity of antibody-like molecules with the efficiency of immune effector cells through the use of genetically modified T cells. Data on long-term remissions and long-term consequences still need to mature in order to finally evaluate efficacy and feasibility, especially of prolonged therapies.

[Not Available]

Zusammenfassung. Die Möglichkeiten der Diagnostik und Therapie allergischer Erkrankungen der Atemwege hat sich in den letzten Jahren deutlich verbessert. Bei der Abklärung und auch Initiierung einer Therapie ist die Einschaltung des Spezialisten oft hilfreich. Die Indikation zur Immuntherapie sollte möglichst früh gestellt werden, da damit die Erfolgsaussichten steigen.

[Transcutaneous applications for vaccination and immunotherapy]

Although Edward Jenner applied the first vaccines by scratching cow pox material into the skin, the profound immunological properties of the skin have become evident through research and discoveries only in the last 20 years. The immunological cells in the epidermis and the dermis are suitable targets for transcutaneous vaccination and immunotherapy. However, as the skin represents a natural barrier for topically administered large molecules, novel methods to overcome this barrier function have been described. There are chemical, biochemical and physical methods, many of which are pain-free and therefore especially suitable for children. Also for adults non-invasive methods of vaccination and immunotherapy are attractive as self-administration is feasible. Future products are currently undergoing clinical tests which provide promising results.