Magyar onkologia最新文献

With the increasing use of immunotherapy, numerous gastroenterological side effects may occur, significantly impacting patients' quality of life and potentially leading to life-threatening complications. The most common adverse effects include diarrhea, colitis, hepatitis, pancreatitis, but other gastrointestinal manifestations such as those affecting the upper digestive tract and celiac disease have also been reported. Rapid recognition and intervention are crucial for improving patient outcomes, with corticosteroids being the primary treatment option, and various biological therapies are available depending on the specific side effect. This article provides a detailed analysis of the diagnostic and therapeutic approaches for common side effects, facilitating the exclusion of other etiologies and enabling effective treatment planning.

The spectacular development of radiotherapy technology in the twenty-first century and the everyday availability of this modern technique have founded the possibility of combining radiotherapy with various systemic oncological treatments with increasing safety and effectiveness. The most novel systemic treatment modality, the modern immunotherapy, which is also the achievement of the present century, and the latest milestone in its rapid spread across the therapeutic spectrum in cancer care is the step forward to the treatment of earlier tumor stages with curative intent. The inevitable meeting point of these rapidly developing treatment modalities is the care of locally advanced tumors, achieving the theory and practice of the combination of immunotherapy with definitive radiotherapy. The success of the PACIFIC, ADRIATIC or KEYNOTE-A18 studies proves that further progress is possible in the definitive, curative treatment of locally advanced cancer diseases. In this paper, we describe this combination therapy algorithm, the biological background and the successful or less successful clinical trial results in the most relevant and important tumor types and indications.

Gastroesophageal cancers still rank among the leading causes of cancer-related death. With the introduction of immunotherapy, the treatment strategy has evolved. In the neoadjuvant setting for gastroesophageal junction (GEJ) and gastric adenocarcinoma, the results of the MATTERHORN clinical trial, presented at this year's ASCO meeting, are expected to shift future treatment strategies. In esophageal tumors, adjuvant nivolumab is used. In metastatic disease, depending on the histological subtype, molecular testing such as PD-L1 CPS and TPS, HER2, and MSI-H is required to determine the treatment decision. In the metastatic setting, combinations of nivolumab or pembrolizumab with fluoropyrimidine- and platinum-based chemotherapy have improved survival. Among HER2-positive patients, adding pembrolizumab to trastuzumab and chemotherapy - in PDL1 CPS ≥1 cases - has become a new standard. A special mention must be made of MSI-H tumors, in which immunotherapy is highly effective, and adjuvant chemotherapy is not recommended according to current guidelines.

Immune checkpoint inhibitors (ICIs) have brought a major breakthrough in the treatment of malignant tumors. However, the use of ICIs has led to the emergence of new, previously unknown side effects in oncology. These agents disrupt immunological homeostasis and reduce T-cell tolerance, which can lead to the activation of autoreactive T-cells, causing various immune-related adverse events (irAEs). Side effects affecting endocrine organs develop relatively frequently with immunotherapy, affecting approximately 10% of patients. Any endocrine organ, or even several at the same time, can be damaged (autoimmune polyendocrine syndrome, APS). The most commonly affected organs are the thyroid and pituitary glands, but the adrenal glands, pancreas, and parathyroid glands can also be affected. The treatment of endocrine side effects differs fundamentally from that of other irAEs in three ways: highdose corticosteroid treatment is not required (except for hypophysitis causing visual complaints and thyrotoxic crisis); damage to endocrine organs is usually permanent, requiring lifelong hormone replacement; permanent discontinuation of ICI therapy is usually not necessary even in severe cases, as it is of no benefit due to the already established irreversible damage. Our aim is to review endocrine adverse events caused by ICIs, their symptoms, diagnosis, and provide guidance on the management of these adverse events.

The advent of immune checkpoint inhibitors has brought a major breakthrough in the treatment of solid tumors, particularly in non-small cell lung cancer, melanoma, renal cell carcinoma, and bladder cancer. However, the use of these agents has also been associated with the emergence of a new type of side effect profile, among which pulmonary complications are of outstanding importance. The most frequent and severe of these is immune-related pneumonitis, a potentially life-threatening condition. Clinical symptoms are often nonspecific and may mimic other respiratory or infectious diseases, posing a diagnostic challenge in daily practice. Rapid recognition, careful differential diagnosis, and appropriate management are crucial for treatment continuity and patient safety. The aim of this article is to provide a comprehensive overview of pulmonary immune-related adverse events, to present their clinical and radiological characteristics, and to review current treatment recommendations.

Aim: To review the development of immunotherapy (IO) for urological cancers (urothelial carcinoma - UC, renal cell carcinoma - RCC, prostate cancer - PCa , testicular germ cell tumors - TGCT) with a focus on the latest studies, combination strategies, and the messages of the 2025 guidelines.

Methods: Review of randomized phase II-III studies published in 2024-2025, international guidelines, and biomarker- guided approaches.

Results: In UC, the combination of enfortumab vedotin and pembrolizumab has been a breakthrough and has become the new first-line standard, while maintenance and adjuvant immunotherapies have also been strengthened. In RCC, IO- TKI and IO-IO combinations show long-term survival benefits, but the IO-after-IO strategy has proven questionable. In PCa, the efficacy of immunotherapy is mainly limited to biomarker-driven subgroups (MSI-H/dMMR), while in TGCT, cisplatin-based treatment remains the standard, and the role of IOs is being evaluated in further studies.

Conclusions: By 2025, immunotherapy has become the therapeutic basis for UC and RCC, both in metastatic and curative treatments. In PCa and TGCT, immunotherapy options remain in the experimental phase, but research is ongoing with new combinations and biomarker-driven strategies.

Breast cancer is the most common malignancy in women worldwide, with triple-negative breast cancer (TNBC) posing the greatest therapeutic challenge due to limited treatment options and high recurrence rates. Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has redefined management in TNBC, with pembrolizumab now a standard of care in both early-stage and metastatic settings. Emerging strategies, including cancer vaccines, adoptive cellular therapies, and combination immunotherapies are under investigation, and yet to demonstrate clinical benefit. Key unmet needs include biomarker development for better patient selection and prediction of risk for immune related adverse events, as well as rapid diagnosis, and management of immune-related toxicities. Despite these challenges, immunotherapy offers transformative potential to improve outcomes in breast cancer.

Immune-related dermatologic side effects are among the most common and often the earliest toxicities of immunotherapies. Clinically, they cover a wide spectrum, ranging from mild skin symptoms to severe, life-threatening conditions. Most cases can be well managed with early recognition and personalized treatment. The dermatologist plays a key role in rapid diagnosis, therapeutic decision-making, and multidisciplinary oncological collaboration. The goal of supportive oncodermatology is, in addition to controlling side effects, to ensure the continuation of immunotherapy and to preserve the patient's quality of life.

In the case of non-small cell lung cancer, systemic treatment plays a key role in early, locally advanced as well as metastatic stages. The neoadjuvant approach is represented by the combination of immunotherapy+chemotherapy, while targeted therapy does not yet have an evidence-based place in this indication. Immune checkpoint inhibitor treatment has an important role in clinical practice in adjuvant setting as well. Several trials have also concluded with positive results regarding perioperative immunotherapy. Currently, the role of the multidisciplinary tumor board in the personalized decision-making process is essential. In locally advanced cases, immunotherapy after radiochemotherapy is also evidence-based. In advanced, non oncogene-addicted non-small cell lung cancer, the place of immunotherapy is well defined, both as monotherapy and in combination with chemotherapy. Progress has also been made in small cell lung cancer, both in extensive and limited stages, with immune checkpoint inhibitor treatment.

Skin cancers are the most commonly diagnosed malignancies worldwide; however, effective treatment of advanced tumors was unavailable until recent years. In the past decade, the introduction of immune checkpoint inhibitors (ICIs), targeting CTLA-4, PD-1, PD-L1 and recently LAG-3, has revolutionized therapeutic strategies for advanced skin cancers and improved survival outcomes. In this review, we present the current therapeutic opportunities and future directions of immunotherapy in the management of malignant melanoma, cutaneous squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma, accompanied by a brief overview of their mechanisms of action. Ambrus L, Balatoni T. Immunotherapy of cutaneous neoplasms.