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29 juni 2015: Bron: J Transl Med. 2011; 9: 17. Published online 2011 Jan 27. doi: 10.1186/1479-5876-9-17

Immuuntherapie geeft bij darmkanker met minimale ziekte - weinig zichtbare tumoren - uitstekende resultaten op ziektevrije tijd, kans op recidief en overall overleving. Dit geldt voor zowel darmkanker stadium I, II, en III waarbij debulking of andere behandeling die tumoren in aantal en omvang deed afnemen werd toegepast. In vergelijking met controlegroepen die geen immuuntherapie werd aangeboden waren de verschillen statistisch significant. Voor gevorderde damkanker stadium IV was er een iets beter resultaat maar veel minder dan voor de andere stadia met minimale ziekte. Dit blijkt uit een grote review studie van totaal 49 studies uitgevoerd in een periode van 12 jaar (1998 t/m 2010). Algemeen blijkt het overall resultaat nog altijd tussen de 22% en 31% te bedragen in gevorderde darmkanker, zie deze grafiek

Bovenstaande zijn de meest gebruikte vormen van immuuntherapie

Dat immuuntherapie het beste werkt bij minimale ziekte, weinig tumoren in het lichaam, of na debulking operatie of na eerdere andere behandelingen of al in beginstadium van de ziekte is in feite algemeen bekend. Maar studies worden nog bijna altijd alleen gedaan bij mensen met vergevorderde ziekte na falen van vele andere behandelingen. En waarbij dan weer DNA mutaties ontstaan die minder gevoelig lijken voor immuuntherapie. En niet opbelangrijk: daarvoor dan hele dure personalised medicine worden ingezet zonder debulking vooraf.

Ik weet dat voor darmkankerpatienten die succesvol geopereerd zijn zelden of nooit immuuntherapie, met bv. autovaccinatie, zie in gerelateerde artikelen, wordt aangeboden, terwijl studies hebben uitgewezen dat autovaccinatie superieure resultaten laat zien in vergelijking met eerstelijns standaard behandelingen na operatie met chemo combinaties. En nog een groot voordeel, immuuntherapie laat zelden enstige bijwerkingen zien, zeker niet bij minimale ziekte.

Bij patiënten met darmkanker in stadium II en III met, al of neit debulking, een minimale ziekte verdubbelde de ziektevrije tijd met ASI, zie deze grafiek.

Zo laat nu dus ook deze reviewstudie in alle resultaten zien dat ASI - actieve specifieke immuuntherapie in feite eerste keus zou moeten zijn, zeker bij darmkanker met minimale ziekte:

Resultaten:
1375 patiënten met vormen van darmkanker, waaronder ook endeldarmkanker, met minimale ziekte (weinig tot geen zichtbare tumoren) werden geëvalueerd in een meta-analyse:

een algemeen statistisch significante overall overleving en ziektevrije tijd werd gevonden voor ASI - actieve specifieke vorm van immuuntherapie (voor OS - overall overleving: HR = 0.76, P = 0.007; voor DFS - ziektevrije tijd: HR = 0.76, P = 0.03).
Voor ASI in stadium II met veronderstelde minimale ziekte, OS bereikte statistische significante verschillen met de controlegroepen (HR = 0.71, P = 0.09);
het verschil in ziektevrije tijd voor ASI voor stadium II met veronderstelde minimale ziekte bereikte statistische significantie (HR = 0.66, P = 0.02).
Voor ASI bij darmkanker stadium III met na bv. debulking veronderstelde minimale ziekte bereikte statistische significantie voor zowel OS en DFS - ziektevrije tijd (Voor OS: HR = 0.76, P = 0.02; Voor DFS: HR = 0.81, P = 0.03).
656 patiënten met vergevorderde darmkanker stadium werden ook geanalyseerd in een meta-analyse. 11 complete remissies en partiële remissies werden gezien wat betekent een overall gemeten response van 1,68%.
Er werden overall bij alle 2031 deelnemende patiënten geen ernstige bijwerkingen gemeld gerelateerd aan de vormen van immuuntherapie die waren toegepast.

Conclusies:

De onderzoekers stellen dan ook dat ASI - actieve specifieke vorm van immuuntherapie waarschijnlijk geen standaardbehandeling kan worden voor darmkanker in stadium IV met vergevorderde ziekte. Echter de resultaten geven ook aan dat ASI - actieve specifieke vorm van immuuntherapie voor darmkanker in stadia I, II, en III hoopgevend zijn en het is duidelijk dat immuuntherapie het beste werkt bij darmkankerpatiënten met minimale ziekte, weinig tot geen zichtbare tumoren.

Reden te meer om dit rapport eens mee te nemen naar uw behandelend arts of hem/haar toe te sturen. Zefls als u op dit moment veel uitzaaiingen hebt. Met debulking technieken kan tegenwoordig aardig wat worden weggehaald en misschien heeft dan een ASI - actieve specifieke vorm van immuuntherapie nog steeds zin? Voor mensen met nieuwe diagnose van bv. operabele darmkanker en nog weinig zichtbare tumoren of aantoonbaar geen uitzaaiingen heeft een gesprek hierover zeker zin lijkt mij.

In het studierapport: Clinical outcomes of active specific immunotherapy in advanced colorectal cancer and suspected minimal residual colorectal cancer: a meta-analysis and system review dat gratis is in te zien staan heel veel meer gegevens met mooie grafieken enz.

Hier het abstract van de studie.

This Meta-analysis and System Review clearly supports the idea that a statistically significantly improved DFS or OS was shown in all stage suspected minimal residual CRC patients. Meanwhile, there was also a clear indication that the objective clinical outcome of ASI in advanced CRC was only 1.6%. The results showed it is unlikely that ASI will provide a standard complementary therapeutic approach for advanced CRC in the near future. However, it has become clear that immunotherapy works best in situations of patients with suspected minimal residual CRC

J Transl Med. 2011; 9: 17.

Published online 2011 Jan 27. doi: 10.1186/1479-5876-9-17

PMCID: PMC3041676

Clinical outcomes of active specific immunotherapy in advanced colorectal cancer and suspected minimal residual colorectal cancer: a meta-analysis and system review

Benqiang Rao,^1,⁴ Minyan Han,² Lei Wang,^1,⁴ Xiaoyan Gao,³ Jun Huang,¹ Meijin Huang,¹ Huanliang Liu,⁴ and Jianping Wang^1,⁴

Author information ► Article notes ► Copyright and License information ►

Abstract

Background

To evaluate the objective clinical outcomes of active specific immunotherapy (ASI) in advanced colorectal cancer (advanced CRC) and suspected minimal residual colorectal cancer (suspected minimal residual CRC).

Methods

A search was conducted on Medline and Pub Med from January 1998 to January 2010 for original studies on ASI in colorectal cancer (CRC). All articles included in this study were assessed with the application of predetermined selection criteria and were divided into two groups: ASI in advanced CRC and ASI in suspected minimal residual CRC. For ASI in suspected minimal residual CRC, a meta-analysis was executed with results regarding the overall survival (OS) and disease-free survival (DFS). Regarding ASI in advanced colorectal cancer, a system review was performed with clinical outcomes.

Results

1375 colorectal carcinoma patients with minimal residual disease have been enrolled in Meta-analysis. A significantly improved OS and DFS was noted for suspected minimal residual CRC patients utilizing ASI (For OS: HR = 0.76, P = 0.007; For DFS: HR = 0.76, P = 0.03). For ASI in stage II suspected minimal residual CRC, OS approached significance when compared with control (HR = 0.71, P = 0.09); however, the difference in DFS of ASI for the stage II suspected minimal residual CRC reached statistical significance (HR = 0.66, P = 0.02). For ASI in stage III suspected minimal residual CRC compared with control, The difference in both OS and DFS achieved statistical significance (For OS: HR = 0.76, P = 0.02; For DFS: HR = 0.81, P = 0.03). 656 advanced colorectal patients have been evaluated on ASI in advanced CRC. Eleven for CRs and PRs was reported, corresponding to an overall response rate of 1.68%. No serious adverse events have been observed in 2031 patients.

Conclusions

It is unlikely that ASI will provide a standard complementary therapeutic approach for advanced CRC in the near future. However, the clinical responses to ASI in patients with suspected minimal residual CRC have been encouraging, and it has become clear that immunotherapy works best in situations of patients with suspected minimal residual CRC.

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