Onkológia 1/2023

Gastrointestinal malignancies – current position of imunotherapy

Gastrointestinal cancers (including colorectal cancer, stomach cancer and liver cancer) are the most common cause of cancer mortality worldwide with significant associated morbidity. If managed as early stages, radical approaches can lead to better outcomes, contrasted with less than 15% survival rates in advanced stage disease, in long-term follow up. Palliative treatment with chemotherapy, biological treatment, or combination of both, provides limited progression-free survival and overall survival prolongation. Immune system plays a crucial role in cancer development and progression. Immunotherapy has revolutionized cancer treatment due to its ability to produce durable responses in patients with certain types of advanced cancer. Till 2022, FDA approved more than 200 indications for immunotherapy administration. Majority of them were monoclonal antibodies blocking PD-1, PD-L1 or CTLA-4. Results of clinical trials, published in last 5 years, have completely changed ESMO guidelines of systemic therapy in the majority of gastrointestinal cancers. Choosing the right intent to treat population, using novel predictive markers such as TPS, CPS or MSI-high/dMMR, will result in significant prolongation of both progression-free and overall survival and improvement of objective response rate. The aim of this article is to provide the review of published trials, that have changed recent guidelines of gastrointestinal malignancies published by ESMO

Keywords: immunotherapy, gastrointestinal cancer, predictive factor, systemic therapy