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<p>The incidence of neuroendocrine neoplasms (NEN) is increasing overall. Homogenization in pathological characterization and improved diagnostics for local and distant disease have contributed to this development. While we have some established therapeutic approaches for neuroendocrine tumors (NET; G1–G3) and the spectrum will expand in the future, there is a&#xa0;lack of promising options for neuroendocrine carcinomas (NEC;&#xa0;G3) in addition to classic chemotherapy. The identification of new therapeutic strategies, such as the evaluation of immunotherapy in various approaches, could be decisive. Current data on immune checkpoint inhibition (ICI) as monotherapy are disappointing. In unselected patients, only low efficacy has been shown. Although combination therapies of ICI with CTLA‑4 inhibitor or chemotherapy are potentially more effective than single agents, no therapeutic approach of standard chemotherapy has so far proven to be more effective. Other new treatment strategies include bispecific antibodies and cell therapy. However, specific biomarkers are lacking for all immunologically-triggered therapeutic approaches. Only for the rarely detected microsatellite instability (MSI-high) is immunotherapy an essential early treatment. Further studies with broad molecular profiling are required to establish predictive signatures for immunotherapies. In addition, the evaluation of new ICI combinations with targeted therapies appears to be necessary.</p>

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Immuntherapie bei neuroendokrinen Neoplasien des Gastrointestinaltrakts

  • 期刊论文

  • 发表日期：

    2025年5月22日

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  • Sebastian Krug,
  • Leonidas Apostolidis

摘要

The incidence of neuroendocrine neoplasms (NEN) is increasing overall. Homogenization in pathological characterization and improved diagnostics for local and distant disease have contributed to this development. While we have some established therapeutic approaches for neuroendocrine tumors (NET; G1–G3) and the spectrum will expand in the future, there is a lack of promising options for neuroendocrine carcinomas (NEC; G3) in addition to classic chemotherapy. The identification of new therapeutic strategies, such as the evaluation of immunotherapy in various approaches, could be decisive. Current data on immune checkpoint inhibition (ICI) as monotherapy are disappointing. In unselected patients, only low efficacy has been shown. Although combination therapies of ICI with CTLA‑4 inhibitor or chemotherapy are potentially more effective than single agents, no therapeutic approach of standard chemotherapy has so far proven to be more effective. Other new treatment strategies include bispecific antibodies and cell therapy. However, specific biomarkers are lacking for all immunologically-triggered therapeutic approaches. Only for the rarely detected microsatellite instability (MSI-high) is immunotherapy an essential early treatment. Further studies with broad molecular profiling are required to establish predictive signatures for immunotherapies. In addition, the evaluation of new ICI combinations with targeted therapies appears to be necessary.