Zusammenfassung
Hintergrund: Das Auftreten von Autoimmunreaktionen bei Tumorpatienten scheint mit einer besseren
Prognose assoziiert zu sein. Ziel dieser retrospektiven Datenanalyse war die Erfassung
von Autoimmunreaktionen unter Therapie mit pegyliertem Interferon-alpha-2b und die
Untersuchung einer Korrelation zwischen Autoimmuninduktion und Überlebenszeit.
Patienten und Methodik: Hierzu wurden bei 25 Patienten mit histologisch nachgewiesenem malignem Melanom im
R0-resezierten Stadium Ib-IV vor Therapiebeginn sowie alle drei Monate während einer
18-monatigen adjuvanten Therapie mit 2 µg/kg pegyliertem Interferon-alpha-2b pro Woche
klinische und serologische Parameter zur Detektierung einer Autoimmunerkrankung erhoben.
Ergebnisse: Unter Therapie entwickelten 16 von 25 Patienten (64 %) Autoantikörper. Die Überlebenszeiten
der Patienten mit nachweislich neuen Autoantikörpern und solche ohne Entwicklung von
Autoantikörpern unterschieden sich nur unwesentlich voneinander (31,6 versus 31,9
Monate). Alle 6 Patienten, die unter Interferontherapie eine klinisch manifeste Autoimmunthyreoiditis
und/oder spezifische antinukleäre Antikörper entwickelten, waren jedoch 36 Monate
nach Beginn der Therapie noch am Leben, davon zwei Patienten in kompletter Remission
im Stadium IV. Verglichen hierzu lag die mittlere Überlebenszeit in der AK-positiven
physiologisch irrelevanten Restgruppe bei 26,73 Monaten (n = 10/16).
Schlussfolgerung: Die Anzahl unserer Patienten, die eine Autoimmunreaktion unter pegyliertem Interferon-alpha-2b
entwickelten, ist verglichen mit publizierten Daten zum nicht pegylierten Interferon-alpha
deutlich höher. Die Relevanz spezifischer Autoimmunreaktionen als prognostischer Marker
einer krankheitskontrollierenden antitumorösen Immunantwort bleibt zu beweisen.
Abstract
Background: The appearance of autoimmunity in tumor patients seems to be associated with a better
prognosis. The aim of this retrospective study was to detect autoimmunity under adjuvant
treatment with pegylated interferon-alpha-2b and to determine a correlation between
autoimmune induction and survival.
Patients and Methods: To detect autoimmunity clinical and serological parameters were examined in 25 patients
with R0-resected histological proven stage Ib-IV melanoma before and every three months
during an 18-month adjuvant treatment with 2 µg/kg pegylated interferon-alpha-2b given
once a week.
Results: Under treatment 16 of 25 patients (64 %) developed autoantibodies. There was no significant
difference regarding survival data in patients with or without induction of autoantibodies
(31,6 versus 31,9 months). However, it is remarkable that all 6 patients developing
a clinically significant autoimmune thyroiditis and/or specific antinuclear antibodies
were still alive 36 months after treatment beginning, with two of these patients being
in complete remission from stage IV melanoma, compared to a mean survival time of
26,73 months for the remaining patient group with physiological irrelevant positive
antibodies (n = 10/16).
Conclusions: In our cohort, the number of patients who developed autoimmunity under pegylated
interferon-alpha-2b is significantly higher as published data of non-pegylated interferon-alpha.
Nevertheless, the significance of specific autoimmune induction as a prognostic indicator
for a disease controlling antitumor immune response still needs to be confirmed.
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Dr. med. Carmen Loquai
Klinik und Poliklinik für Dermatologie
Universität Mainz
Langenbeckstr. 1
55131 Mainz
eMail: carmen.loquai@ukmainz.de