Nowakowski Grzegorz S, Ansell Stephen M
Mayo Clinic, Rochester, MN.
Hematology Am Soc Hematol Educ Program. 2014 Dec 5;2014(1):169-73. doi: 10.1182/asheducation-2014.1.169. Epub 2014 Nov 18.
Immune and nonimmune microenvironmental factors play a critical role in the progression, transformation, and resistance to therapy in follicular lymphoma (FL). A recent increase in our understanding of the role of microenvironment in FL biology has led to the development of novel therapeutic strategies targeting the nonimmune and immune microenvironment. These include immunomodulatory drugs, immune checkpoint inhibitors, immnunoconjugates, and small-molecule inhibitors with an impact on the microenvironment in addition to direct antitumor activity. These agents are now at different stages of clinical development, ranging from early clinical trials in relapsed disease to phase 3 studies in the upfront setting, including combinations with other agents such as monoclonal antibodies and chemotherapy. It is important to recognize that, although the current upfront therapy of FL is associated with favorable outcomes in the majority of patients, a significant proportion experience early disease progression and develop treatment resistance and transformation to aggressive lymphoma. Although the development of "chemo-free" combinations using drugs targeting the microenvironment offers a promising approach to minimize toxicity, the identification of patients at risk of relapse and the use of biomarkers allowing the personalization of therapy will likely play a major role in the development of maintenance strategies. Against this landscape of currently available therapy options, this chapter discusses the clinical status of therapies targeting the microenvironment in FL.
免疫和非免疫微环境因素在滤泡性淋巴瘤(FL)的进展、转化及治疗耐药中起着关键作用。最近,我们对微环境在FL生物学中的作用的理解有所增加,这促使了针对非免疫和免疫微环境的新型治疗策略的发展。这些策略包括免疫调节药物、免疫检查点抑制剂、免疫偶联物以及除了直接抗肿瘤活性外还对微环境有影响的小分子抑制剂。这些药物目前处于不同的临床开发阶段,从复发疾病的早期临床试验到一线治疗的3期研究,包括与单克隆抗体和化疗等其他药物联合使用。必须认识到,尽管目前FL的一线治疗在大多数患者中能带来良好的结果,但仍有相当一部分患者会出现疾病早期进展,并产生治疗耐药以及转化为侵袭性淋巴瘤。尽管使用针对微环境的药物开发“无化疗”联合方案为最小化毒性提供了一种有前景的方法,但识别复发风险患者以及使用能实现治疗个性化的生物标志物可能会在维持治疗策略的发展中发挥主要作用。在当前可用治疗方案的背景下,本章讨论了FL中针对微环境治疗的临床现状。