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非小细胞肺癌中的免疫疗法:一种充满希望且具有革命性的武器。

Immunotherapy in NSCLC: A Promising and Revolutionary Weapon.

作者信息

Rolfo Christian, Caglevic Christian, Santarpia Mariacarmela, Araujo Antonio, Giovannetti Elisa, Gallardo Carolina Diaz, Pauwels Patrick, Mahave Mauricio

机构信息

Phase I-Early Clinical Trials Unit, Oncology Department, University Hospital Antwerp, Edegem, Belgium.

Center or Oncological Research (CORE), Antwerp University, Antwerp, Belgium.

出版信息

Adv Exp Med Biol. 2017;995:97-125. doi: 10.1007/978-3-319-53156-4_5.

Abstract

Lung cancer is the leader malignancy worldwide accounting 1.5 millions of deaths every year. In the United States the 5 year-overall survival is less than 20% for all the newly diagnosed patients. Cisplatin-based cytotoxic chemotherapy for unresectable or metastatic NSCLC patients in the first line of treatment, and docetaxel in the second line, have achieved positive results but with limited benefit in overall survival. Targeted therapies for EGFR and ALK mutant patients have showed better results when compared with chemotherapy, nevertheless most of patients will fail and need to be treated with chemotherapy if they still have a good performance status.Immunotherapy recently has become the most revolutionary treatment in solid tumors patients. First results in unresectable and metastatic melanoma patients treated with an anti CTLA-4 monoclonal antibody showed an unexpected 3-year overall survival of at least 25%.Lung cancer cells have multiple immunosuppressive mechanisms that allow to escape of the immune system and survive, however blocking CTLA-4 pathway with antibodies as monotherapy treatment have not achieved same results than in melanoma patients. PD-1 expression has been demonstrated in different tumor types, suggesting than PD-1 / PD-L1 pathway is a common mechanism used by tumors to avoid immune surveillance and favoring tumor growth. Anti PD-1 and anti PD-L1 antibodies have showed activity in non-small cell lung cancer patients with significant benefit in overall survival, long lasting responses and good safety profile, including naïve and pretreated patients regardless of the histological subtype. Even more, PD-1 negative expression patients achieve similar results in overall survival when compared with patients treated with chemotherapy. In the other side high PD-1 expression patients that undergo immunotherapy treatment achieve better results in terms of survival with lesser toxicity. Combining different immunotherapy treatments, combination of immunotherapy with chemotherapy or with targeted treatment are under research with some promising PRELIMINARY results in non-small cell lung cancer patients.This chapter attempts to summarize the development of immunotherapy treatment in non-small cell lung cancer patients and explain the results that have leaded immunotherapy as a new standard of treatment in selected NSCLC patients.

摘要

肺癌是全球首要的恶性肿瘤,每年导致150万人死亡。在美国,所有新诊断患者的5年总生存率低于20%。以顺铂为基础的细胞毒性化疗用于一线治疗不可切除或转移性非小细胞肺癌患者,多西他赛用于二线治疗,已取得积极效果,但对总生存率的益处有限。与化疗相比,针对表皮生长因子受体(EGFR)和间变性淋巴瘤激酶(ALK)突变患者的靶向治疗显示出更好的效果,然而,大多数患者仍会治疗失败,若其身体状况仍良好,则需要接受化疗。免疫疗法最近已成为实体瘤患者最具革命性的治疗方法。用抗细胞毒性T淋巴细胞相关蛋白4(CTLA-4)单克隆抗体治疗不可切除和转移性黑色素瘤患者的初步结果显示,其3年总生存率出人意料地至少达到25%。肺癌细胞具有多种免疫抑制机制,使其能够逃避免疫系统并存活,然而,用抗体单药治疗阻断CTLA-4途径并未取得与黑色素瘤患者相同的效果。程序性死亡受体1(PD-1)表达已在不同肿瘤类型中得到证实,这表明PD-1/程序性死亡受体配体1(PD-L1)途径是肿瘤用于逃避免疫监视并促进肿瘤生长的常见机制。抗PD-1和抗PD-L1抗体在非小细胞肺癌患者中显示出活性,对总生存率有显著益处,反应持久且安全性良好,包括初治和经治患者,无论组织学亚型如何。甚至,与接受化疗的患者相比,PD-1阴性表达患者在总生存率方面取得了相似的结果。另一方面,接受免疫治疗的高PD-1表达患者在生存率方面取得了更好的效果,且毒性较小。将不同的免疫治疗方法联合使用,免疫治疗与化疗或靶向治疗联合使用正在研究中,在非小细胞肺癌患者中取得了一些有前景的初步结果。本章试图总结非小细胞肺癌患者免疫治疗的发展,并解释使免疫治疗成为部分非小细胞肺癌患者新治疗标准的结果。

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