Wang Gary X, Guo Lan Qian, Gainor Justin F, Fintelmann Florian J
1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
2 Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada.
AJR Am J Roentgenol. 2017 Sep;209(3):567-575. doi: 10.2214/AJR.16.17770. Epub 2017 Jun 28.
The purpose of this article is to review the mechanisms of action of immune checkpoint inhibitors in the treatment of non-small cell lung cancer (NSCLC), highlight imaging manifestations of common adverse events, and discuss new criteria for using imaging to assess unique treatment response patterns.
Immune checkpoint inhibitor therapy is a breakthrough in cancer treatment that has shown unprecedented success when used for a variety of malignancies. In recent phase 3 clinical trials for NSCLC, monoclonal antibodies that target the programmed death-1 (PD-1) receptor and its ligand PD-L1 (i.e., the PD-1/PD-L1 axis) were associated with better overall survival in head-to-head comparisons with conventional cytotoxic chemotherapy. On the strength of the results of these trials, the PD-1 inhibitors nivolumab and pembrolizumab and the PD-L1 inhibitor atezolizumab recently received regulatory approval by the U.S. Food and Drug Administration for the treatment of advanced NSCLC. Because of their unique mechanisms of action, these agents differ from conventional cytotoxic chemotherapy in both patterns of treatment response and treatment-related adverse events. Given the rapidly expanding clinical use of immune checkpoint inhibitors and the central role of radiology in the care of patients with lung cancer, it is important for radiologists to be familiar with these agents and their unique imaging findings.
本文旨在综述免疫检查点抑制剂治疗非小细胞肺癌（NSCLC）的作用机制，强调常见不良事件的影像学表现，并讨论使用影像学评估独特治疗反应模式的新标准。
免疫检查点抑制剂疗法是癌症治疗的一项突破，在用于多种恶性肿瘤时已显示出前所未有的成功。在最近针对NSCLC的3期临床试验中，与传统细胞毒性化疗进行头对头比较时，靶向程序性死亡1（PD-1）受体及其配体PD-L1（即PD-1/PD-L1轴）的单克隆抗体与更好的总生存期相关。基于这些试验结果，PD-1抑制剂纳武单抗和派姆单抗以及PD-L1抑制剂阿特珠单抗最近获得了美国食品药品监督管理局的监管批准，用于治疗晚期NSCLC。由于其独特的作用机制，这些药物在治疗反应模式和治疗相关不良事件方面均与传统细胞毒性化疗不同。鉴于免疫检查点抑制剂的临床应用迅速扩大以及放射学在肺癌患者护理中的核心作用，放射科医生熟悉这些药物及其独特的影像学表现非常重要。
