Samson Pamela, Lockhart A Craig
Division of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Division of Oncology, Washington University in St. Louis, St. Louis, MO, USA.
J Gastrointest Oncol. 2017 Jun;8(3):418-429. doi: 10.21037/jgo.2016.11.13.
Biologic agents, including targeted antibodies as well as immunomodulators, are demonstrating unparalleled development and study across the entire spectrum of human malignancy. This review summarizes the current state of biologic therapies for esophageal, esophagogastric, and gastric malignancies, including those that target human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), c-Met, mechanistic target of rapamycin (mTOR) and immunomodulators. We focus primarily on agents that have been included in phase II and III clinical trials in locally advanced, progressive, or metastatic esophageal and gastric malignancies. At this time, only two biologic therapies are recommended by the National Comprehensive Cancer Network (NCCN): trastuzumab for patients with esophageal/esophagogastric or gastric adenocarcinomas with HER2 overexpression and ramucirumab, a VEGFR-2 inhibitor, as a second-line therapy for metastatic disease. However, recent reports of increases in overall and progression-free survival for agents including pertuzumab, apatinib, and pembrolizumab will likely increase the use of targeted biologic therapy in clinical practice for esophageal and gastric malignancies.
生物制剂，包括靶向抗体以及免疫调节剂，在人类恶性肿瘤的整个领域都展现出了无与伦比的发展和研究态势。本综述总结了食管、食管胃交界和胃恶性肿瘤生物治疗的现状，包括那些靶向人类表皮生长因子受体2（HER2）、表皮生长因子受体（EGFR）、血管内皮生长因子（VEGF）、c-Met、雷帕霉素靶蛋白（mTOR）的生物制剂以及免疫调节剂。我们主要关注已纳入局部晚期、进展期或转移性食管和胃恶性肿瘤II期和III期临床试验的药物。目前，美国国立综合癌症网络（NCCN）仅推荐两种生物治疗方法：曲妥珠单抗用于HER2过表达的食管/食管胃交界或胃腺癌患者，以及雷莫西尤单抗（一种VEGFR-2抑制剂）作为转移性疾病的二线治疗。然而，近期关于帕妥珠单抗、阿帕替尼和派姆单抗等药物总生存期和无进展生存期增加的报道，可能会增加靶向生物治疗在食管和胃恶性肿瘤临床实践中的应用。
