Merryman Reid W, Armand Philippe, Wright Kyle T, Rodig Scott J
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and.
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
Blood Adv. 2017 Dec 12;1(26):2643-2654. doi: 10.1182/bloodadvances.2017012534.
Classical Hodgkin lymphoma (cHL) is characterized by nearly universal genetic alterations in 9p24.1, resulting in constitutive expression of PD-1 ligands. This likely underlies the unique sensitivity of cHL to PD-1 blockade, with response rates of ∼70% in relapsed/refractory disease. There are now numerous clinical trials testing PD-1 inhibitors in earlier stages of treatment and in combination with many other therapies. In general, non-Hodgkin lymphomas (NHLs) do not display a high frequency of 9p24.1 alterations and do not share cHL's vulnerability to PD-1 blockade. However, a few entities have genetic or immunologic features that may predict sensitivity to immune checkpoint blockade. These include primary mediastinal B cell lymphoma, primary central nervous system lymphoma, and primary testicular lymphoma, which harbor frequent alterations in 9p24.1, as well as Epstein Barr virus (EBV)-infected lymphomas, where EBV infection leads to increased PD-L1 expression. Although these subtypes may be specifically vulnerable to PD-1 blockade, the majority of NHLs appear to be minimally sensitive to PD-1 blockade monotherapy. Current investigations in NHL are therefore focusing on targeting other checkpoints or studying PD-1-based combination therapy. Looking forward, additional insight into the most common mechanisms of resistance to immune checkpoint inhibitors will be important to guide rational clinical trial design. In this review, we describe the biological basis for checkpoint blockade in cHL and NHL and summarize the clinical data generated to date. Guided by our rapidly evolving understanding of the pathobiology of various lymphoma subtypes, we are hopeful that the role of checkpoint inhibitors in lymphoma treatment will continue to grow.
经典型霍奇金淋巴瘤(cHL)的特征是9p24.1几乎普遍存在基因改变,导致程序性死亡受体1(PD-1)配体的组成性表达。这可能是cHL对PD-1阻断具有独特敏感性的基础,复发/难治性疾病的缓解率约为70%。目前有许多临床试验正在测试PD-1抑制剂在治疗早期阶段以及与许多其他疗法联合使用的效果。一般来说,非霍奇金淋巴瘤(NHL)9p24.1改变的频率不高,也不具有cHL对PD-1阻断的易感性。然而,一些实体具有可能预测对免疫检查点阻断敏感性的遗传或免疫特征。这些包括原发性纵隔B细胞淋巴瘤、原发性中枢神经系统淋巴瘤和原发性睾丸淋巴瘤,它们在9p24.1中频繁发生改变,以及爱泼斯坦-巴尔病毒(EBV)感染的淋巴瘤,其中EBV感染导致PD-L1表达增加。尽管这些亚型可能对PD-1阻断特别敏感,但大多数NHL似乎对PD-1阻断单一疗法的敏感性最低。因此,目前对NHL的研究集中在靶向其他检查点或研究基于PD-1的联合疗法。展望未来,进一步了解免疫检查点抑制剂最常见的耐药机制对于指导合理的临床试验设计将非常重要。在这篇综述中,我们描述了cHL和NHL中检查点阻断的生物学基础,并总结了迄今为止产生的临床数据。在我们对各种淋巴瘤亚型病理生物学的快速发展的理解的指导下,我们希望检查点抑制剂在淋巴瘤治疗中的作用将继续扩大。