Domagała-Kulawik Joanna
1Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland, Banacha 1a, 02-097 Warszawa, Poland.
Adv Respir Med. 2018;86(3). doi: 10.5603/ARM.2018.0022.
Immunotherapy with immune checkpoint inhibitors (ICIs) revolutionized therapy of solid tumors, among them- lung cancer. PD-1, PD-L1 blockers have been shown to improve overall survival in advanced, metastatic non-small cell lung cancer. In individual patients, 3-5-year survival has been achieved. Nivolumab, pembrolizumab, atezolizumab are approved in lung cancer treatment. Practical observations in reallife show that the results are comparable with those achieved in clinical trials. The effects of ICIs depend on the patient performance status; age, sex, histology; the presence of brain metastases have not modified treatment results. ICIs therapy is safe and well tolerated; immune related adverse events are observed. Pneumonitis may be a serious and fatal complication, but glucocorticoids are usually curative. For proper patients selection for ICIs treatment, the detection of PD-L1 expression on cancer cells is used. The so-called "hot" tumors with high expression of PD-L1 and abundant infiltration by cytotoxic cells seem to better respond to treatment than "cold" tumors.
使用免疫检查点抑制剂（ICI）进行免疫治疗彻底改变了实体瘤的治疗方式，肺癌也在其中。PD-1、PD-L1阻断剂已被证明可提高晚期转移性非小细胞肺癌的总生存率。在个别患者中，已实现3至5年的生存期。纳武单抗、帕博利珠单抗、阿特珠单抗已获批用于肺癌治疗。现实生活中的实际观察表明，结果与临床试验结果相当。ICI的疗效取决于患者的体能状态、年龄、性别、组织学类型；脑转移的存在并未改变治疗结果。ICI治疗安全且耐受性良好；会观察到免疫相关不良事件。肺炎可能是一种严重且致命的并发症，但糖皮质激素通常可治愈。为了正确选择适合ICI治疗的患者，会检测癌细胞上PD-L1的表达。与“冷”肿瘤相比，具有高PD-L1表达且有丰富细胞毒性细胞浸润的所谓“热”肿瘤似乎对治疗反应更好。
