Foller S, Oppel-Heuchel H, Grimm M-O
Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Urologe A. 2018 Nov;57(11):1316-1325. doi: 10.1007/s00120-018-0788-y.
In contrast to chemotherapy, treatment with immune checkpoint inhibitors occasionally results in an unconventional pattern of response. Besides an early partial or complete response or tumor progression, a so-called pseudoprogression, a "mixed response" or late responses can also be observed. Treatment beyond radiographically defined progression may therefore be appropriate in selected cases. For these treatment decisions, the clinical evaluation of the patient (performance status, symptoms, etc.), the "dynamics" of the underlying malignancy, and the availability of other treatment options are of paramount importance. However, the time to initiate another treatment should not be missed by rapid progression. In PD-1 (programmed cell death protein 1) immune checkpoint inhibition in urothelial cancer after platinum-based chemotherapy, response or progression can be observed early at week 8 in the vast majority of the cases. In contrast, in second-line treatment of renal cell carcinoma around 25% of responses are seen late, at week 24 or later (occasionally after 1 year). Therefore, immune checkpoint inhibition should be continued for stable disease. At present, it remains unclear how long to continue therapy in cases with partial or complete remission.
与化疗不同，使用免疫检查点抑制剂进行治疗偶尔会产生一种非常规的反应模式。除了早期部分或完全缓解或肿瘤进展外，还可观察到所谓的假性进展、“混合反应”或晚期反应。因此，在某些选定的病例中，超越影像学定义的进展进行治疗可能是合适的。对于这些治疗决策，患者的临床评估（体能状态、症状等）、潜在恶性肿瘤的“动态变化”以及其他治疗选择的可用性至关重要。然而，不应因快速进展而错过启动另一种治疗的时机。在铂类化疗后的尿路上皮癌中进行PD-1（程序性细胞死亡蛋白1）免疫检查点抑制时，绝大多数病例在第8周时可早期观察到反应或进展。相比之下，在肾细胞癌的二线治疗中，约25%的反应出现较晚，在第24周或更晚（偶尔在1年后）。因此，对于病情稳定的患者，应继续进行免疫检查点抑制治疗。目前，对于部分或完全缓解的病例，尚不清楚应持续治疗多长时间。
