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胶质母细胞瘤中的免疫检查点与创新疗法

Immune Checkpoints and Innovative Therapies in Glioblastoma.

作者信息

Romani Massimo, Pistillo Maria Pia, Carosio Roberta, Morabito Anna, Banelli Barbara

机构信息

Laboratory of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Department of Health Sciences, University of Genova, Genova, Italy.

出版信息

Front Oncol. 2018 Oct 23;8:464. doi: 10.3389/fonc.2018.00464. eCollection 2018.

Abstract

Targeting the Immune Checkpoint molecules (ICs; CTLA-4, PD-1, PD-L1/2, and others) which provide inhibitory signals to T cells, dramatically improves survival in hard-to-treat tumors. The establishment of an immunosuppressive environment prevents endogenous immune response in glioblastoma; therefore, manipulating the host immune system seems a reasonable strategy also for this tumor. In glioma patients the accumulation of CD4/CD8 T cells and Treg expressing high levels of CTLA-4 and PD-1, or the high expression of PD-L1 in glioma cells correlates with WHO high grade and short survival. Few clinical studies with IC inhibitors (ICis) were completed so far. Notably, the first large-scale randomized trial (NCT 02017717) that compared PD-1 blockade and anti-VEGF, did not show an OS increase in the patients treated with anti-PD-1. Several factors could have contributed to the failure of this trial and must be considered to design further clinical studies. In particular the possibility of targeting at the same time different ICs was pre-clinically tested in an animal model were inhibitors against IDO, CTLA-4 and PD-L1 were combined and showed persistent and significant antitumor effects in glioma-bearing mice. It is reasonable to hypothesize that the immunological characterization of the tumor in terms of type and level of expressed IC molecules on the tumor and TIL may be useful to design the optimal ICi combination for a given subset of tumor to overcome the immunosuppressive milieu of glioblastoma and to efficiently target a tumor with such high cellular complexity.

摘要

靶向免疫检查点分子(ICs;CTLA-4、PD-1、PD-L1/2等),这些分子会向T细胞提供抑制信号,可显著提高难治性肿瘤患者的生存率。免疫抑制环境的形成会阻止胶质母细胞瘤的内源性免疫反应;因此,操纵宿主免疫系统似乎也是针对这种肿瘤的合理策略。在胶质瘤患者中,表达高水平CTLA-4和PD-1的CD4/CD8 T细胞和调节性T细胞(Treg)的积累,或胶质瘤细胞中PD-L1的高表达与世界卫生组织(WHO)高级别和生存期短相关。到目前为止,很少有关于IC抑制剂(ICis)的临床研究完成。值得注意的是,第一项比较PD-1阻断和抗血管内皮生长因子(VEGF)的大规模随机试验(NCT 02017717)并未显示接受抗PD-1治疗的患者总生存期(OS)增加。该试验失败可能有多种因素,在设计进一步的临床研究时必须加以考虑。特别是,在动物模型中对同时靶向不同ICs的可能性进行了临床前测试,在该模型中,将针对吲哚胺2,3-双加氧酶(IDO)、CTLA-4和PD-L1的抑制剂联合使用,在荷胶质瘤小鼠中显示出持续且显著的抗肿瘤作用。有理由推测,根据肿瘤和肿瘤浸润淋巴细胞(TIL)上表达的IC分子的类型和水平对肿瘤进行免疫特征分析,可能有助于为特定肿瘤亚群设计最佳的ICi组合,以克服胶质母细胞瘤的免疫抑制环境,并有效靶向具有如此高细胞复杂性的肿瘤。

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