Divisions of Pharmacology, Utrecht University, Utrecht, The Netherlands.
Medical Oncology and Molecular Oncology & Immunology, Utrecht University, Utrecht, The Netherlands.
Ann Oncol. 2019 Feb 1;30(2):219-235. doi: 10.1093/annonc/mdy551.
BACKGROUND: Cancer immunotherapy has changed the standard of care for a subgroup of patients with advanced disease. Immune checkpoint blockade (ICB) in particular has shown improved survival compared with previous standards of care for several tumor types. Although proven to be successful in more immunogenic tumors, ICB is still largely ineffective in patients with tumors that are not infiltrated by immune cells, the so-called cold tumors. PATIENTS AND METHODS: This review describes the effects of different chemotherapeutic agents on the immune system and the potential value of these different types of chemotherapy as combination partners with ICB in patients with solid tumors. Both preclinical data and currently ongoing clinical trials were evaluated. In addition, we reviewed findings regarding different dosing schedules, including the effects of an induction phase and applying metronomic doses of chemotherapy. RESULTS: Combining ICB with other treatment modalities may lead to improved immunological conditions in the tumor microenvironment and could thereby enhance the antitumor immune response, even in tumor types that are so far unresponsive to ICB monotherapy. Chemotherapy, that was originally thought to be solely immunosuppressive, can exert immunomodulatory effects which may be beneficial in combination with immunotherapy. Each chemotherapeutic drug impacts the tumor microenvironment differently, and in order to determine the most suitable combination partners for ICB it is crucial to understand these mechanisms. CONCLUSION: Preclinical studies demonstrate that the majority of chemotherapeutic drugs has been shown to exert immunostimulatory effects, either by inhibiting immunosuppressive cells and/or activating effector cells, or by increasing immunogenicity and increasing T-cell infiltration. However, for certain chemotherapeutic agents timing, dose and sequence of administration of chemotherapeutic agents and ICB is important. Further studies should focus on determining the optimal drug combinations, sequence effects and optimal concentration-time profiles in representative preclinical models.
背景:癌症免疫疗法改变了一部分晚期疾病患者的治疗标准。特别是免疫检查点阻断(ICB)与几种肿瘤类型的先前治疗标准相比,提高了生存率。尽管在更具免疫原性的肿瘤中被证明是成功的,但 ICB 在免疫细胞浸润不足的肿瘤患者中仍然基本上无效,即所谓的冷肿瘤。
患者和方法:本文综述了不同化疗药物对免疫系统的影响,以及这些不同类型的化疗作为联合治疗伙伴与免疫检查点抑制剂联合应用于实体瘤患者的潜在价值。评估了临床前数据和目前正在进行的临床试验。此外,我们还综述了不同剂量方案的发现,包括诱导期和应用节拍化疗剂量的影响。
结果:将 ICB 与其他治疗方式联合使用可能会改善肿瘤微环境中的免疫状态,从而增强抗肿瘤免疫反应,即使在迄今为止对 ICB 单药治疗无反应的肿瘤类型中也是如此。最初被认为仅具有免疫抑制作用的化疗药物可以发挥免疫调节作用,与免疫治疗联合使用可能是有益的。每种化疗药物对肿瘤微环境的影响不同,为了确定最适合与 ICB 联合使用的组合伙伴,了解这些机制至关重要。
结论:临床前研究表明,大多数化疗药物已被证明具有免疫刺激作用,通过抑制免疫抑制细胞和/或激活效应细胞,或通过增加免疫原性和增加 T 细胞浸润来实现。然而,对于某些化疗药物,化疗药物的时间、剂量和给药顺序以及 ICB 的时间、剂量和给药顺序非常重要。进一步的研究应集中在确定代表临床前模型的最佳药物组合、顺序效应和最佳浓度-时间曲线。
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