Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
National University Cancer Institute, Singapore, Singapore.
J Immunother Cancer. 2019 Jun 27;7(1):162. doi: 10.1186/s40425-019-0637-6.
In non-small cell lung cancer, response rates to chemotherapy given after immune checkpoint inhibitors has been reported to be higher compared to response rates to chemotherapy given before immune checkpoint inhibitors. However, this phenomenon has not been reported in patients with gastrointestinal cancers nor with the use of multi-targeted kinase inhibitors.
We present a series of six patients who received multi-targeted kinase inhibitors or chemotherapy after progression on immune checkpoint inhibitors and showed unexpected response. Five of these patients had metastatic hepatocellular carcinoma and received salvage multi-targeted kinase inhibitors. Two of these five patients had no response to initial multi-targeted kinase inhibitors but had unexpected response to re-challenge with multi-targeted kinase inhibitors after immune checkpoint inhibitors exposure. The sixth patient had metastatic rectal cancer and showed response to salvage chemotherapy following immune checkpoint inhibitors.
We postulate that the sequencing of immune checkpoint inhibitors prior to other forms of systemic therapy may potentially lead to an immunomodulatory effect in gastrointestinal cancers with potential improvement in response rates.
在非小细胞肺癌中，与免疫检查点抑制剂治疗前相比，免疫检查点抑制剂治疗后化疗的反应率更高。然而，这种现象在胃肠道癌症患者中，也没有在使用多靶点激酶抑制剂的患者中报道过。
我们报告了一系列 6 名患者，他们在免疫检查点抑制剂治疗进展后接受了多靶点激酶抑制剂或化疗，并显示出意外的反应。这 5 名患者中有 5 名患有转移性肝细胞癌，接受了挽救性多靶点激酶抑制剂治疗。其中 2 名患者最初对多靶点激酶抑制剂无反应，但在免疫检查点抑制剂暴露后再次接受多靶点激酶抑制剂治疗时出现了意外反应。第 6 名患者患有转移性直肠癌，在接受免疫检查点抑制剂治疗后对挽救性化疗有反应。
我们推测，在其他形式的系统治疗之前使用免疫检查点抑制剂可能会导致胃肠道癌症产生免疫调节作用，从而潜在地提高反应率。
