Perkhofer Lukas, Beutel Alica K, Ettrich Thomas J
Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm, Germany.
Visc Med. 2019 Mar;35(1):28-37. doi: 10.1159/000497291. Epub 2019 Feb 7.
Pancreatic ductal adenocarcinoma (PDAC) and extrahepatic biliary tract cancer (BTC) are among the malignancies with the highest morbidity and mortality. Despite increasing knowledge on biology and novel therapies, outcome remains poor in these patients. Recent progress in immunotherapies created new hopes in the treatment of PDAC and extrahepatic BTC. Several trials tested immunotherapies in various therapeutic situations as monotherapies or in combinations. Although responses were seen in some of the trials, the value of immunotherapy in PDAC and extrahepatic BTC remains unclear in the current situation, especially regarding the complex biological characteristics with a high stroma component, intrinsic resistance mechanisms and an immunosuppressive, hypoxic microenvironment. These major hurdles have to be taken into account and overcome if immunotherapies should be successful in these tumor entities. Thereby, combinational approaches that allow on the one hand targeted therapy and on the other restore or boost the function of immune cells are promising.
胰腺导管腺癌（PDAC）和肝外胆管癌（BTC）是发病率和死亡率最高的恶性肿瘤之一。尽管对生物学和新疗法的了解不断增加，但这些患者的预后仍然很差。免疫疗法的最新进展为PDAC和肝外BTC的治疗带来了新希望。多项试验在各种治疗情况下对免疫疗法进行了单药或联合测试。虽然在一些试验中观察到了反应，但在当前情况下，免疫疗法在PDAC和肝外BTC中的价值仍不明确，尤其是考虑到其具有高基质成分、内在抗性机制以及免疫抑制、缺氧微环境等复杂生物学特性。如果免疫疗法要在这些肿瘤实体中取得成功，就必须考虑并克服这些主要障碍。因此，一方面允许靶向治疗、另一方面恢复或增强免疫细胞功能的联合方法很有前景。
