Radiation Oncology Department, Centre Jean Perrin, Clermont Ferrand, France.
Department of Oncology, Lausanne University Hospital and UNIL, Lausanne, Switzerland.
Curr Opin Oncol. 2020 May;32(3):196-202. doi: 10.1097/CCO.0000000000000628.
PURPOSE OF REVIEW: The role of the immune system is important in both initiation and development of head and neck cancers. Various immune checkpoints have been discovered that can be exploited by cancer to evade immune mediated destruction. Therefore, immune checkpoint inhibitors have been developed to overcome cancer immune-evasion and are currently in clinical use in head and neck cancers. In addition, the immune system appears to play an important role in the response to radiotherapy. The combination of immunotherapy with radiotherapy may increase the ability to induce immunogenic death by removing the locks blocking the immune system. RECENT FINDINGS: Although the antitumour efficacy of radiotherapy is based primarily on the toxicity of DNA damage, studies have suggested that this efficacy is based not only on this local cytotoxic and antiproliferative effect, but also on the interactions between the tumor and its microenvironment that are altered. Thus, the cytotoxic action of radiotherapy on tumor cells provides T lymphocytes with tumor neoantigens, and releases proinflammatory cytokines that promote the immune response. Cell death inducing this type of immune response is called immunogenic death. Therefore, several phase 3 clinical trials are currently ongoing evaluating the combination of radiotherapy and immune checkpoint inhibitors in head and neck cancers. SUMMARY: Combining immunotherapy and radiotherapy in head and neck cancers is promising. Several phase 3 clinical trials are ongoing that may be practice changing.
综述目的:免疫系统在头颈部癌症的发生和发展中起着重要作用。已经发现了各种免疫检查点,癌症可以利用这些检查点来逃避免疫介导的破坏。因此,已经开发出免疫检查点抑制剂来克服癌症的免疫逃逸,并在头颈部癌症的临床治疗中得到应用。此外,免疫系统似乎对头颈部癌症的放射治疗反应起着重要作用。免疫疗法与放射治疗相结合可能会通过消除阻止免疫系统的障碍来增加诱导免疫原性细胞死亡的能力。
最新发现:虽然放射治疗的抗肿瘤疗效主要基于 DNA 损伤的毒性,但研究表明,这种疗效不仅基于这种局部细胞毒性和抗增殖作用,还基于肿瘤与其微环境之间的相互作用的改变。因此,放射治疗对肿瘤细胞的细胞毒性作用为 T 淋巴细胞提供了肿瘤新抗原,并释放了促进免疫反应的促炎细胞因子。诱导这种免疫反应的细胞死亡称为免疫原性细胞死亡。因此,目前正在进行几项 3 期临床试验,评估免疫检查点抑制剂联合放射治疗在头颈部癌症中的应用。
总结:将免疫疗法与放射治疗相结合对头颈部癌症具有广阔的前景。目前正在进行几项 3 期临床试验,可能会改变临床实践。
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Curr Opin Oncol. 2019-5