Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Investigational Cancer Therapeutics, The University of Texas MD Anderson Center, Houston, TX, USA.
Adv Exp Med Biol. 2020;1244:93-106. doi: 10.1007/978-3-030-41008-7_5.
Gastrointestinal (GI) cancers represent a variety of malignancies, each with a unique interplay between the tumor and local immune microenvironment. The successes that immunotherapy, particularly immune checkpoint inhibition, has brought to various other solid tumors have largely not yielded the same benefits to patients with GI cancers. There are subsets of patients for whom immunotherapy has been FDA approved in recent years. For example, anti-PD-1 therapy is approved for patients with pretreated hepatocellular carcinoma. Additionally, patients with PD-L1-positive gastric cancer are eligible to receive anti-PD-1 therapy in the third line setting. Outside of the rare subset of patients who harbor MSI-H/dMMR tumors, the vast majority of patients with colorectal, anal, biliary tract, and pancreatic cancers have not responded to single-agent immune checkpoint inhibitors. Innovative techniques with thoughtful treatment combinations, adoptive cell therapy, CAR-T cells, as well as novel predictive biomarkers are needed to bring the benefits of immunotherapy to the majority of patients with GI malignancies.
胃肠道（GI）癌症代表了多种恶性肿瘤，每种肿瘤的肿瘤与局部免疫微环境之间都存在独特的相互作用。免疫疗法，特别是免疫检查点抑制，在各种实体肿瘤中取得的成功，并没有给胃肠道癌症患者带来同样的益处。近年来，免疫疗法已经获得了 FDA 的批准，适用于某些患者群体。例如，抗 PD-1 疗法已被批准用于治疗预处理后的肝细胞癌患者。此外，PD-L1 阳性胃癌患者在三线治疗中也有资格接受抗 PD-1 治疗。除了少数具有 MSI-H/dMMR 肿瘤的罕见患者亚群外，绝大多数结直肠癌、肛门癌、胆道癌和胰腺癌患者对单药免疫检查点抑制剂没有反应。需要创新的技术和深思熟虑的治疗组合、过继细胞疗法、CAR-T 细胞以及新型预测性生物标志物，才能将免疫疗法的益处带给大多数胃肠道恶性肿瘤患者。
