Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
Radiat Oncol. 2020 Jul 9;15(1):167. doi: 10.1186/s13014-020-01595-3.
Immune-checkpoint inhibitors (ICI) have dramatically changed the landscape of lung cancer treatment. Preclinical studies investigating combination of ICI with radiation show a synergistic improvement of tumor control probability and have resulted in the development of novel therapeutic strategies. For advanced non-small cell lung cancer (NSCLC), targeting immune checkpoint pathways has proven to be less toxic with more durable treatment response than conventional chemotherapy. In inoperable Stage III NSCLC, consolidation immune checkpoint inhibition with the PD-L1 inhibitor durvalumab after completion of concurrent platinum-based chemoradiotherapy resulted in remarkable improvement of progression-free and overall survival. This new tri-modal therapy has become a new treatment standard. Development of predictive biomarkers and improvement of patient selection and monitoring is the next step in order to identify patients most likely to derive maximal benefit from this new multimodal approach. In this review, we discuss the immunological rationale and current trials investigating chemoradioimmunotherapy for inoperable stage III NSCLC.
免疫检查点抑制剂 (ICI) 极大地改变了肺癌治疗的格局。研究 ICI 与放疗联合的临床前研究显示出肿瘤控制概率的协同改善，并催生了新的治疗策略。对于晚期非小细胞肺癌 (NSCLC)，与传统化疗相比，靶向免疫检查点通路的毒性更小，治疗反应更持久。在不可切除的 III 期 NSCLC 中，在完成顺铂为基础的放化疗后，用 PD-L1 抑制剂 durvalumab 进行巩固免疫检查点抑制，显著改善了无进展生存期和总生存期。这种新的三模式疗法已成为一种新的治疗标准。为了识别最有可能从这种新的多模式方法中获得最大获益的患者，开发预测性生物标志物和改善患者选择和监测是下一步。在这篇综述中，我们讨论了免疫治疗的基本原理和目前正在研究的不可切除 III 期 NSCLC 的放化疗免疫治疗的临床试验。
