免疫检查点阻断在鳞状细胞癌和腺癌 NSCLC 中的临床疗效及潜在免疫逃逸机制。

Clinical outcomes of immune checkpoint blockades and the underlying immune escape mechanisms in squamous and adenocarcinoma NSCLC.

机构信息

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China.

出版信息

Cancer Med. 2021 Jan;10(1):3-14. doi: 10.1002/cam4.3590. Epub 2020 Nov 24.

Abstract

Immune checkpoint blockades (ICBs) have changed the standard of care of squamous and adenocarcinoma non-small cell lung cancer (NSCLC). Whereas detailed researches regarding ICBs in the two major histological subtypes are rare. In order to uncover the clinical efficacy differences between squamous and adenocarcinoma NSCLC and better understand the underlying immune-regulatory mechanisms, we compared the survival benefits of ICBs between the two subtypes by revealing phase 3 randomized trials and attempted to uncover the immune-regulatory discrepancy. Generally, compared with nonsquamous NSCLC, squamous NSCLC benefited more from ICBs in Keynote 024, CheckMate 026, CheckMate 227 and CheckMate 017 and similar in OAK, but less in Keynote 010 and PACIFIC. We revealed that the tumor mutation burden (TMB) level, the programmed cell death ligand 1 (PD-L1) expression, tumor infiltrating lymphocytes (TILs) in the tumor microenvironment (TME), chemokines, and oncogenic driver alterations within the two subtypes may contributed to the clinical outcomes of ICBs. We prospected that the combinations of ICBs with chemotherapy, radiation therapy, and antiangiogenic therapy could be promising strategies to re-immunize the less immunogenic tumors and further enhance the efficacy of ICBs.

摘要

免疫检查点阻断 (ICB) 改变了鳞状细胞癌和腺癌非小细胞肺癌 (NSCLC) 的治疗标准。然而,关于这两种主要组织学亚型的 ICB 的详细研究很少。为了揭示鳞状细胞癌和腺癌 NSCLC 之间临床疗效的差异,并更好地了解潜在的免疫调节机制,我们通过揭示 III 期随机试验比较了两种亚型的 ICB 生存获益,并试图揭示免疫调节差异。一般来说,与非鳞状 NSCLC 相比,鳞状 NSCLC 在 Keynote 024、CheckMate 026、CheckMate 227 和 CheckMate 017 中从 ICB 中获益更多,在 OAK 中相似,但在 Keynote 010 和 PACIFIC 中获益较少。我们揭示了肿瘤突变负担 (TMB) 水平、程序性细胞死亡配体 1 (PD-L1) 表达、肿瘤微环境 (TME) 中的肿瘤浸润淋巴细胞 (TIL)、趋化因子和两种亚型内的致癌驱动改变可能对 ICB 的临床结局有影响。我们预计 ICB 联合化疗、放疗和抗血管生成治疗可能是一种有前途的策略,可以重新免疫较少免疫原性的肿瘤,并进一步提高 ICB 的疗效。

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