Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Hematology and Oncology, Hôpital Du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
JCO Oncol Pract. 2021 Aug;17(8):465-471. doi: 10.1200/OP.20.00949. Epub 2021 Mar 15.
Treatment for metastatic non-small-cell lung carcinoma has seen important advances in recent years with the introduction of targeted therapies and immunotherapy. Immune checkpoint inhibitors, which target the programmed death 1 receptor and programmed death ligand-1, alone or in combination with platinum-based chemotherapy, have become standard of care in the first-line setting for patients with advanced non-small-cell lung carcinoma without targetable driver mutations. However, several clinical questions have now since emerged. Physicians treating lung cancer lack guidance when treating patients who have a poor performance status, patients who are receiving corticosteroids, and those known for pre-existing autoimmune disorders. Furthermore, data are scarce on rechallenging a patient with immune checkpoint inhibitors after the occurrence of a significant immune-related adverse event. In this review, we aim to shed light on these topics.
近年来，随着靶向治疗和免疫疗法的引入，转移性非小细胞肺癌的治疗取得了重要进展。免疫检查点抑制剂，单独或与铂类化疗联合，针对程序性死亡受体 1 和程序性死亡配体 1，已成为无可靶向驱动突变的晚期非小细胞肺癌患者一线治疗的标准治疗方法。然而，目前已经出现了一些临床问题。对于体力状况不佳、正在接受皮质类固醇治疗以及已知存在自身免疫性疾病的患者，以及在发生严重免疫相关不良事件后重新使用免疫检查点抑制剂的患者，治疗肺癌的医生缺乏指导。此外，关于重新挑战免疫检查点抑制剂的患者的数据也很少。在这篇综述中，我们旨在阐明这些问题。
