Department of Medicine, Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Expert Opin Biol Ther. 2021 Dec;21(12):1623-1634. doi: 10.1080/14712598.2021.1921140. Epub 2021 May 4.
: Cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) represent inhibitory immune checkpoints. Combination immune checkpoint inhibitor (ICI) therapy with anti-CTLA-4 plus anti-PD-1 antibodies in preclinical models demonstrated greater anti-tumor effect than therapy with either antibody alone. Based upon this anti-tumor effect, anti-CTLA-4 plus anti-PD-1 antibodies have since been tested in a patients, across tumor types, with advanced malignancies.: Herein we describe the biologic rationale for combining anti-CTLA-4 plus anti-PD-1 antibodies, the early studies which established different treatment schedules of the ICI combination in melanoma, the definitive studies which established the role for anti-CTLA-4 plus anti-PD-1 antibodies in patients with advanced malignancies and the toxicity profiles of these agents. We also discuss several experimental disease settings where combined CTLA-4 and PD-1 blockade is being explored.: We anticipate that combination therapy with anti-CTLA-4 plus anti-PD-1 antibodies will become a treatment standard for patients with cancers both responsive and unresponsive to single agent ICI therapy. Given the toxicity profile, we expect that most patients will be treated with lower doses of anti-CTLA-4 and full doses of anti-PD-1 antibodies, however, there may be instances in which a higher dose of anti-CTLA-4 is preferred.
细胞毒性 T 淋巴细胞相关抗原 4(CTLA-4)和程序性细胞死亡蛋白 1(PD-1)代表抑制性免疫检查点。在临床前模型中,使用抗 CTLA-4 加抗 PD-1 抗体的联合免疫检查点抑制剂(ICI)治疗比单独使用任何一种抗体的治疗效果更好。基于这种抗肿瘤作用,抗 CTLA-4 加抗 PD-1 抗体已在不同肿瘤类型的晚期恶性肿瘤患者中进行了测试。
在此,我们描述了联合使用抗 CTLA-4 和抗 PD-1 抗体的生物学原理,早期研究确定了 ICI 联合治疗在黑色素瘤中的不同治疗方案,明确研究确定了抗 CTLA-4 加抗 PD-1 抗体在晚期恶性肿瘤患者中的作用,以及这些药物的毒性特征。我们还讨论了几种实验性疾病情况,其中正在探索联合 CTLA-4 和 PD-1 阻断。
我们预计,抗 CTLA-4 加抗 PD-1 抗体联合治疗将成为对单药 ICI 治疗有反应和无反应的癌症患者的治疗标准。鉴于其毒性特征,我们预计大多数患者将接受低剂量的抗 CTLA-4 和全剂量的抗 PD-1 抗体治疗,但在某些情况下,可能需要更高剂量的抗 CTLA-4。