Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Ann Surg Oncol. 2021 Nov;28(12):7463-7473. doi: 10.1245/s10434-021-10192-x. Epub 2021 May 28.
Limited therapy options exist for patients with treatment-refractory metastatic colorectal or anal cancers, prompting investigation into alternative therapies. Immunotherapy in the form of immune checkpoint blockade is one such emerging treatment that has demonstrated promising results in other tumour streams.x This review aims to assess the current use of immune checkpoint blockade in patients with lower gastrointestinal tumours.
Embase, Medline and Cochrane databases were searched for included studies. Clinical trials published in English and utilising immune checkpoint blockade for primary tumours situated in the lower gastrointestinal tract were included. Databases were searched for studies reporting on at least one of overall survival, progression-free survival or response to therapy.
In total, 972 abstracts were screened, with 10 studies included in the final review. Eight trials (833 patients) assessed immune checkpoint blockade in the setting of colorectal cancers. These included pembrolizumab, nivolumab, durvalumab, atezolizumab, tremelimumab and ipilimumab. A total of 20 patients across all studies achieved a complete response, and 111 patients achieved a partial response to treatment. Two trials (62 patients) assessed immune checkpoint blockade in anal cancer, utilising nivolumab and pembrolizumab. Two patients across both studies achieved a complete response, and 11 patients achieved a partial response.
A number of patients with advanced lower gastrointestinal tumours achieved a complete response to treatment for what would otherwise be considered palliative disease. Presented data have highlighted that particular patients may benefit from first-line or combination immunotherapy, and thus, further investigation is warranted to individualise treatment.
对于治疗耐药转移性结直肠或肛门癌患者，治疗选择有限，这促使人们探索替代疗法。免疫检查点阻断的免疫疗法是一种新兴的治疗方法，在其他肿瘤类型中已显示出良好的疗效。x 本综述旨在评估免疫检查点阻断在治疗下消化道肿瘤患者中的应用。
检索了 Embase、Medline 和 Cochrane 数据库中的纳入研究。纳入了在英文发表的、针对下消化道原发性肿瘤使用免疫检查点阻断的临床试验。检索了至少报告总生存期、无进展生存期或治疗反应的研究。
共筛选了 972 篇摘要，最终有 10 项研究纳入了综述。八项试验（833 例患者）评估了免疫检查点阻断在结直肠癌中的应用。这些试验包括 pembrolizumab、nivolumab、durvalumab、atezolizumab、tremelimumab 和 ipilimumab。所有研究中共有 20 例患者完全缓解，111 例患者部分缓解。两项试验（62 例患者）评估了免疫检查点阻断在肛门癌中的应用，使用了 nivolumab 和 pembrolizumab。两项研究中共有 2 例患者完全缓解，11 例患者部分缓解。
一些晚期下消化道肿瘤患者对原本认为是姑息性疾病的治疗产生了完全缓解。目前的数据表明，某些患者可能受益于一线或联合免疫治疗，因此需要进一步研究以实现个体化治疗。
