Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Aug 28;46(8):894-899. doi: 10.11817/j.issn.1672-7347.2021.200872.
Over the past decade, immunotherapy has been shown to have antitumor activity in a variety of solid tumors, such as melanoma, renal cell carcinoma, and non-small cell lung cancer, keeping a lead in a new era of tumor immunotherapy. Colorectal cancer with high microsatellite instability (MSI-H) or mismatch repair deficient (dMMR) is sensitive to immune checkpoint inhibitors (ICIs). ICIs monotherapy and ICIs combination therapy have made breakthroughs in the treatment of MSI-H/dMMR CRC. At present, a variety of ICIs have been approved for first- and post-line treatment in patients with CRC. However, MSI-H/dMMR type tumors only account for 5% of metastatic CRC, and the most CRCs were microsatellite stable (MSS) or mismatch repair proficient (pMMR). Many clinical trials are exploring effective treatments for patients with MSS/pMMR CRC, and the combination of ICIs and drugs with different mechanisms is expected to improve the efficacy of MSS/pMMR CRC patients. In the future, attention should be paid to finding the potential therapeutic markers of ICIs and the drug resistance mechanism of ICIs, so as to break through the immune tolerance of MSS/pMMR CRC patients.
在过去的十年中，免疫疗法已被证明在多种实体肿瘤中具有抗肿瘤活性，如黑色素瘤、肾细胞癌和非小细胞肺癌，在肿瘤免疫治疗的新时代保持领先地位。高微卫星不稳定性（MSI-H）或错配修复缺陷（dMMR）的结直肠癌对免疫检查点抑制剂（ICI）敏感。ICI 单药治疗和 ICI 联合治疗在 MSI-H/dMMR CRC 的治疗中取得了突破。目前，多种 ICI 已被批准用于 CRC 患者的一线和后线治疗。然而，MSI-H/dMMR 型肿瘤仅占转移性 CRC 的 5%，大多数 CRC 为微卫星稳定（MSS）或错配修复功能正常（pMMR）。许多临床试验正在探索 MSS/pMMR CRC 患者的有效治疗方法，ICI 与具有不同作用机制的药物联合有望提高 MSS/pMMR CRC 患者的疗效。未来，应注意寻找 ICI 的潜在治疗标志物和 ICI 的耐药机制，以突破 MSS/pMMR CRC 患者的免疫耐受。
