The Queen Elizabeth Hospital, Woodville south, SA, Australia.
Flinders Centre For Innovation in Cancer, Flinders Medical Centre, Bedford Park, SA, Australia.
Br J Cancer. 2022 Jul;127(1):21-29. doi: 10.1038/s41416-022-01751-4. Epub 2022 Mar 8.
Cancers of the upper gastrointestinal tract are a leading cause of cancer-related death world-wide and historically have a poor prognosis. The incidence and histology of these cancers have varied temporally and geographically over the last three decades, with an emerging understanding of the differences in the molecular and genetic profiles across different subgroups. Management of oesophagogastric cancers is by a multidisciplinary team with utilisation of surgery, radiotherapy and systemic treatments in combinations where appropriate. Immune checkpoint inhibition (ICI) has drastically changed the treatment landscape of multiple solid malignancies in the last 5 years. In oesophagogastric cancer, clinical trials have only recently shown activity that is often associated with the molecular characteristics of these tumours, in particular PD-L1 scores or microsatellite instability (MSI-H). This review looks to present the pivotal trials in this space, discuss the complexities between trials that may explain the disparate results and assess the benefit ICI offers in the treatment landscape at present.
上消化道癌症是全球癌症相关死亡的主要原因，历史上预后较差。在过去的三十年中，这些癌症的发病率和组织学在时间和空间上都有所变化，人们对不同亚组之间分子和遗传特征的差异有了更深入的了解。上消化道癌症的治疗是由多学科团队进行的，根据具体情况结合手术、放疗和全身治疗。免疫检查点抑制剂（ICI）在过去 5 年中极大地改变了多种实体恶性肿瘤的治疗格局。在上消化道癌症中，临床试验最近才显示出与这些肿瘤的分子特征相关的活性，特别是 PD-L1 评分或微卫星不稳定性（MSI-H）。本文旨在介绍这一领域的关键试验，讨论试验之间可能导致结果差异的复杂性，并评估 ICI 在目前治疗领域中的获益。
