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微卫星稳定或错配修复功能正常的结直肠癌新辅助免疫治疗

[Neoadjuvant immunotherapy in microsatellite stability or mismatch repair proficient colorectal cancer].

作者信息

Zhang J W, Deng Y H

机构信息

Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Mar 25;25(3):193-198. doi: 10.3760/cma.j.cn441530-20211217-00505.

Abstract

Immunotherapy has become an important treatment option for microsatellite instability-high (MSI-H) and mismatch repair deficient (dMMR) colorectal cancer. From late-line to first-line treatment, and even in neoadjuvant setting for early stage colorectal cancer, promising efficacy was observed with immunotherapy. In microsatellite stability (MSS) or mismatch repair proficient (pMMR) colorectal cancer, the researches of neoadjuvant immunotherapy have been conducted constantly. This paper focuses on the recent researches and progress of neoadjuvant immunotherapy for MSS or pMMR colorectal cancer. Neoadjuvant immunotherapy alone led to a good pathological response in a subset of patients. Studies of induction or consolidation immunotherapy before or after neoadjuvant chemoradiotherapy or concurrent immunotherapy during radiotherapy showed higher pathological complete remission (pCR) rates as compared to standard chemoradiotherapy. Studies on sequential dual immunotherapy after radiochemotherapy and targeted therapy combined with neoadjuvant immunotherapy are ongoing. At present, most of these are pilot studies with small sample size. More researches and long-term follow-up are needed to prove the efficacy of neoadjuvant immunotherapy in MSS or pMMR colorectal cancer.

摘要

免疫疗法已成为微卫星高度不稳定(MSI-H)和错配修复缺陷(dMMR)结直肠癌的重要治疗选择。从晚期治疗到一线治疗,甚至在早期结直肠癌的新辅助治疗中,免疫疗法都显示出了良好的疗效。在微卫星稳定(MSS)或错配修复功能正常(pMMR)的结直肠癌中,新辅助免疫疗法的研究也在不断进行。本文重点关注MSS或pMMR结直肠癌新辅助免疫疗法的最新研究及进展。单纯新辅助免疫疗法在部分患者中可产生良好的病理反应。新辅助放化疗前或后的诱导或巩固免疫疗法研究,以及放疗期间的同步免疫疗法研究显示,与标准放化疗相比,病理完全缓解(pCR)率更高。放化疗后序贯双重免疫疗法以及靶向疗法联合新辅助免疫疗法的研究正在进行中。目前,这些大多是小样本的探索性研究。需要更多研究和长期随访来证实新辅助免疫疗法在MSS或pMMR结直肠癌中的疗效。

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