Yang Hui, Jin Tao, Li Mengqian, Xue Jianxin, Lu Bo
Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.
Precis Clin Med. 2019 Mar;2(1):57-70. doi: 10.1093/pcmedi/pbz004. Epub 2019 Mar 13.
Lately, the success of ICIs has drastically changed the landscape of cancer treatment, and several immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration (FDA) for advanced non-small cell lung cancer (NSCLC). However, numerous patients are resistant to ICIs and require additional procedures for better efficacy results. Thus, combination therapy is urgently needed to strengthen the anti-tumor immunity. A variety of preclinical and clinical studies combining ICIs with radiotherapy (RT) have demonstrated that the combination could induce synergistic effects, as RT overcomes the resistance to ICIs. However, the underlying mechanism of the synergistic effect and the optimal arrangement of the combination therapy are indecisive now. Hence, this review was conducted to provide an update on the current clinical trial results and highlighted the ongoing trials. We also discussed the optimal parameters in clinical trials, including radiation dose, radiation fractionation, radiation target field, and sequencing of combination therapy. In this review, we found that combination therapy showed stronger anti-tumor immunity with tolerable toxicities in clinical trials. However, the best combination mode and potential biomarkers for the target patients in combination therapy are still unclear.
最近，免疫检查点抑制剂（ICI）的成功极大地改变了癌症治疗的格局，几种免疫检查点抑制剂已被美国食品药品监督管理局（FDA）批准用于晚期非小细胞肺癌（NSCLC）。然而，许多患者对ICI耐药，需要额外的治疗手段以获得更好的疗效。因此，迫切需要联合治疗来增强抗肿瘤免疫力。各种将ICI与放射治疗（RT）相结合的临床前和临床研究表明，这种联合治疗可以产生协同效应，因为放疗可以克服对ICI的耐药性。然而，目前协同效应的潜在机制以及联合治疗的最佳方案仍不明确。因此，本综述旨在提供当前临床试验结果的最新信息，并重点介绍正在进行的试验。我们还讨论了临床试验中的最佳参数，包括辐射剂量、分割放疗、辐射靶区以及联合治疗的顺序。在本综述中，我们发现联合治疗在临床试验中显示出更强的抗肿瘤免疫力且毒性可耐受。然而，联合治疗中最佳的联合模式以及针对目标患者的潜在生物标志物仍不清楚。
