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新型免疫肿瘤学靶点和耐药机制。

New Immuno-oncology Targets and Resistance Mechanisms.

机构信息

Division of Medical Oncology, University of Washington, Seattle, WA, USA.

Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.

出版信息

Curr Treat Options Oncol. 2022 Sep;23(9):1201-1218. doi: 10.1007/s11864-022-01005-8. Epub 2022 Aug 18.

Abstract

Immune checkpoint inhibition (ICI) has revolutionized the field of non-small cell lung cancer (NSCLC); currently, most patients with advanced disease receive upfront ICI either alone or in combination with chemotherapy. These advances have recently extended into early-stage NSCLC, with ICI incorporation into neoadjuvant and adjuvant treatment regimens. However, despite these successes, immunotherapy (IO) resistance remains a fundamental challenge in NSCLC, introducing a central quandary of how to precisely select the appropriate IO therapy or IO combination therapy for each individual patient. To address this vital need in the field, there has been an explosion of research in immuno-oncology to identify mechanisms of resistance, ranging from genomic alterations in the tumor to immunosuppressive conditions in the tumor microenvironment (TME). There remain many questions about how this complex interplay between the tumor and the immune microenvironment translates into clinical phenotypes of primary and acquired resistance. In NSCLC, a number of novel therapeutics are being developed to prevent and overcome resistance to ICI. Particular promise has been shown with therapeutics targeting novel T cell immune checkpoint inhibitors and targeting innate immune cells in the TME, chief among these cells are natural killer cells, neutrophils, and macrophages. Further research into tissue-based and non-invasive biomarkers that can be prospectively integrated into therapeutic trial design will be critical to advance the field's understanding of individual resistance patterns and enable the ultimate goal of precision immuno-oncology.

摘要

免疫检查点抑制(ICI)彻底改变了非小细胞肺癌(NSCLC)领域;目前,大多数晚期疾病患者接受 ICI 一线治疗,单独使用或与化疗联合使用。这些进展最近已扩展到早期 NSCLC,ICI 已纳入新辅助和辅助治疗方案。然而,尽管取得了这些成功,免疫疗法(IO)耐药仍然是 NSCLC 的一个基本挑战,这就提出了一个核心难题,即如何为每个患者精确选择合适的 IO 治疗或 IO 联合治疗。为了满足该领域的这一重要需求,免疫肿瘤学领域已经进行了大量研究,以确定耐药的机制,从肿瘤中的基因组改变到肿瘤微环境(TME)中的免疫抑制状态。关于肿瘤与免疫微环境之间的这种复杂相互作用如何转化为原发性和获得性耐药的临床表型,仍有许多问题尚未解决。在 NSCLC 中,正在开发许多新的疗法来预防和克服对 ICI 的耐药性。针对新型 T 细胞免疫检查点抑制剂和靶向 TME 中固有免疫细胞的疗法显示出特别有希望的结果,其中主要的细胞是自然杀伤细胞、中性粒细胞和巨噬细胞。进一步研究组织和非侵入性生物标志物,这些标志物可以前瞻性地整合到治疗试验设计中,对于推进该领域对个体耐药模式的理解并实现精准免疫肿瘤学的最终目标至关重要。

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