Madan Ankit, Uronis Hope E, Strickler John H
SOVAH Cancer Center, Danville, VA, USA.
Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
J Gastrointest Oncol. 2022 Aug;13(4):2007-2019. doi: 10.21037/jgo-22-55.
BACKGROUND AND OBJECTIVE: Despite recent advances in the multidisciplinary management of esophagogastric cancer, overall prognosis remains poor. There is a need for improved treatment options, along with predictive biomarkers that improve therapeutic decision-making. METHODS: We conducted an extensive review of immunotherapy articles in the PubMed database between December 2013 and October 2021. Articles in English were included. We included phase 1, 2, and 3 clinical trials for immunotherapy review, and prospective, retrospective, and meta-analyses for biomarker review. KEY CONTENT AND FINDINGS: Initial studies of immunotherapy were performed in patients with relapsed refractory metastatic disease and demonstrated a modest survival benefit. Subsequent studies have evaluated the use of these agents in combination with first line chemotherapy for metastatic disease. Finally, recent data indicates that immunotherapy in the adjuvant setting after concurrent chemoradiation and surgery improves disease free survival. Both microsatellite instability high (MSI-H) status and Epstein-Barr virus (EBV) positivity predict response to immunotherapy, but many patients without these biomarkers still benefit. The predictive impact of programmed cell death-ligand 1 (PD-L1) expression and tumor mutational burden (TMB) have been variable, and the optimal cutoff point for these biomarkers remains poorly defined. CONCLUSIONS: While immunotherapy agents have demonstrated clinical benefit and are now incorporated into the current standard of care, novel immunotherapy approaches such as dual immunotherapy combinations, chimeric antigen receptor (CAR) T cells, and tumor vaccines need to be further investigated. As the era of precision medicine beckons, refined biomarkers to predict benefit are needed.
背景与目的:尽管近年来食管癌和胃癌的多学科管理取得了进展,但总体预后仍然较差。需要改进治疗方案以及可改善治疗决策的预测性生物标志物。 方法:我们对2013年12月至2021年10月期间PubMed数据库中的免疫治疗文章进行了广泛回顾。纳入英文文章。我们纳入了1、2和3期免疫治疗临床试验进行综述,并纳入了前瞻性、回顾性和荟萃分析进行生物标志物综述。 关键内容与发现:免疫治疗的初步研究是在复发难治性转移性疾病患者中进行的,显示出适度的生存获益。随后的研究评估了这些药物与一线化疗联合用于转移性疾病的情况。最后,最近的数据表明,同步放化疗和手术后辅助治疗中使用免疫治疗可改善无病生存期。微卫星高度不稳定(MSI-H)状态和爱泼斯坦-巴尔病毒(EBV)阳性均预测对免疫治疗有反应,但许多没有这些生物标志物的患者仍然受益。程序性细胞死亡配体1(PD-L1)表达和肿瘤突变负荷(TMB)的预测影响各不相同,这些生物标志物的最佳临界值仍定义不清。 结论:虽然免疫治疗药物已显示出临床益处,现已纳入当前的治疗标准,但新型免疫治疗方法,如双免疫治疗联合、嵌合抗原受体(CAR)T细胞和肿瘤疫苗,仍需进一步研究。随着精准医学时代的到来,需要更精确的生物标志物来预测疗效。
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