Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
University of Missouri Kansas City, Kansas City, Missouri, USA.
J Immunother Cancer. 2022 Sep;10(9). doi: 10.1136/jitc-2022-005413.
The broad activity of agents blocking the programmed cell death protein 1 and its ligand (the PD-(L)1 axis) revolutionized oncology, offering long-term benefit to patients and even curative responses for tumors that were once associated with dismal prognosis. However, only a minority of patients experience durable clinical benefit with immune checkpoint inhibitor monotherapy in most disease settings. Spurred by preclinical and correlative studies to understand mechanisms of non-response to the PD-(L)1 antagonists and by combination studies in animal tumor models, many drug development programs were designed to combine anti-PD-(L)1 with a variety of approved and investigational chemotherapies, tumor-targeted therapies, antiangiogenic therapies, and other immunotherapies. Several immunotherapy combinations improved survival outcomes in a variety of indications including melanoma, lung, kidney, and liver cancer, among others. This immunotherapy renaissance, however, has led to many combinations being advanced to late-stage development without definitive predictive biomarkers, limited phase I and phase II data, or clinical trial designs that are not optimized for demonstrating the unique attributes of immune-related antitumor activity-for example, landmark progression-free survival and overall survival. The decision to activate a study at an individual site is investigator-driven, and generalized frameworks to evaluate the potential for phase III trials in immuno-oncology to yield positive data, particularly to increase the number of curative responses or otherwise advance the field have thus far been lacking. To assist in evaluating the potential value to patients and the immunotherapy field of phase III trials, the Society for Immunotherapy of Cancer (SITC) has developed a checklist for investigators, described in this manuscript. Although the checklist focuses on anti-PD-(L)1-based combinations, it may be applied to any regimen in which immune modulation is an important component of the antitumor effect.
阻断程序性细胞死亡蛋白 1 及其配体(PD-(L)1 轴)的药物的广泛应用彻底改变了肿瘤学,为患者带来了长期获益,甚至为曾经预后不良的肿瘤带来了治愈反应。然而,在大多数疾病情况下,只有少数患者接受免疫检查点抑制剂单药治疗能获得持久的临床获益。临床前和相关性研究促使人们了解对 PD-(L)1 拮抗剂无反应的机制,并在动物肿瘤模型中进行联合研究,许多药物开发计划旨在将抗 PD-(L)1 与各种已批准和正在研究的化疗、肿瘤靶向治疗、抗血管生成治疗和其他免疫疗法相结合。一些免疫治疗组合改善了包括黑色素瘤、肺癌、肾癌和肝癌在内的多种适应证的生存结果。然而,这种免疫治疗复兴导致许多组合进入后期开发阶段,而没有明确的预测生物标志物、有限的 I 期和 II 期数据,或临床试验设计没有优化以展示免疫相关抗肿瘤活性的独特属性,例如标志性的无进展生存期和总生存期。在个别研究点启动研究的决定是由研究者驱动的,目前还缺乏评估免疫肿瘤学中 III 期试验产生阳性数据的潜在性的一般框架,特别是为了增加治愈反应的数量或以其他方式推进该领域。为了帮助评估 III 期试验对患者和免疫治疗领域的潜在价值,癌症免疫治疗学会 (SITC) 为研究者制定了一份检查表,本文对此进行了描述。虽然该检查表侧重于基于抗 PD-(L)1 的组合,但它也可以应用于任何将免疫调节作为抗肿瘤作用的重要组成部分的方案。
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