Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Cancer Rep (Hoboken). 2023 Jan;6(1):e1739. doi: 10.1002/cnr2.1739. Epub 2022 Oct 26.
Non-small cell lung cancer (NSCLC) continues to claim millions of lives worldwide. Although its poor prognosis is largely attributed to the lack of adequate and precise detection technologies, cancer cells' suppression of the immune system adds on to the difficulty of identifying abnormal NSCLC tumors in their early stages. Therefore, cancer immunotherapy, which activates the immune system and helps it fight tumors, has recently become the most sought-after technique, especially in the advanced stages of NSCLC, where surgery or chemotherapy may or may not bring about the desired survival benefits in patients.
This review focuses on the various immunotherapeutic interventions and their efficacy in advanced NSCLC clinical trials. Monoclonal antibodies like anti-PD-1/PD-L1 agents and anti-CTLA-4 antibodies, cancer vaccines, oncolytic viruses and adoptive T cell therapy have been discussed in brief. Furthermore, the effects of gender, age, and race on the efficacy of immune checkpoint inhibitors and suggest plausible future approaches in the realm of immuno-oncology.
Immunotherapy is used alone or in combination either with other immunological agents or with chemotherapy. However, the efficacy of these strategies depends extensively on various demographic variables, as some patients respond perfectly well to immunotherapy, while others do not benefit at all or experience disease progression. By targeting a "hallmark" of cancer (immune evasion), immunotherapy has transformed NSCLC management, though several barriers prevent its complete effectiveness.
All these immunological strategies should be interpreted in the current setting of synergistic treatment, in which these agents can be combined with chemotherapy, radiotherapy, and, or surgery following patient and tumor characteristics to proportionate the best-individualized treatment and achieve superior results. To better pursue this goal, further investigations on cost-effectiveness and sex-gender, race, and age differences in immunotherapy are needed.
非小细胞肺癌（NSCLC）在全球范围内仍导致大量患者死亡。尽管其预后不良主要归因于缺乏充分和精确的检测技术，但癌细胞对免疫系统的抑制作用增加了早期识别异常 NSCLC 肿瘤的难度。因此，癌症免疫疗法，即激活免疫系统并帮助其对抗肿瘤，最近已成为最受关注的技术，特别是在 NSCLC 的晚期阶段，手术或化疗可能会或可能不会为患者带来预期的生存获益。
本综述重点讨论了各种免疫治疗干预措施及其在晚期 NSCLC 临床试验中的疗效。简要讨论了单克隆抗体，如抗 PD-1/PD-L1 药物和抗 CTLA-4 抗体、癌症疫苗、溶瘤病毒和过继性 T 细胞疗法。此外，还讨论了性别、年龄和种族对免疫检查点抑制剂疗效的影响，并提出了免疫肿瘤学领域未来可能的方法。
免疫疗法单独使用或与其他免疫制剂或化疗联合使用。然而，这些策略的疗效在很大程度上取决于各种人口统计学变量，因为一些患者对免疫疗法反应良好，而另一些患者则根本没有受益或出现疾病进展。通过靶向癌症的“标志”（免疫逃逸），免疫疗法改变了 NSCLC 的管理方式，尽管仍存在一些障碍阻止其完全有效。
所有这些免疫策略都应在协同治疗的当前背景下进行解读，这些药物可以根据患者和肿瘤特征与化疗、放疗相结合，或在术后使用，以提供最佳个体化治疗并取得更好的效果。为了更好地实现这一目标，需要进一步研究免疫疗法的成本效益以及性别、种族和年龄差异。
