Department of Medicine, Division of Hematology & Oncology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, Indiana, USA.
Cancer. 2023 Apr 15;129(8):1162-1172. doi: 10.1002/cncr.34678. Epub 2023 Feb 19.
Thymic epithelial tumors (TETs) are a rare group of malignancies arising from the thymus. Surgery remains the foundation of treatment for patients with early-stage disease. Limited treatment options are available for the treatment of unresectable, metastatic, or recurrent TETs and are associated with modest clinical efficacy. The emergence of immunotherapies in the treatment of solid tumors has generated significant interest in understanding their role in TET treatment. However, the high rates of comorbid paraneoplastic autoimmune disorders, particularly in thymoma, have tempered expectations regarding the role of immune-based therapies. Clinical studies of immune checkpoint blockade (ICB) in thymoma and thymic carcinoma have revealed higher frequencies of immune-related adverse events (IRAEs) and limited efficacy. Despite these setbacks, the growing understanding of the thymic tumor microenvironment and systemic immune system has advanced the understanding of these diseases and provided opportunities for novel immunotherapy modalities. Ongoing studies are evaluating numerous immune-based treatments in TETs with the goal of improving clinical efficacy and mitigating IRAE risk. This review will provide insight into the current understanding of the thymic immune microenvironment, outcomes of previous ICB studies, and review treatments currently being explored for the management of TET.
胸腺上皮肿瘤（TETs）是一组罕见的来源于胸腺的恶性肿瘤。手术仍然是治疗早期疾病患者的基础。对于不可切除、转移性或复发性 TETs 的治疗选择有限，且疗效有限。免疫疗法在实体瘤治疗中的出现引起了人们对其在 TET 治疗中作用的极大兴趣。然而，高合并副肿瘤自身免疫性疾病的发生率，特别是在胸腺瘤中，降低了对免疫治疗的作用的期望。免疫检查点阻断（ICB）在胸腺瘤和胸腺癌中的临床研究显示出更高的免疫相关不良事件（IRAEs）发生率和有限的疗效。尽管存在这些挫折，对胸腺肿瘤微环境和全身免疫系统的不断深入理解，推动了对这些疾病的认识，并为新的免疫治疗方式提供了机会。目前正在进行的研究评估了 TET 中多种基于免疫的治疗方法，以期提高临床疗效并降低 IRAE 风险。本文综述了目前对胸腺免疫微环境的认识、以前的 ICB 研究结果，以及目前正在探索用于 TET 治疗的治疗方法。
