Zhang Xiaofei, Zhang Jianguo, Liu Peiyi, Wang Juan, Zhao Kuaile, Zhu Zhengfei, Gu Kangsheng, Zhao Weixin
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2023 Feb 8;13:1022042. doi: 10.3389/fonc.2023.1022042. eCollection 2023.
Non-small cell lung cancer negative for actionable molecular markers entered the splendid era of immunotherapy. This review aims to provide an evidence-based summary for immunotherapy for unresectable locally advanced non-small cell lung cancer, and references for clinical strategies of immunotherapy. Through literature review, the standard treatment for unresectable locally advanced non-small cell lung cancer should be radical concurrent radiotherapy and chemotherapy followed by consolidation immunotherapy. However, the efficacy of concurrent radiotherapy, chemotherapy combined with immunotherapy has not been improved, and its safety should be further validated. It is believed that induction immunotherapy plus concurrent radiotherapy and chemotherapy plus consolidation immunotherapy is promising. In clinical practice, the delineation of radiotherapy target should be relatively small. Pemetrexed combined with PD-1 inhibitor induces the strongest immunogenicity in chemotherapy, which is suggested by preclinical pathway study. Although there is no significant difference between PD1 and PD1 for effect, PD-L1 inhibitor is better in the combination treatment of radiotherapy which presents significantly less adverse events.
对于可操作分子标志物呈阴性的非小细胞肺癌，进入了免疫治疗的辉煌时代。本综述旨在为不可切除的局部晚期非小细胞肺癌的免疫治疗提供循证总结，并为免疫治疗的临床策略提供参考。通过文献回顾，不可切除的局部晚期非小细胞肺癌的标准治疗应为根治性同步放化疗，随后进行巩固免疫治疗。然而，同步放化疗联合免疫治疗的疗效并未提高，其安全性有待进一步验证。诱导免疫治疗加同步放化疗加巩固免疫治疗被认为是有前景的。在临床实践中，放疗靶区的勾画应相对较小。培美曲塞联合PD-1抑制剂在化疗中诱导最强的免疫原性，这是临床前通路研究提示的。虽然PD1和PD1在疗效上无显著差异，但PD-L1抑制剂在放疗联合治疗中更好，不良事件明显更少。
