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希望与挑战:携带 - 突变的非小细胞肺癌患者的免疫治疗

Hope and Challenges: Immunotherapy in -Mutant NSCLC Patients.

作者信息

Yan Dan

机构信息

Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.

Department of Pediatrics, Emory University, Atlanta, GA 30322, USA.

出版信息

Biomedicines. 2023 Oct 28;11(11):2916. doi: 10.3390/biomedicines11112916.

Abstract

EGFR tyrosine kinase inhibitors (TKIs) are the preferred initial treatment for non-small cell lung cancer (NSCLC) patients harboring sensitive mutations. Sadly, remission is transient, and no approved effective treatment options are available for EGFR-TKI-advanced -mutant NSCLCs. Although immunotherapy with immune checkpoint inhibitors (ICIs) induces sustained cancer remission in a subset of NSCLCs, ICI therapy exhibits limited activity in most -mutant NSCLCs. Mechanistically, the strong oncogenic EGFR signaling in -mutant NSCLCs contributes to a non-inflamed tumor immune microenvironment (TIME), characterized by a limited number of CD8 T cell infiltration, a high number of regulatory CD4 T cells, and an increased number of inactivated infiltrated T cells. Additionally, -mutant NSCLC patients are generally non-smokers with low levels of PD-L1 expression and tumor mutation burden. Promisingly, a small population of -mutant NSCLCs still durably respond to ICI therapy. The hope of ICI therapy from pre-clinical studies and clinical trials is reviewed in -mutant NSCLCs. The challenges of application ICI therapy in -mutant NSCLCs are also reviewed.

摘要

表皮生长因子受体酪氨酸激酶抑制剂(TKIs)是对携带敏感突变的非小细胞肺癌(NSCLC)患者的首选初始治疗方法。遗憾的是,缓解是短暂的,并且对于表皮生长因子受体酪氨酸激酶抑制剂耐药的晚期突变非小细胞肺癌没有获批的有效治疗方案。尽管使用免疫检查点抑制剂(ICIs)进行免疫治疗可在一部分非小细胞肺癌患者中诱导持续的癌症缓解,但ICI治疗在大多数突变的非小细胞肺癌中活性有限。从机制上讲,突变的非小细胞肺癌中强大的致癌表皮生长因子受体信号促成了一种无炎症的肿瘤免疫微环境(TIME),其特征是CD8 T细胞浸润数量有限、调节性CD4 T细胞数量众多以及浸润的失活T细胞数量增加。此外,突变的非小细胞肺癌患者通常为不吸烟者,其程序性死亡受体配体1(PD-L1)表达水平和肿瘤突变负担较低。有希望的是,一小部分突变的非小细胞肺癌患者仍对ICI治疗有持久反应。本文综述了在突变的非小细胞肺癌中进行ICI治疗的临床前研究和临床试验的前景。同时也综述了在突变的非小细胞肺癌中应用ICI治疗所面临的挑战。

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