Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.
Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA.
J Gastrointest Cancer. 2024 Jun;55(2):483-496. doi: 10.1007/s12029-023-01003-5. Epub 2023 Dec 22.
Gastroesophageal cancer is a major cause of cancer-related mortality worldwide. Treatment of both early stage and advanced disease remains highly reliant on cytotoxic chemotherapy. About 4-24% of gastroesophageal cancers are microsatellite instability high (MSI-H). The MSI-H subtype is associated with favorable prognosis, resistance to cytotoxic chemotherapy, and sensitivity to immune checkpoint inhibitors (ICI). Recent studies have demonstrated promising activity of ICIs in the MSI-H subtype, resulting in fundamental changes in the management of MSI-H gastroesophageal adenocarcinoma.
In this review, we discuss the prevalence, characteristics, prognosis, and management of MSI-H gastroesophageal adenocarcinoma, with a focus on recent and ongoing studies that have changed the landscape of treatment for the MSI-H subtype. We also discuss current challenges in the management of resectable and advanced MSI-H gastroesophageal cancer, including the need for more accurate biomarkers of response to ICI therapy.
胃食管癌症是全球癌症相关死亡率的主要原因。早期和晚期疾病的治疗仍然高度依赖细胞毒性化疗。约 4-24%的胃食管癌症为微卫星不稳定性高（MSI-H）。MSI-H 亚型与良好的预后、对细胞毒性化疗的耐药性以及对免疫检查点抑制剂（ICI）的敏感性相关。最近的研究表明，ICI 在 MSI-H 亚型中具有有前景的活性，导致 MSI-H 胃食管腺癌的管理发生了根本性变化。
在这篇综述中，我们讨论了 MSI-H 胃食管腺癌的流行率、特征、预后和管理，重点介绍了最近和正在进行的研究，这些研究改变了 MSI-H 亚型的治疗格局。我们还讨论了可切除和晚期 MSI-H 胃食管癌症管理中的当前挑战，包括对 ICI 治疗反应的更准确生物标志物的需求。
