4th Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece.
Department of Oncology, Beaumont Hospital, Beaumont RCSI Cancer Centre, Dublin, Ireland.
Am Soc Clin Oncol Educ Book. 2024 Jun;44(3):e432526. doi: 10.1200/EDBK_432526.
Chemoimmunotherapy is currently the preferred first-line treatment option for the majority of patients with advanced non-small cell lung cancer without driver genetic alterations. Most of these patients, however, will experience disease progression within the first year after treatment initiation and both patients and their physicians will be confronted with the dilemma of the optimal second-line treatment. Identification of molecular targets, such as , , , and human epidermal growth factor receptor 2 mutations, and RET rearrangements offer therapeutic opportunities in pretreated patients with corresponding alterations. For those tumors that do not harbor oncogenic drivers, second-line treatment with docetaxel remains the current standard of care despite modest efficacy. Strategies to challenge docetaxel include the combination of immune checkpoint inhibitors (ICIs) with tyrosine inhibitors of multiple kinases or with DNA damage response inhibitors, antibody-drug conjugates, and locoregional treatments for oligoprogressive disease. Next-generation immunotherapy strategies, such as T-cell engagers, immune-mobilizing monoclonal T-cell receptors, chimeric antigen receptor cell therapy, tumor infiltrating lymphocytes, and T-cell receptor cell therapy are being currently investigated in the quest to reverse resistance to ICIs. Importantly, the advent of these new agents heralds a novel spectrum of toxicities that require both the physician's and the patient's education. Herein, we review current and future strategies aiming to outperform docetaxel after chemoimmunotherapy failure, and we provide practical information on how to best communicate to our patients the unique toxicity aspects associated with immunotherapy.
化疗免疫治疗目前是大多数无驱动基因突变的晚期非小细胞肺癌患者的首选一线治疗方案。然而,大多数患者在治疗开始后的一年内会出现疾病进展,患者及其医生将面临最佳二线治疗的困境。识别分子靶点,如 EGFR 突变、ALK 融合、ROS1 融合和人表皮生长因子受体 2 突变,以及 RET 重排,为具有相应改变的预处理患者提供了治疗机会。对于那些没有致癌驱动基因的肿瘤,二线治疗用多西他赛仍然是目前的标准治疗方法,尽管疗效有限。挑战多西他赛的策略包括免疫检查点抑制剂 (ICIs) 与多激酶酪氨酸抑制剂或与 DNA 损伤反应抑制剂、抗体药物偶联物的联合应用,以及寡进展性疾病的局部区域治疗。下一代免疫治疗策略,如 T 细胞衔接器、免疫动员单克隆 T 细胞受体、嵌合抗原受体细胞治疗、肿瘤浸润淋巴细胞和 T 细胞受体细胞治疗,正在被研究,以试图逆转对 ICI 的耐药性。重要的是,这些新药物的出现预示着一种新的毒性谱,需要医生和患者都接受教育。在此,我们回顾了旨在在化疗免疫治疗失败后优于多西他赛的现有和未来策略,并就如何最好地向患者传达与免疫治疗相关的独特毒性方面提供了实用信息。
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