Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
World J Gastroenterol. 2024 Jun 7;30(21):2734-2739. doi: 10.3748/wjg.v30.i21.2734.
In this editorial we comment on the article by Li published in the recent issue of the . We focus specifically on the application of immune checkpoint inhibitors (ICIs) and microsatellite instability (MSI) in gastric cancer (GC). The four pillars of GC management have long been considered, including surgery, chemotherapy, radiotherapy and targeted therapy. However, immunotherapy has recently emerged as a "fifth pillar", and its use is rapidly expanding. There are four principal strategies for tumor immunotherapy: ICIs, tumor vaccines, adoptive immunotherapy and nonspecific immunomodulators. Of them, ICIs are the most advanced and widespread type of cancer immunotherapy for GC. Recent breakthrough results for ICIs have paved the way to a new era of cancer immunotherapy. In particular, inhibition of the PD-1/PD-L1 axis with ICIs, including nivolumab and pembrolizumab, has emerged as a novel treatment strategy for advanced GC. Unfortunately, these therapies are sometimes associated with often subtle, potentially fatal immune-related adverse events (irAEs), including dermatitis, diarrhea, colitis, endocrinopathy, hepatotoxicity, neuropathy and pneumonitis. We must be aware of these irAEs and improve the detection of these processes to prevent inappropriate discharges, emergency department revisits, and downstream complications. Recent studies have revealed that MSI-high or mismatch- repair-deficient tumors, regardless of their primary site, have a promising response to ICIs. So, it is important to detect MSI before applying ICIs for treatment of GC.
在这篇社论中，我们对李在最近一期 上发表的文章进行了评论。我们特别关注免疫检查点抑制剂（ICIs）和微卫星不稳定性（MSI）在胃癌（GC）中的应用。长期以来，GC 的管理有四大支柱，包括手术、化疗、放疗和靶向治疗。然而，免疫疗法最近已经成为了“第五大支柱”，并且其应用正在迅速扩大。肿瘤免疫疗法有四大主要策略：ICI、肿瘤疫苗、过继免疫疗法和非特异性免疫调节剂。其中，ICI 是 GC 肿瘤免疫疗法中最先进和最广泛的类型。ICI 的最新突破性成果为癌症免疫治疗开辟了一个新时代。特别是，ICI 抑制 PD-1/PD-L1 轴，包括 nivolumab 和 pembrolizumab，已成为晚期 GC 的一种新的治疗策略。不幸的是，这些疗法有时会出现通常很微妙的、潜在致命的免疫相关不良事件（irAEs），包括皮炎、腹泻、结肠炎、内分泌病、肝毒性、神经病和肺炎。我们必须意识到这些 irAEs，并提高对这些过程的检测，以防止不当出院、急诊科复诊和下游并发症。最近的研究表明，MSI-高或错配修复缺陷的肿瘤，无论其原发部位如何，对 ICI 都有很好的反应。因此，在应用 ICI 治疗 GC 之前，检测 MSI 非常重要。
