Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, 110001, China.
Clinical Medicine, Shenyang Medical College, Shenyang, 110001, China.
Cancer Lett. 2024 Nov 1;604:217241. doi: 10.1016/j.canlet.2024.217241. Epub 2024 Sep 10.
Immunotherapy, remarkably immune checkpoint inhibitors (ICIs), has significantly altered the treatment landscape for non-small cell lung cancer (NSCLC). Despite their success, the discontinuation of ICIs therapy may occur due to factors such as prior treatment completion, disease progression during ICIs treatment, or immune-related adverse events (irAEs). As numerous studies highlight the dynamic nature of immune responses and the sustained benefits of ICIs, ICIs rechallenge has become an attractive and feasible option. However, the decision-making process for ICIs rechallenge in clinical settings is complicated by numerous uncertainties. This review systematically analyses existing clinical research evidence, classifying ICIs rechallenge into distinct clinical scenarios, exploring methods to overcome ICIs resistance in rechallenge instances, and identifying biomarkers to select patients likely to benefit from rechallenge. By integrating recent studies and new technologies, we offer crucial recommendations for future clinical trial design and provide a practical guideline to maximize the therapeutic benefits of immunotherapy for NSCLC patients.
免疫疗法，尤其是免疫检查点抑制剂（ICIs），已经显著改变了非小细胞肺癌（NSCLC）的治疗格局。尽管取得了成功，但由于先前治疗完成、ICI 治疗期间疾病进展或免疫相关不良事件（irAEs）等因素，ICI 治疗可能会被中断。由于许多研究强调了免疫反应的动态性质和 ICI 的持续获益，ICI 再挑战已成为一种有吸引力且可行的选择。然而，ICI 再挑战在临床实践中的决策过程受到许多不确定因素的影响。本综述系统分析了现有临床研究证据，将 ICI 再挑战分为不同的临床情况，探讨了在再挑战中克服 ICI 耐药的方法，并确定了生物标志物以选择可能从再挑战中获益的患者。通过整合最近的研究和新技术，我们为未来的临床试验设计提供了重要建议，并提供了一个实用的指南，以最大限度地提高 NSCLC 患者免疫治疗的疗效。
