Santoso Andry, Levink Iris, Pihlak Rille, Chau Ian
Gastrointestinal Unit, The Royal Marsden Hospital, London SW3 6JJ, UK.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands.
Curr Oncol. 2024 Dec 31;32(1):24. doi: 10.3390/curroncol32010024.
Biliary tract cancers (BTC) are a highly heterogeneous group of cancers at the genomic, epigenetic and molecular levels. The vast majority of patients initially present at an advanced (unresectable) disease stage due to a lack of symptoms and an aggressive tumour biology. Chemotherapy has been the mainstay of treatment in patients with advanced BTC but the survival outcomes and prognosis remain poor. The addition of immune checkpoint inhibitors (ICI) to chemotherapy have shown only a marginal benefit over chemotherapy alone due to the complex tumour immune microenvironment of these cancers. This review appraises our current understanding of the immune landscape of advanced BTC, including emerging transcriptome-based classifications, highlighting the mechanisms of immune evasion and resistance to ICI and their therapeutic implications. It describes the shifting treatment paradigm from traditional chemotherapy to immunotherapy combinations as well as the potential biomarkers for predicting response to ICI.
胆道癌（BTC）在基因组、表观遗传和分子水平上是一组高度异质性的癌症。由于缺乏症状以及肿瘤生物学行为侵袭性强，绝大多数患者初诊时即为晚期（不可切除）疾病阶段。化疗一直是晚期BTC患者的主要治疗手段，但生存结果和预后仍然很差。由于这些癌症复杂的肿瘤免疫微环境，在化疗中添加免疫检查点抑制剂（ICI）相较于单纯化疗仅显示出边际效益。本综述评估了我们目前对晚期BTC免疫格局的理解，包括新兴的基于转录组的分类，强调免疫逃逸机制以及对ICI的耐药性及其治疗意义。它描述了从传统化疗到免疫治疗联合的治疗模式转变，以及预测对ICI反应的潜在生物标志物。
