胆道系统恶性肿瘤免疫检查点抑制剂治疗
DOI: 10.3969/j.issn.1001-5256.2022.05.005
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:施国明、周俭、樊嘉对文章写作思路有关键贡献; 陆品相、曹军、裴晏梓参与研究数据获取和分析;裴晏梓、施国明起草文章。
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摘要: 胆道系统恶性肿瘤起病隐匿、发展迅速,大多患者初诊时已丧失手术根治机会,预后不良。以吉西他滨为基础的化疗是胆道系统恶性肿瘤的一线治疗,但效果有限。二代测序技术的进步为胆道系统恶性肿瘤精准治疗提供了可能性,但靶点阳性率低及治疗药物可及性差限制了胆道系统恶性肿瘤精准治疗的应用和发展。以免疫检查点抑制剂程序性死亡受体及其配体单抗为代表的免疫治疗时代的到来,为恶性肿瘤包括胆道系统恶性肿瘤治疗提供了令人鼓舞的前景。以免疫检查点抑制剂为基础的联合化疗和/或靶向治疗已经在胆道系统恶性肿瘤治疗中显现良好的效果,是未来晚期胆道系统恶性肿瘤治疗的方向。Abstract: Biliary malignant tumors have an insidious onset and rapid development, and most patients have lost the opportunity for radical surgery at initial diagnosis and often have poor prognosis. Gemcitabine-based chemotherapy is the first-line treatment for biliary malignant tumors, but with a limited clinical effect. The improvement in next-generation sequencing technology provides the possibility for the precise treatment of biliary malignant tumors, but the application and development of the precise treatment of biliary malignant tumors are limited by the low positive rate of targets and the poor accessibility of therapeutic drugs. The advent of the era of immunotherapy represented by the immune checkpoint inhibitor PD1/PD-L1 monoclonal antibody brings a promising future for the treatment of malignant tumors, including biliary malignant tumors. Combined chemotherapy and/or targeted therapy based on immune checkpoint inhibitors has shown a good effect in the treatment of biliary malignant tumors, which is the direction of the treatment of advanced biliary malignant tumors in the future.
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[1] SUNG H, FERLAY J, SIEGEL RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660. [2] LU JC, ZENG HY, SUN QM, et al. Distinct PD-L1/PD1 profiles and clinical implications in intrahepatic cholangiocarcinoma patients with different risk factors[J]. Theranostics, 2019, 9(16): 4678-4687. DOI: 10.7150/thno.36276. [3] VALLE J, WASAN H, PALMER DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer[J]. N Engl J Med, 2010, 362(14): 1273-1281. DOI: 10.1056/NEJMoa0908721. [4] ABOU-ALFA GK, SAHAI V, HOLLEBECQUE A, et al. Pemigatinib for previously treated, locally advanced or metastatic cholangiocarcinoma: A multicentre, open-label, phase 2 study[J]. Lancet Oncol, 2020, 21(5): 671-684. DOI: 10.1016/S1470-2045(20)30109-1. [5] FENG YH. Updated analysis with longer follow up of a phase 2a study evaluating erdafitinib in Asian patients (pts) with advanced cholangiocarcinoma (CCA) and fibroblast growth factor receptor (FGFR) alterations[R]. 2022 ASCO GI430# [6] ABOU-ALFA GK, MACARULLA T, JAVLE MM, et al. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): A multicentre, randomised, double-blind, placebo-controlled, phase 3 study[J]. Lancet Oncol, 2020, 21(6): 796-807. DOI: 10.1016/S1470-2045(20)30157-1. [7] GUO XJ, LU JC, ZENG HY, et al. CTLA-4 synergizes with PD1/PD-L1 in the inhibitory tumor microenvironment of intrahepatic cholangiocarcinoma[J]. Front Immunol, 2021, 12: 705378. DOI: 10.3389/fimmu.2021.705378. [8] HASLAM A, PRASAD V. Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs[J]. JAMA Netw Open, 2019, 2(5): e192535. DOI: 10.1001/jamanetworkopen.2019.2535. [9] HOOS A. Development of immuno-oncology drugs - from CTLA4 to PD1 to the next generations[J]. Nat Rev Drug Discov, 2016, 15(4): 235-247. DOI: 10.1038/nrd.2015.35. [10] MOTZER RJ, TANNIR NM, MCDERMOTT DF, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma[J]. N Engl J Med, 2018, 378(14): 1277-1290. DOI: 10.1056/NEJMoa1712126. [11] OVERMAN MJ, MCDERMOTT R, LEACH JL, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): An open-label, multicentre, phase 2 study[J]. Lancet Oncol, 2017, 18(9): 1182-1191. DOI: 10.1016/S1470-2045(17)30422-9. [12] OVERMAN MJ, LONARDI S, WONG K, et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair-deficient/microsatellite instability-high metastatic colorectal cancer[J]. J Clin Oncol, 2018, 36(8): 773-779. DOI: 10.1200/JCO.2017.76.9901. [13] SCHMID P, ADAMS S, RUGO HS, et al. Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer[J]. N Engl J Med, 2018, 379(22): 2108-2121. DOI: 10.1056/NEJMoa1809615. [14] GANDHI L, RODRÍGUEZ-ABREU D, GADGEEL S, et al. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer[J]. N Engl J Med, 2018, 378(22): 2078-2092. DOI: 10.1056/NEJMoa1801005. [15] NAKAMURA H, ARAI Y, TOTOKI Y, et al. Genomic spectra of biliary tract cancer[J]. Nat Genet, 2015, 47(9): 1003-1010. DOI: 10.1038/ng.3375. [16] ZHOU G, SPRENGERS D, MANCHAM S, et al. Reduction of immunosuppressive tumor microenvironment in cholangiocarcinoma by ex vivo targeting immune checkpoint molecules[J]. J Hepatol, 2019, 71(4): 753-762. DOI: 10.1016/j.jhep.2019.05.026. [17] SILVA VW, ASKAN G, DANIEL TD, et al. Biliary carcinomas: Pathology and the role of DNA mismatch repair deficiency[J]. Chin Clin Oncol, 2016, 5(5): 62. DOI: 10.21037/cco.2016.10.04. [18] MARABELLE A, LE DT, ASCIERTO PA, et al. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: Results from the phase Ⅱ KEYNOTE-158 study[J]. J Clin Oncol, 2020, 38(1): 1-10. DOI: 10.1200/JCO.19.02105. [19] PIHA-PAUL SA, OH DY, UENO M, et al. Efficacy and safety of pembrolizumab for the treatment of advanced biliary cancer: Results from the KEYNOTE-158 and KEYNOTE-028 studies[J]. Int J Cancer, 2020, 147(8): 2190-2198. DOI: 10.1002/ijc.33013. [20] KIM RD, CHUNG V, ALESE OB, et al. A Phase 2 multi-institutional study of nivolumab for patients with advanced refractory biliary tract cancer[J]. JAMA Oncol, 2020, 6(6): 888-894. DOI: 10.1001/jamaoncol.2020.0930. [21] JIAN Z, FAN J, SHI GM, et al. Lenvatinib plus toripalimab as first-line treatment for advanced intrahepatic cholangiocarcinoma: A single-arm, phase 2 trial[J]. J Clin Oncol, 2021, 39(15_suppl): 4099. https://www.researchgate.net/publication/352072246_Lenvatinib_plus_toripalimab_as_first-line_treatment_for_advanced_intrahepatic_cholangiocarcinoma_A_single-arm_phase_2_trial [22] KEMP A. Imfinzi plus chemotherapy significant improved overall survival in 1st-line advanced biliary tract cancer in TOPAZ-1 phase Ⅲ trial at interim analysis[EB/OL]. (2021-10-25). News release. AstraZeneca. https://bit.ly/3vMk79.
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