局所的なdMMR/MSI-H胃がんに対するネオアジュバント免疫チェックポイント阻害剤:メタ解析
W K Schwengber1, R A Pereira2, L F Leite da Silva3
1Internal Medicine Division, Mayo Clinic, Phoenix, USA.
ESMO open
|February 13, 2026
まとめ
ネオアジュバント免疫チェックポイント阻害剤 (ICI) は,欠陥不一致修復 (dMMR) とマイクロサテライト不安定性高い (MSI-H) 胃がんに対する有望な効果を示しています. より長い治療期間は,病理学的完全応答 (pCR) 率を改善し,非手術的管理に関するさらなる研究を支援する可能性があります.
科学分野:
- 腫瘍学 腫瘍学
- 胃腸内科 胃腸内科
- 免疫療法による免疫療法です.
背景:
- 局所的欠陥不一致修復 (dMMR) とマイクロサテライト不安定性高い (MSI-H) 胃と消化管結路 (GEJ) がんでは,ネオアジュバント免疫チェックポイント阻害剤 (ICI) による有望な腫瘍収縮が示されています.
- 既存のデータは主に小規模でランダム化されていない研究から得られており,有効性および安全性に関する結果を総合的にまとめることが必要である.
研究 の 目的:
- 局所的なdMMR/MSI-H胃がんおよびGEJがんにおけるネオアジュバントICIの有効性と安全性を体系的に評価する.
- この患者コホートにおける非手術療法 (NOM) と関連したアウトカムを特徴づける.
主な方法:
- 2025年6月までの主要データベース (PubMed,EMBASE,Scopus,Web of Science,Cochrane Reviews) で体系的な文献検索が行われました.
- データ抽出と品質評価は,PRISMAのガイドラインに従って2人の独立したレビュー者によって行われました.
- 効果のエンドポイントのプールされた推定値とNOMアウトカムの定性的な要約が生成されました.
主要な成果:
- 396人の患者を対象とした20件の研究が含まれており,そのほとんどはICI単独療法または併用療法を受けた.
- 総合的な病理学的完全応答 (pCR) 率は41.9%で,臨床的完全応答は63.8%でした.
- 3ヶ月以上の治療期間は,<3ヶ月 (28.4%) と比較して,かなり高いpCR率 (50.2%) と関連していました. グレード3〜4の免疫関連の有害事象は,患者の6.7%で発生しました.
結論:
- ネオアジュバントICIは,局所的なdMMR/MSI-H胃がんおよびGEJがんにおいて,好ましい有効性および安全性プロファイルを示しています.
- 延長されたネオアジュバントICI治療 (3ヶ月以上) はpCR率を高めることがあります.
- 治療期間を最適化し,NOM.のような臓器保存戦略の役割を確立するために,さらなる将来性研究が不可欠です.
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