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在黑色素瘤中使用免疫检查点抑制剂
Matteo S Carlino1, James Larkin2, Georgina V Long3
1Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology Blacktown and Westmead Hospitals, Sydney, NSW, Australia.
Lancet (London, England)
|September 12, 2021
概括
免疫检查点抑制剂,如抗CTLA4和抗PD-1,显著改善了晚期黑色素瘤的结果. 需要进一步的研究来比较新的组合并确定反应生物标志物.
科学领域:
- 癌症学
- 免疫学
- 癌症治疗
背景情况:
- 免疫检查点抑制剂 (ICI) 利用免疫系统,特别是CD8+ T细胞,破坏癌细胞.
- 抗CTLA4和抗PD-1抗体已经改变了晚期黑色素瘤的治疗,在近50%的患者中提供了持久的反应.
- 结合抗CTLA4和抗PD-1疗法在包括脑转移在内的晚期黑色素瘤中显示出最高的5年生存率.
研究的目的:
- 审查目前的免疫检查点抑制剂在晚期黑色素瘤.
- 讨论已知和新兴ICI组合的疗效和安全性.
- 强调对免疫相关不良事件的预测生物标志物和管理策略的需要.
主要方法:
- 对晚期黑色素瘤的临床试验数据和已确定的治疗指南的审查.
- 对不同患者群体的存活率,无进展存活率和反应的分析.
- 检查免疫相关不良事件的机制和临床影响.
主要成果:
- 结合抗CTLA4和抗PD-1抑制可以在晚期黑色素瘤中提供更好的存活率.
- 将抗LAG3添加到nivolumab中可以改善无进展的存活率,但对整体存活率的影响尚不清楚.
- 由于缺乏敏感和特定的测试,目前的患者选择依赖于临床因素,而不是特定的生物标志物.
结论:
- ICI,特别是双重封锁, 代表了高级黑色素瘤治疗的重大进步.
- 需要进一步研究以阐明新型ICI组合的比较疗效,并确定预测生物标志物.
- 对免疫相关的不良事件的管理对于患者的安全和治疗坚持至关重要.
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