总的新辅助疗法与PD-1阻塞对高风险的熟练的不匹配修复直肠癌
Yingjie Li1, Chaohu Pan2,3, Yuye Gao1
1State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Unit III, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China.
JAMA surgery
|February 21, 2024
概括
总的新辅助疗法 (TNT) 与免疫疗法相结合,对具有熟练的不匹配修复 (pMMR) 的高风险直肠癌患者有希望. 这种方法证明了安全性和有效性,病理完整反应率为33.3%.
科学领域:
- 在瘤学瘤学.
- 胃肠道癌症研究研究
- 免疫治疗是一种免疫疗法.
背景情况:
- 总的新辅助疗法 (TNT) 是局部晚期直肠癌的标准,特别是在具有高风险因素的情况下.
- 在熟练不匹配修复 (pMMR) 的直肠癌中,将TNT与免疫疗法结合使用的疗效在很大程度上仍未被探索.
研究的目的:
- 评估TNT治疗方案的安全性和有效性,包括诱导化疗免疫疗法,然后在高风险的pMMR直肠癌患者中进行化疗辐射.
- 为了确定潜在的分子生物标志物预测治疗反应.
主要方法:
- 一个单臂的2期临床试验,涉及25名患有高风险的pMMR直肠癌的患者.
- 患者接受了诱导性氧沙利丁,卡佩西塔宾和卡梅利祖马布,随后进行化疗辐射和巩固化疗.
- 对治疗前活检和血进行基因组分析,以识别生物标志物.
主要成果:
- 观察到病理完整反应率为33.3%.
- 在所有可评估患者 (100%) 中实现了R0切除.
- LRP1B突变与瘤缩和临床完整反应有关,并与高瘤突变负担相关.
结论:
- 总的新辅助疗法与诱导化疗免疫疗法,其次是化疗辐射是高风险的pMMR直肠癌的安全和有效选择.
- 进一步验证LRP1B和其他生物标志物是有必要的,以预测治疗反应.
- 需要进行更大规模的研究来证实这种新的治疗策略的有效性.
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