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在先进和转移性子宫内膜癌的第一线治疗中添加免疫疗法

G Bogani¹, B J Monk², M A Powell³

¹Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

Annals of oncology : official journal of the European Society for Medical Oncology

|March 2, 2024

概括

一线免疫疗法与化疗相结合,显著改善了晚期子宫内膜癌的无进展生存率. 在不匹配修复缺陷 (MMRd/MSI-H) 瘤中,益处最为明显,显示出显著的生存优势.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
妇科瘤学妇科瘤学

背景情况:

免疫疗法彻底改变了子宫内膜癌的治疗方法,特别是在不匹配修复缺陷 (MMRd/微卫星不稳定性高 (MSI-H)) 的瘤中.
证据支持将免疫疗法与化疗结合起来,作为先进或复发性子宫内膜癌的第一线策略.
最近的III期试验 (RUBY,NRG-GY018,AtTEnd,DUO-E) 已经揭示了重要的发现.

研究的目的:

对先进或复发性子宫内膜癌的第一线免疫疗法进行第三期试验进行审查和元分析.
评估免疫疗法与化疗相结合的疗效与单独的化疗.
评估不同分子子组的生存结果.

主要方法:

对来自四项主要III期试验的2320名患者的汇总数据的元分析.
在晚期或复发性子宫内膜癌中研究无进展生存 (PFS) 和整体生存 (OS).
基于不匹配修复缺陷 (MMRd/MSI-H) 状态的结果分层.

主要成果:

化疗加免疫治疗在所有患者中显著改善了PFS (HR 0.70,95%CI 0.62-0.79).
MMRd/MSI-H瘤显示出明显的PFS益处 (HR 0.33,95% CI 0.23-0.43),而MMR熟练/微卫星稳定 (MSS) 瘤也显示出益处 (HR 0.74,95% CI 0.60-0.91).
综合疗法提高了整体存活率 (HR 0.75,95% CI 0.63-0.89),尽管数据成熟度有限.

结论:

将免疫疗法纳入一线治疗实质性地改善了晚期和转移性子宫内膜癌的瘤结果.
MMRd/MSI-H子组显示出显著的益处,并且是无化疗方案的重点.
目前正在进行探索性分析,以确定临床试验注册的非响应者.

关键词:

化疗化疗是一种化学疗法.这是子宫内膜癌的癌症.第一个行第一行.免疫疗法免疫疗法

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