胃食道腺癌与缺陷不匹配修复:当前知识和临床管理
Matthew R Strickland1, Eric M Lander2, Michael K Gibson2
11Division of Hematology-Oncology, Department of Medicine, Massachusetts General Cancer Center, Boston, MA.
Journal of the National Comprehensive Cancer Network : JNCCN
|March 19, 2024
概括
检测不匹配修复缺陷/微卫星不稳定性 (dMMR/MSI-H) 对所有胃食道腺癌患者至关重要. 这种生物标志物确定了一个从免疫检查点抑制剂中显著受益的子组,可能避免化疗.
科学领域:
- 胃肠道瘤学 胃肠道瘤学
- 癌症生物标志物 癌症生物标志物
- 免疫治疗是一种免疫疗法.
背景情况:
- 胃食道腺癌 (Gastroesophageal adenocarcinomas,简称GEA) 是全球癌症死亡的主要原因之一.
- 生物标志物导向疗法,包括HER2和Claudin18.2,在特定的GEA亚组中改善了结果.
- 免疫检查点抑制剂 (ICI) 在GEA中表现有前途,但需要超过PD-L1的验证生物标志物.
研究的目的:
- 突出显示不匹配修复缺陷和/或高微卫星不稳定性 (dMMR/MSI-H) 作为GEA中的生物标志物的重要性.
- 审查dMMR/MSI-H状态在GEA不同阶段的临床影响.
- 倡导在诊断时对所有GEA患者进行普遍的MMR/MSI测试.
主要方法:
- 对现有文献和临床数据的审查dMMR/MSI-H在GEA的流行情况.
- 对接受ICI和化疗的dMMR/MSI-H GEA患者治疗结果的分析.
- 在dMMR/MSI-H GEA中评估术后和辅助治疗策略的证据.
主要成果:
- 在非转移性GEA的8-22%和转移性GEA的3-5%中发现dMMR/MSI-H.
- dMMR/MSI-H瘤通常有更好的预后,并且对ICI反应良好,即使在前线设置中.
- 非转移性dMMR/MSI-H GEA患者可能不会从术后或辅助化疗中受益,无化疗的ICI疗法显示出前景.
结论:
- 对于所有GEA患者来说,MMR/MSI测试应该是诊断时的标准,以确定dMMR/MSI-H亚组.
- 这一小组证明ICI具有显著的益处,支持其在治疗线上使用,包括前线.
- 对于非转移性dMMR/MSI-H GEA,在外科和辅助设置中可能会省略化疗,这需要进一步调查.
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