基于免疫疗法的随机化II期试验,用于有效的不匹配修复或微卫星稳定局部先进的直肠癌 (TORCH) 的全新辅助疗法
概括
将PD-1抑制剂与全新辅助疗法 (iTNT) 结合,显著改善了熟练不匹配修复/微卫星稳定 (pMMR/MSS) 局部晚期直肠癌 (LARC) 的完全响应 (CR) 率. 这种方法支持可接受毒性的观察和等待策略.
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:
- 具有熟练的不匹配修复或微卫星稳定 (pMMR/MSS) 状态的局部晚期直肠癌 (LARC) 提出了治疗挑战.
- 传统的全新辅助疗法 (TNT) 是有前途的,但需要进一步优化,以提高完整响应 (CR) 率.
- 将PD-1抑制剂集成到新辅助治疗策略中是增强抗瘤反应的新兴领域.
研究的目的:
- 评估是否将PD-1抑制剂与全新辅助疗法 (iTNT) 整合,可以提高pMMR/MSS LARC中的CR率.
- 评估在iTNT之后观察和等待 (WW) 策略的可行性.
- 为了在iTNT框架内比较诱导化疗和短期放射治疗的不同序列.
主要方法:
- 一个前性的,多中心的,随机的,开放标签的,第二阶段试验,采用选择获胜者的设计.
- 患有LARC (T3-4和/或N+) 的患者随机分配为短期放射治疗 (SCRT),然后进行巩固性免疫化学疗法 (A组) 或诱导性免疫化学疗法,然后进行SCRT (B组).
- 托里帕利马布是一种PD-1抑制剂,与capecitabine和oxaliplatin结合使用. 治疗反应决定了在全腹腔切除或WW之间做出选择.
主要成果:
- 总共有121名pMMR/MSS LARC患者可以进行评估. 在A组中,CR利率为56.5%,在B组中为54.2%,两者都超过了25%的历史基准.
- 在这两组中,病态CR (pCR) 率为50%. 每组15名患者成功接受了WW,并保持无疾病.
- 与B组相比,A组的临床CR (cCR) 率更高 (43.5%vs35.6%) 和3-4级血小板缺血症较少.
结论:
- 与历史对照相比,iTNT疗法在pMMR/MSS LARC中显著提高了CR率,毒性可控.
- 两种iTNT计划都显示出有效性,支持在精选患者中潜在的WW策略.
- 预先进行SCRT,然后进行免疫化疗 (A组) 成为未来最终研究的首选策略.
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