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CTLA4阻断消除了与KEAP1/STK11相关的PD-L) 1抑制剂的抵抗
Ferdinandos Skoulidis1, Haniel A Araujo2, Minh Truong Do2
1Department of Thoracic and Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. fskoulidis@mdanderson.org.
晚期非小细胞肺癌 (NSCLC) 和STK11/KEAP1突变患者受益于双免疫检查点阻塞 (ICB) 加上化疗. 这种组合克服了单独对PD- L) 1抑制剂的耐药性,改善了抗瘤活性.
科学领域:
- 癌症学
- 免疫学
- 遗传学
背景情况:
- 与单独使用PD- L1抑制剂相比,使用CTLA4和PD- L1抑制剂的双免疫检查点阻塞 (ICB) 显示出较高的抗瘤活性,同时也显示出较高的非小细胞肺癌 (NSCLC) 毒性.
- 目前没有经过验证的生物标志物可以预测双ICB对患者的益处.
研究的目的:
- 确定预测双ICB在NSCLC患者中的益处的生物标志物.
- 在患有STK11和/ 或KEAP1瘤抑制基因突变的患者中研究双ICB的疗效.
主要方法:
- 对POSEIDON第三阶段随机试验数据的分析.
- 在NSCLC模型中进行无偏的基因选.
- 在小鼠模型和患者中评估瘤微环境.
主要成果:
- 患有STK11/ KEAP1突变的患者从双重ICB (杜尔瓦卢马布加特梅利马布) 加上化疗中获得临床益处,而不是单独使用杜尔瓦卢马布.
- KEAP1的丧失是双重ICB疗效的最强的基因组预测因素.
- STK11/ KEAP1的变化与免疫抑制性瘤微环境有关,CD8+ T细胞减少,但不影响CD4+效应细胞.
- 双ICB重编程骨髓细胞和参与的CD4+效应细胞,有助于抗瘤功效.
结论:
- 在接受化疗免疫治疗的NSCLC患者中,STK11和/或KEAP1的改变预示着双ICB的益处.
- 在这组患者中,双ICB可以克服对PD- L) 1抑制的抗性.
- 针对STK11/KEAP1突变NSCLC与双ICB是一种有前途的治疗策略.
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