高瘤突变负担减轻了化疗史对免疫检查点阻塞疗法的负面影响
1Beijing Institute of Basic Medical Sciences, 27 Taiping Road, Beijing 100850, China; Academy of Military Medical Sciences, 27 Taiping Road, Beijing 100850, China.
Seminars in oncology
|March 13, 2025
概括
之前的化疗降低了免疫检查点抑制剂 (ICI) 在肺癌中的有效性,特别是在低瘤突变负担 (TMB) 的患者中. 高TMB可能会克服这种抗性,建议ICI作为一些患者的第一线选择.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
- 基因组学就是基因组学.
背景情况:
- 非小细胞肺癌 (NSCLC) 是癌症死亡的主要原因.
- 免疫检查点抑制剂 (ICI) 已经改变了先进的NSCLC治疗.
- 化疗史可能会对ICI疗效产生负面影响,但瘤突变负担 (TMB) 的作用尚不清楚.
研究的目的:
- 为了研究化疗史如何影响ICI治疗结果在先进的NSCLC.
- 为了确定TMB是否可以减轻化疗对ICI治疗的负面影响.
- 根据TMB和先前治疗,确定最佳的治疗策略.
主要方法:
- 分析了512名晚期NSCLC患者的数据,这些患者接受了PD-1/PD-L1或CTLA-4抑制剂的治疗.
- 对客观反应率 (ORR),总生存率 (OS) 和无进展生存率 (PFS) 的评估.
- 患者的分层基于TMB (低<15突变/Mb,高≥15突变/Mb) 和化疗史.
主要成果:
- 之前的化疗显著降低了ORR到ICI在低TMB的患者.
- 高TMB (≥15mut/Mb) 将化疗对ICI疗效的负面影响降至最低.
- 在低TMB患者中,化疗史与较差的OS和PFS相关,但在高TMB患者中并非如此.
结论:
- TMB是预测ICI反应的关键生物标志物,用于预先接受化疗的患者.
- 高TMB可以克服化疗诱导的ICI治疗的耐药性.
- 个性化测序,潜在地优先考虑ICI为低TMB患者的第一线治疗,可能会改善结果.
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