免疫疗法在头癌中的进展和挑战
Hazem Aboaid1, Taimur Khalid2, Abbas Hussain1
1Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, NV, United States.
Frontiers in immunology
|June 23, 2025
概括
免疫疗法,包括免疫检查点抑制剂 (ICI),对头部和部状细胞癌 (HNSCC) 有望. 虽然一些试验在局部发达的HNSCC中显示出有限的益处,但ICI正在改善复发性/转移性疾病的结果,并正在研究生物标志物和新策略.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 癌症研究 癌症研究
背景情况:
- 头部和部状细胞癌 (HNSCC) 具有显著的治疗挑战,生存率低于最佳.
- 免疫疗法,特别是针对PD-1/PD-L1的免疫检查点抑制剂 (ICI),已成为癌症治疗的转变模式.
- 在HNSCC中免疫治疗的全部潜力和最佳应用仍在积极调查中.
研究的目的:
- 审查当前的免疫治疗局部先进 (LA) 和复发性/转移性 (R/M) HNSCC.
- 讨论关键的临床试验,新兴生物标志物和新的治疗策略.
- 突出HNSCC免疫疗法的挑战和未来研究方向.
主要方法:
- 关键的第三期临床试验的评估 (例如,KEYNOTE-412,JAVELIN头部和部100,KEYNOTE-048,检查机141).
- 从外科手术期间免疫治疗研究 (例如,KEYNOTE-689,NIVOPOSTOP GORTEC 2018-01) 的数据分析.
- 审查新兴的免疫治疗策略 (瘤性病毒疗法,CAR-T,癌症疫苗) 和生物标志物 (PD-L1,TMB,HPV).
主要成果:
- 在未经选择的LA-HNSCC群体中,ICI-化学放射治疗组合显示出有限的生存益处,但在PD-L1阳性瘤中具有潜在的疗效.
- 在切除的HNSCC中,外科手术期间的ICI显示出有前途.
- ICI已经为R/M HNSCC制定了新的护理标准,FDA批准了pembrolizumab和nivolumab.
- 双检查点封锁试验的结果各不相同,表明复杂的免疫抵抗机制.
- 有望的临床前期和早期临床数据存在于新的策略,如型病毒疗法和CAR-T疗法.
结论:
- 免疫疗法对R/M HNSCC治疗产生了重大影响,目前正在努力优化其在LA HNSCC中的使用.
- 生物标志物如PD-L1表达,TMB和HPV状态对于治疗选择至关重要,但需要进一步验证.
- 挑战包括异质反应,与免疫相关的毒性,以及将免疫疗法整合到多式疗法中.
- 未来的研究应该专注于生物标记驱动的算法,合理的免疫疗法组合,以及调节瘤微环境.
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