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[针对局部晚期直肠癌的新辅助免疫疗法的进展]

Y Wang¹, F Tian¹, C Q Jing¹

¹Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.

Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery

|June 23, 2025

概括

免疫疗法对直肠癌有希望,特别是在dMMR/MSI-H患者中,改善完整反应率. 对于pMMR/MSS患者来说,正在探索与化疗放射治疗的结合,人工智能有助于未来的精确治疗.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
结直肠癌研究结直肠癌研究

背景情况:

新辅助化学放射治疗 (NACRT) 是局部晚期直肠癌 (LARC) 的标准,但病理完整反应 (pCR) 率低于最佳.
免疫疗法,特别是抗PD-1抗体,为dMMR/MSI-H LARC提供了新的选择,实现了高响应率,并使观察和等待策略成为可能.
仅仅抑制PD-1在pMMR/MSS LARC中的有效性有限,需要组合疗法.

研究的目的:

审查免疫治疗在LARC管理中的当前作用和未来方向.
为了突出基于不匹配修复 (MMR) 状态的免疫疗法的差异性疗效.
探索新的组合策略和生物标志物发现,以优化LARC治疗.

主要方法:

关于LARC免疫治疗的当前文献的综述.
对dMMR/MSI-H和pMMR/MSS LARC中的抗PD-1疗法的临床试验数据的分析.
讨论组合疗法和生物标志物开发的新兴研究.

主要成果:

反PD-1抗体在dMMR/MSI-H LARC中实现高pCR,支持非手术管理.
免疫疗法与化疗放射治疗的结合显示出pMMR/MSS LARC的潜力,毒性可控.
图像和病理反应之间的不一致仍然是一个挑战.

结论:

免疫疗法对于特定的LARC子集 (dMMR/MSI-H) 是一个重要的进步.
结合方法和生物标志物发现对于改善pMMR/MSS LARC的结果至关重要.
未来的研究应该专注于优化ICI疗法,探索双重免疫疗法,并利用AI用于LARC的精密医学.

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