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在分子复杂的肺腺素状瘤中持久的免疫治疗反应:病例报告和文献综述

Jun Zhu¹, Xin Xun¹, Jiayun Liu¹

¹Department of Oncology, 920th Hospital of Joint Logistics Support Force, People's Liberation Army, Kunming, Yunnan, China.

Frontiers in immunology

|July 11, 2025

概括

本案例研究详细介绍了一种罕见的肺腺素状癌 (ASC),具有多个突变. 用PD-1抑制剂和化疗治疗导致持续的完全反应,为类似的晚期肺癌患者提供了希望.

科学领域:

在瘤学瘤学.
基因组学就是基因组学.
免疫治疗是一种免疫疗法.

背景情况:

肺腺性癌 (ASC) 是一种罕见的,侵袭性的非小细胞肺癌 (NSCLC) 亚型.
对其分子格局和最佳治疗策略的理解有限.
晚期IVa ASC带来了重大的治疗挑战.

研究的目的:

报告一种具有同时发生突变的高级肺ASC的独特病例.
评估免疫检查点抑制剂 (ICI) 治疗在这种特定的分子环境中的疗效.
强调在罕见的肺癌中全面分子分析的重要性.

主要方法:

下一代测序 (NGS) 用于全面的基因组分析.
生物标记分析包括PD-L1表达,瘤突变负担 (TMB) 和微卫星不稳定性 (MSI).
第一线治疗是用tislelizumab (PD-1抑制剂) 结合化疗,然后进行维持疗法.

主要成果:

NGS发现了同时发生的突变:KRAS G12C,BRAF (非V600E),PIK3CA和FLT1.
生物标志物:PD-L1 18.11% (TPS),TMB 3.7 mut/Mb,MSI-L (35.29%) 这两种类型的生物标志物.
持续的完整反应 (CR),无进展生存期 (PFS) 为46.5个月 (与典型的8-12个月相比).

结论:

这是第一个报告的高级肺ASC病例,同时发生的驱动突变对ICI治疗有显著的反应.
综合的分子分析对于管理罕见的肺癌亚型至关重要.
包括免疫疗法在内的合理组合策略,对基因组学上相似的病例显示出希望.

关键词:

基因突变是一种基因突变.免疫检查点抑制剂 (ICI)免疫疗法免疫疗法肺部腺素状癌瘤非小细胞肺癌 (NSCLC) 是一种非小细胞肺癌.

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