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临床和分子差异表明高瘤突变负担的微卫星稳定固体瘤对免疫检查点抑制剂的反应不同

Imran Nizamuddin¹, Tarik Demir², Katrina Dobinda³

¹Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.

|August 28, 2025

概括

在先进的固体瘤中确定了免疫检查点抑制剂 (ICI) 反应的预测因素. 没有肝转移和TERT突变的患者表现更好,而MYC途径和MLL2突变显示反应较差.

科学领域:

癌症学
免疫疗法
基因组学

背景情况:

鉴定免疫检查点抑制剂 (ICI) 反应的预测因子对于优化癌症治疗至关重要.
瘤突变负担 (TMB) ≥10 mut/Mb是一个已知的因素,但需要进一步的预测因素.

研究的目的:

确定高TMB的晚期固体瘤对ICI反应的临床和遗传预测因素.
将特定的基因突变和临床因素与无进展生存率 (PFS) 和整体生存率 (OS) 相关联.

主要方法:

仅使用ICI治疗的117名晚期固体瘤患者的回顾性分析.
卡普兰-梅尔方法用于PFS和OS;对组比较进行日志等级测试.
使用威尔科克森等级和奇平方和费舍尔临床和遗传变量精确测试的单变量分析.

主要成果:

总体反应率为34% (14%的完整反应). 平均PFS为8. 05个月,正常生存期为26. 8个月.
较高的PFS与ICI敏感的瘤相关,没有肝转移,没有先前的全身治疗.
在非ICI敏感患者中,TMB≥15mut/ Mb改善了结果. TERT突变预测了更好的反应;MYC途径和MLL2突变预测了更差的反应.

结论:

缺少肝转移,TERT突变和高TMB (≥15mut/ Mb) 与优异的ICI反应有关.
在先进的固体瘤中,MYC路径和MLL2基因突变与ICI反应的恶化有关.

关键词:

基因突变免疫检查点抑制剂肝脏转移预测生物标志物固体瘤瘤突变负担

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