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在指导先进非小细胞肺癌的第一线免疫化疗中,瘤信息的ctDNA

Kailun Fei¹, Jie Zhao¹, Jiachen Xu¹

¹State Key Laboratory of Molecular Oncology, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.

Advanced science (Weinheim, Baden-Wurttemberg, Germany)

|November 25, 2025

概括

基于瘤的循环瘤DNA (ctDNA) 可以预测对一线免疫检查点抑制剂以及晚期非小细胞肺癌 (NSCLC) 中的化疗 (ICI-chemo) 的反应. ctDNA阳性确定了那些从ICI化疗中获益最多的患者,而不是单独的化疗.

科学领域:

在瘤学瘤学.
分子诊断学分子诊断
翻译研究是翻译研究.

背景情况:

一线免疫检查点抑制剂加化疗 (ICI-chemo) 是高级非小细胞肺癌 (NSCLC) 的标准治疗方法.
预测性生物标志物对于患者选择至关重要,以优化ICI-chemo疗效.
循环瘤DNA (ctDNA) 为评估瘤负担和免疫性提供了一种最小侵入性的方法.

研究的目的:

评估瘤告知ctDNA的预测价值,用于先进NSCLC的第一线ICI化疗.
基于ctDNA状态来比较ICI化疗与单独化疗的疗效.
评估ctDNA清除与临床结果之间的相关性.

主要方法:

从第三阶段CHOICE-01试验中预期收集和分析治疗前和治疗期间的组织和血样本.
基于组织识别突变的瘤告知ctDNA检测.
在治疗手臂和子组之间对无进展生存 (PFS) 和整体生存 (OS) 的统计分析.

主要成果:

接受ICI化疗的具有瘤信息的ctDNA阳性患者与单独化疗相比,PFS和OS显著改善 (PFS HR 0.45,OS HR 0.66).
在ctDNA负子组的治疗臂之间没有观察到PFS或OS的显著差异.
在治疗期间ctDNA清除与更好的生存状况和PFS相关 (LOG-rank p = 0.0004对于生存状况,p = 0.044对于PFS).

结论:

基于瘤的ctDNA是一种强大的预测生物标志物,用于先进NSCLC的第一线ICI化疗.
这种生物标志物独立于其他免疫生物标志物和ctDNA指标,并且优于它们.
治疗期间ctDNA动态为接受ICI化疗的患者提供预后信息.

关键词:

化学疗法化疗化疗免疫检查点抑制剂免疫检查点抑制剂预测性的生物标志物瘤信息化的ctDNA

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