新辅助化疗免疫疗法用于手术切除的非小细胞肺癌:平衡承诺和陷
Parth Anil Desai1, Hossein Borghaei1, Martin J Edelman1
1Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Clinical lung cancer
|December 5, 2025
概括
新辅助化学免疫疗法改善了非小细胞肺癌 (NSCLC) 的结果,但有可能导致手术不合格. 需要进一步的研究来比较术前治疗与辅助治疗的策略,并确定可切除NSCLC的最佳患者选择.
科学领域:
- 医学瘤学 医学瘤学
- 胸部外科手术 胸部外科手术
- 免疫治疗是一种免疫疗法.
背景情况:
- 绝对的手术是可切除非小细胞肺癌 (NSCLC) 的标准.
- 辅助疗法,包括免疫检查点抑制剂 (ICI),提供增量生存益处.
- 正在探索新辅助化疗-免疫疗法,以提高治疗疗效.
研究的目的:
- 评估新辅助化学免疫疗法在可切除NSCLC中的益处和风险.
- 为了比较新辅助策略与传统的前期手术,其次是辅助疗法.
- 确定优化治疗顺序和患者选择的优先事项.
主要方法:
- 随机试验的分析 (CheckMate 816,KEYNOTE-671,AEGEAN,CheckMate 77T) 评估了新辅助化学免疫疗法.
- 评估无事件生存,病理反应和整体生存.
- 审查患者在新辅助治疗后不进行手术的原因.
主要成果:
- 与单独使用辅助化学疗法相比,新辅助化学免疫疗法改善了无事件生存率和病理反应.
- 很大一部分患者 (15-24%) 没有接受手术,主要是由于疾病进展或不合格.
- 前置手术之后的辅助疗法仍然是基准,没有直接的头对头比较与外科手术期间的方法.
结论:
- 新辅助化疗-免疫疗法显示出有前途,但存在手术磨损的风险.
- 优先事项包括前性试验,比较外科手术与辅助策略 (例如,PROSPECT-LUNG试验).
- 生物标志物发现和共享决策对于优化可切除NSCLC的治疗序列和患者选择至关重要.
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