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在第一线和第二线设置中广泛阶段小细胞肺癌中的免疫疗法:系统性审查和元分析

Nupur Krishnan¹, Patsy Lee², Gabriel Boldt³

¹Global Health, Michael G. DeGroote School of Medicine, McMaster University, Hamilton.

American journal of clinical oncology

|December 9, 2025

概括

免疫检查点抑制剂 (ICI) 当作为一线治疗时,可以改善扩展阶段小细胞肺癌 (ES-SCLC) 的存活率. 然而,由于缺乏益处和增加毒性,ICI不应该被用作二线治疗.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
临床试验临床试验

背景情况:

小细胞肺癌 (SCLC) 呈现出高复发率和不良预后,尽管初始化疗反应.
扩展阶段SCLC (ES-SCLC) 治疗仍然具有挑战性,需要新的治疗策略.
免疫检查点抑制剂 (ICI) 已成为各种癌症的有希望的治疗类.

研究的目的:

系统地审查和分析ICI在ES-SCLC治疗中的疗效和安全性.
评估ICI在ES-SCLC不同疗法中的作用.
在ES-SCLC患者中确定ICI使用的潜在好处和风险.

主要方法:

2010年至2025年间发表的随机对照试验 (RCT) 的系统审查和元分析.
搜索的数据库包括Medline (PubMed),EMBASE和Cochrane图书馆,并补充了会议记录.
主要终点:总生存率 (OS) 和无进展生存率 (PFS);次要终点:客观反应率 (ORR) 和不良事件.

主要成果:

在一线ES-SCLC中,ICI显著降低了19%的死亡风险 (HR:0.81) 和22%的疾病进展 (HR:0.78).
仅在一线设置中观察到OS和PFS的好处,在二线设置中对PFS产生不利影响.
ICI改善了ORR,但与3级+腹的显著增加有关.

结论:

在第一线ES-SCLC治疗中,ICI显示出有效性和可接受的安全性.
由于缺乏益处和潜在危害,不建议在ES-SCLC中进行二线ICI单疗.
预测生物标志物的开发对于优化ES-SCLC中ICI的长期结果至关重要.

关键词:

扩展阶段的小细胞肺癌.免疫检查点抑制剂免疫检查点抑制剂免疫疗法免疫疗法系统审查和元分析.

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