激素受体阳性乳腺癌中的新辅助免疫疗法:从瘤微环境重编程到组合疗法策略
Zimei Tang1, Tao Huang1, Tinglin Yang1
1Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
激素受体阳性乳腺癌,曾经被认为是免疫学上的"冷",在新的免疫疗法策略中显示出希望. 生物标志物选择识别了从化疗与免疫检查点抑制剂结合中受益的患者.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 遗传学 遗传学 是一个
背景情况:
- 激素受体阳性 (HR+) 乳腺癌是全球最常见的类型.
- HR+瘤传统上被认为是"冷"的,并且由于PD-L1低,瘤透淋巴细胞减少和瘤突变负担低,对免疫疗法没有反应.
- 新出现的证据突出显示了HR+瘤中的分子异质性,表明了治疗重编程的潜力.
研究的目的:
- 审查HR+乳腺癌中遗传因素和瘤微环境 (TME) 之间的相互作用.
- 在新辅助环境中评估涉及化疗和免疫检查点抑制剂的组合策略.
- 探索以生物标志物为指导的患者选择,以优化免疫治疗反应.
主要方法:
- 对HR+乳腺癌31项新辅助药临床试验的分析.
- 对遗传决定因素和TME特征的审查.
- 评估生物标记算法 (MammaPrint Ultra-High 2,同源重组缺陷,瘤透淋巴细胞).
主要成果:
- 通过生物标志物选择的,免疫丰富的HR+子集,在免疫检查点抑制剂组合下显示出显著的病理完整反应率.
- 化疗诱导的免疫细胞死亡可以提高免疫治疗的疗效.
- 最佳的结果取决于生物标志物引导的选择,精确的测序和了解药物的免疫调节作用.
结论:
- 精确的新辅助免疫疗法可以在分子定义的HR+乳腺癌子集中实现.
- 与复合生物标记算法集成的平台试验设计代表了范式的转变.
- 针对遗传和TME特征可以改变特定HR+乳腺癌人群的结果.
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