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新辅助化学辐射疗法加上编程细胞死亡蛋白-1阻塞与肌肉侵入性膀癌单独化学辐射疗法:现实世界的比较研究

Fan Zhang^1,2, Jingsuo Wang¹, Yanhang Yu¹

¹Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China.

Frontiers in immunology

|December 15, 2025

概括

将PD-1阻断添加到新辅助化学放射治疗 (NACRT) 中,显著改善了肌肉侵入性膀癌 (MIBC) 患者的病理完整反应率,而不会增加毒性. 需要进一步的试验来证实生存效益.

科学领域:

在瘤学瘤学.
尿癌研究尿癌研究
癌症治疗策略癌症治疗策略

背景情况:

肌肉侵入性膀癌 (MIBC) 携带高复发风险和细胞切除术后的死亡率.
新辅助化学放射疗法 (NACRT) 正在探索膀保护,但其与PD-1抑制剂在激进囊切除术环境中的组合正在调查中.
PD-1 抑制剂在尿路癌中表现出抗瘤活性,这表明与 NACRT 的潜在协同作用.

研究的目的:

为了在MIBC患者中比较单独使用NACRT与与PD-1阻断 (NACRT+PD-1) 结合使用NACRT的病理反应和短期安全性.
评估PD-1抑制剂 (托利帕利马布,蒂塞利祖马布) 在激进囊切除术前增强瘤反应的疗效.

主要方法:

在2021年1月至2024年12月期间接受治疗的59名MIBC患者 (cT2-T4aN0M0) 的回顾性分析.
患者接受单独的NACRT (n=27) 或NACRT+PD-1抑制剂 (n=32).
标准化疗 (gemcitabine/cisplatin),强度调节的盆腔放射疗法和PD-1抗体输注进行了治疗;主要终点是病理下降阶段和完全响应率.

主要成果:

病理完整响应率 (PCRR) 从单独使用NACRT的44.44%显著增加到NACRT + PD-1 (p=0.033) 的71.88%.
与单独使用NACRT (74.07%) 相比,NACRT+PD-1组的病态衰退率在数值上更高 (87.50%),尽管在统计学上并不显著 (p=0.187).
没有发生≥4级不良事件或与治疗相关的死亡;EA频率在各组之间相似,表明可比的短期安全性.

结论:

将NACRT与PD-1阻断相结合,可显著提高MIBC患者进行激进囊切除术的病理完整响应率.
这种组合治疗表明可以接受的短期安全性,与单独使用NACRT相比,严重不良事件没有增加.
这些发现支持在前性试验中进一步调查,以确认NACRT + PD-1阻断对长期生存的潜在益处.

关键词:

这是一种PD-1抑制剂.肌肉侵入性膀癌是一种肌肉侵入性膀癌.新辅助性化疗或放射治疗.病态的完整反应.在安全方面,安全是安全的.

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