在局部晚期胰腺癌 (pMMR,CPS 30) 中对BRICS的完整反应:一个病例报告
Songlong Yang1, Liangxiu Shao2, Yating Wu3
1Department of Spleen-Stomach-Hepatobiliary, Quanzhou Hospital of Traditional Chinese Medicine, Quanzhou, Fujian, China.
Frontiers in immunology
|February 6, 2026
概括
一种结合益生菌,放射治疗,免疫治疗,化疗和立体疗法的新型多式疗法在患有晚期胰腺癌的患者中实现了完全的反应. 这种方法对治疗不匹配修复能力强的胰腺癌充满希望,挑战目前的免疫疗法耐药性假设.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
- 胃肠病学 胃肠病学
背景情况:
- 局部晚期胰腺癌 (LAPC) 的预后不佳,治疗选择有限.
- 免疫检查点抑制剂 (ICI) 在因免疫抑制瘤微环境 (TME) 而导致的不匹配修复性 (pMMR) 胰腺管腺癌中表现出有限的疗效.
- 对于pMMR LAPC,迫切需要新的治疗策略.
研究的目的:
- 报告一个pMMRLAPC病例,该病例是用一种新型多式模式治疗方案治疗的.
- 评估这种治疗方案的有效性和安全性,以实现完整的反应.
- 探索克服pMMR胰腺癌免疫疗法耐药性的潜在机制.
主要方法:
- 一名pMMR LAPC和高PD-L1表达 (CPS=30) 的患者接受了BRICS疗法:双菌补充剂,低分离放射疗法,免疫疗法 (PD-1 抑制剂),低剂量化疗和立体疗法.
- 具体治疗包括SBRT,toripalimab,nab-paclitaxel,anlotinib和Bifidobacterium. 这三种药物是最常见的.
- 通过成像和瘤标记物来评估治疗反应.
主要成果:
- 患者在治疗后5个月内实现了瘤标志物正常化的完整反应 (CR).
- 多模式治疗耐受性良好,没有严重的不良事件.
- 瘤标志物 (CA19-9,CEA) 在治疗后显著下降.
结论:
- 结合SBRT,化疗,抗血管生成疗法,ICI和益生菌的综合模式方法可以在pMMRLAPC中实现CR,具有高PD-L1表达,即使没有手术.
- 这些发现挑战了 pMMR 状态总是预测免疫疗法耐药性的观点.
- 多模式策略可以重塑TME并克服pMMR胰腺癌中的免疫抵抗,这代表了一个有前途的治疗方向.
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