针对晚期胃食道癌的免疫治疗和向治疗:ASCO指南更新
Manish A Shah1, Erin B Kennedy2, Dana Deighton3
1Weill Cornell Medicine, New York, NY.
概括
更新的指导方针建议免疫治疗和针对性治疗晚期胃食道癌症. 生物标志物测试指导精通不匹配修复/微卫星稳定或不匹配修复缺陷/微卫星不稳定性高的癌症的治疗决策.
科学领域:
- 胃肠道瘤学 胃肠道瘤学
- 医学瘤学 医学瘤学
- 癌症治疗指南 癌症治疗指南
背景情况:
- 胃食道癌 (GEC) 涵盖了一系列恶性瘤,包括腺癌和状细胞癌.
- 对于高级GEC的治疗决定是复杂的,并且随着新的治疗选择而不断发展.
研究的目的:
- 为先进的GEC提供免疫治疗和向治疗的最新临床实践建议.
- 引导瘤学家根据患者和瘤特征选择最佳治疗策略.
主要方法:
- 对12项III期随机对照试验进行了系统审查.
- 由ASCO召集的专家小组制定了临床实践建议.
主要成果:
- 对于精通的不匹配修复 (pMMR) /微卫星稳定 (MSS) HER2-阴性GEC,PD-L1表达≥1.1,建议进行免疫疗法加双重化疗.
- 对于具有阳性CLDN18.2表达和PD-L1 <1.1.的GEC,建议使用zolbetuximab.
- 对于pMMR/MSS HER2-阳性胃/胃食道结 (GEJ) 腺癌,推使用trastuzumab和双重化疗,可选 pembrolizumab 治疗PD-L1 ≥1.
结论:
- 及时进行生物标志物测试 (例如,不匹配修复,PD-L1,CLDN18.2,HER2) 对于在先进的GEC中提供治疗决策的信息至关重要.
- 根据生物标志物状态和瘤类型,为一线和二线治疗提供了具体建议.
- 在双重PD-L1和CLDN18.2阳性患者中,鼓励共享决策.
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