放疗前诱导免疫治疗在不可切除Ⅲ期非小细胞肺癌中的研究进展

Research progress of induction immunotherapy before radiotherapy in unresectable stage Ⅲ non-small cell lung cancer

  • 摘要: 肺癌是全世界癌症相关死亡的主要原因,其中以非小细胞肺癌(non-small cell lung cancer,NSCLC)最为常见。临床中超过1/3的NSCLC患者在初诊时已处于Ⅲ期,且其中大部分不可切除。放化疗(chemoradiotherapy,CRT)为不可切除Ⅲ期NSCLC的标准治疗方案,然而疗效较差。随着免疫检查点抑制剂的出现,CRT后的巩固免疫治疗使得不可切除Ⅲ期NSCLC患者的生存率较单纯CRT显著提升,但仍有部分患者未能从巩固免疫治疗中获益。目前,基于诱导免疫治疗在可切除Ⅲ期NSCLC中取得的显著效果,探索诱导免疫治疗在不可切除Ⅲ期NSCLC的研究已展开。本文就放疗前的诱导免疫治疗在不可切除Ⅲ期NSCLC的作用机制、最新临床研究进展和诱导免疫治疗周期进行综述,以期为不可切除Ⅲ期NSCLC的临床治疗提供参考依据。

     

    Abstract: Lung cancer is the leading cause of cancer-related deaths worldwide, and non-small cell lung cancer (NSCLC) is the most common type. Because more than one-third of NSCLC patients are diagnosed at stage Ⅲ, most of these tumors are unresectable. Chemoradiotherapy (CRT) is the standard treatment for unresectable stage Ⅲ NSCLC; however, its curative efficacy is poor. Compared with simple CRT, the survival rate of patients with unresectable stage Ⅲ NSCLC following consolidated immunotherapy after CRT has significantly improved owing to the emergence of immune checkpoint inhibitors. However, a subset of patients do not benefit from consolidated immunotherapy. Based on the effectiveness of induction immunotherapy in resectable stage Ⅲ NSCLC, studies have been conducted to extend its application in unresectable stage Ⅲ NSCLC. This article reviews the mechanism of action, recent advancements in clinical research, and cycle of induction immunotherapy before radiotherapy in unresectable stage Ⅲ NSCLC to provide a reference for clinical treatment of unresectable stage Ⅲ NSCLC.

     

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