新辅助免疫联合治疗在局部晚期头颈部鳞状细胞癌的应用进展
Application of neoadjuvant immunotherapy in locally advanced squamous cell carcinoma of head and neck
马艺轩 1李晓娟 2靳晴 2纪鸾 2乔俏3
作者信息
- 1. 中国医科大学第二临床学院,辽宁沈阳 110122
- 2. 中国医科大学第一临床学院,辽宁沈阳 110122
- 3. 中国医科大学附属第一医院放疗科,辽宁沈阳 110001
- 折叠
摘要
目的 总结新辅助免疫联合治疗方式在局部晚期头颈部鳞状细胞癌(LA-HNSCC)中的最新研究成果与临床应用现状,为优化综合治疗方案、改善LA-HNSCC患者的治疗效果和生活质量提供参考依据.方法 以"头颈部肿瘤、鳞状细胞癌、新辅助治疗、免疫治疗、新辅助联合治疗、生物标志物、毒副反应"为中文关键词,以"head and neck neoplasm、squamous cell carcinoma、neoadjuvant therapy、Immunotherapy、neoadjuvant combination therapy、biomarkers、toxic and side effects"为英文关键词,检索PubMed数据库和维普数据库2010年10月-2023年8月发表的关于LA-HNSCC新辅助免疫联合治疗方面的文献.纳入标准:(1)LA-HNSCC;(2)新辅助联合免疫治疗.排除标准:(1)会议性、评论类等文献;(2)鼻咽癌相关的文献.共纳入47篇文献,其中中文文献5篇,英文文献42篇.结果 基于新辅助免疫治疗的联合治疗有利于LA-HNSCC患者实现病理缓解,3个周期后病理完全缓解(pCR)率为37.0％～100％,主要病理缓解(MPR)率为40％～100％.实现病理缓解的HNSCC患者较非病理缓解者的无病生存期和总生存期更长,且差异均有统计学意义.程序性死亡配体1(PD-L1)高表达和HPV相关HNSCC作用更为明显,PD-L1高表达者客观缓解率为68.2％～100％,HPV相关HNSCC患者pCR率和MPR率分别为90％和100％.从新辅助免疫联合治疗HNSCC的毒副作用来看,3～4级治疗相关不良事件偶见,未见治疗相关死亡病例,整体可控.结论 新辅助免疫联合治疗LA-HNSCC可有效提高肿瘤的客观反应率,且对PD-L1高表达及HPV相关HNSCC作用更为明显.然而新辅助免疫联合治疗对LA-HNSCC 长期生存的益处有待进一步研究.
Abstract
Objective To summarize the latest research results and clinical application of neoadjuvant immunotherapy in lo-cally advanced head and neck squamous cell carcinoma(LA-HNSCC)in order to optimize the comprehensive treatment plan and improve the treatment effect and quality of life of LA-HNSCC patients.Methods Using"head and neck tumor,squamous cell carcinoma,neoadjuvant therapy,immunotherapy,neoadjuvant combination therapy,biomarkers,toxic and side effects"as Chinese and English keywords,we searched for literature on neoadjuvant immunotherapy combination for LA-HNSCC published in PubMed and VIP databases from October 2010 to August 2023.Inclusion criteria:(1)Locally advanced head and neck squamous cell carcinoma;(2)Neoadjuvant combined immunotherapy.Exclusion criteria:(1)Con-ference and commentary literature;(2)Nasopharyngeal carcinoma related literature.A total of 47 literature were includ-ed,including 5 Chinese literature and 42 English literature.Results Combination therapy based on neoadjuvant immuno-therapy is beneficial in achieving pathological remission in patients with LA-HNSCC,with a pathologic complete response(pCR)rate of 37.0％-100％and major pathologic response(MPR)rate of 40％-100％after three cycles.Patients with HNSCC who achieved pathological remission have higher disease-free survival and overall survival than those without pathological remission,and the differences are statistically significant.The effect of high expression of programmed death-ligand 1(PD-L1)and human papillomavirus(HPV)-associated HNSCC is more obvious:the objective response rate of high expression of PD-L1 is 68.0％-100％.The pCR and MPR of HPV-associated HNSCC patients are 90％and 100％.From the toxicities and side effects of neoadjuvant combined immunotherapy for HNSCC,Grade 3-4 treatment-related adverse events(TRAEs)are occasional,and no treatment-related deaths are found,indicating that the overall tox-icity is controllable.Conclusions Neoadjuvant immunotherapy combination therapy of advanced LA-HNSCC can effec-tively improve the objective response rate of tumor,and the effect of PD-L1 overexpression and HPV-associated HNSCC is more obvious.However,the long-term survival benefit of neoadjuvant immunotherapy combination therapy for LA-HNSCC needs to be further studied.
关键词
头颈部肿瘤/鳞状细胞癌/新辅助治疗/免疫治疗/新辅助联合治疗/生物标志物/毒副作用/综述文献Key words
head and neck neoplasm/squamous cell carcinoma/neoadjuvant therapy/immunotherapy/neoadjuvant combina-tion therapy/biomarkers/toxic and side effects/review literature引用本文复制引用
出版年
2024
NETL
NSTL
万方数据