Progress of immune checkpoint inhibitors in advanced gastric cancer with PD-L1 negative and low expression
Objective To review the research progress of immune checkpoint inhibitors(ICIs)in advanced gastric cancer,especially in patients with programmed death-ligand 1(PD-L1)negative and low expression,and to provide reference for its clinical application.Methods Using"gastric cancer,immunotherapy,immune checkpoint inhibitor,programmed death-ligand 1(PD-L1)"as the keywords,the relevant literature were searched from PubMed,China National Knowledge Infrastructure(CNKI)Database from January 1,2000 to February 1,2024.Inclusion criteria:(1)clinical studies invol-ving patients with advanced gastric cancer;(2)immunotherapy and biomarkers;(3)efficacy of PD-L1 and ICIs.Exclu-sion criteria:studies with duplicate and incomplete data were excluded.Finally,63 articles were included.Among them,there was 1 Chinese literature and 62 English literature.Result ICIs is widely used in advanced gastric cancer.In gener-al,the higher the expression level of PD-L1,the better the immunotherapy efficacy of patients with advanced gastric cancer.However,in advanced gastric cancer patients with low PD-L1 combined positive score(CPS)expression(CPS＜5),it is unclear whether ICIs can significantly prolong the survival of patients.On the one hand,the CPS＜5 population should be further subdivided into CPS 1-4 and CPS＜1 populations,the former of which may benefit from immunothera-py,but the latter of which is difficult to benefit.On the other hand,due to the heterogeneity of PD-L1 expression and the limitations of detection methods,its value in predicting immune efficacy is limited,and it should be combined with other biomarkers or clinical characteristics to judge.Larger,deeper and more precise studies are needed to explore and optimize treatment options for patients with low PD-L1 expression of gastric cancer.Conclusions ICIs plays an important role in the treatment of advanced gastric cancer,and the expression level of PD-L1 is closely related to the immune efficacy,but it is not the only determining factor.The benefits of ICIs in patients with low and negative PD-L1 expression should be differentiated and further validated in large clinical studies.
gastric cancerimmunotherapyimmune checkpoint inhibitorPD-L1review literature
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