肿瘤突变负荷对肺癌免疫治疗疗效的预测价值

Predictive Value of Tumor Mutation Burden in Immunotherapy for Lung Cancer

肺癌的发病率和死亡率居全球首位,除化疗、放疗和靶向治疗外,免疫治疗也成为其不容忽视的治疗策略。美国食品药品监督管理局(Food and Drug Administration, FDA)相继批准免疫检查点抑制剂作为晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)二线治疗和部分患者一线治疗的标准方案。美国国家综合癌症网(National Comprehensive Cancer Network, NCCN)也推荐免疫检查点抑制剂用于复发小细胞肺癌(small cell lung cancer,SCLC)的治疗。目前肺癌治疗已进入精准治疗时代,因此挑选有效及可靠的生物标记物,筛选出接受免疫治疗的优势人群成为精准治疗的重点。越来越多的研究提示肿瘤突变负荷(tumor mutation burden, TMB)未来可能成为免疫治疗的独立预测生物标记物,但是TMB在预测免疫疗效方面仍有一定局限性。本文综述了TMB对于肺癌免疫治疗疗效的预测价值及临床应用中相关问题。

The morbidity and mortality of lung cancer is the first in the world,immunotherapy has become a important treatment strategy in addition to chemotherapy,radiotherapy and targeted therapy.In recent years,the US Food and Drug Administration(FDA)has successively approved immunological checkpoint inhibitors as standard programs for non-small cell lung cancer(NSCLC)in second-line or first-line treatment.The National Comprehensive Cancer Network(NCCN)also recommends immunological checkpoint inhibitors as the standard treatment for small cell lung cancer(SCLC).Now,the treatment for lung cancer has entered the era of precision treatment,it is very important to select effective and reliable biomarker for the dominant populations of lung cancer to receive immunotherapy.A large number of researchs indicated that tumor mutation burden(TMB)may be an independent predicted biomarker for immunotherapy,but with limitations.This article reviewed the predictive value of TMB and its limitations in the field of immunotherapy for lung cancer.