免疫治疗在广泛期小细胞肺癌中的临床应用

Clinical application of immunotherapy for extensive-stage small-cell lung cancer

小细胞肺癌(small cell lung cancer,SCLC)是临床难治肿瘤之一,约75%~80%患者发现时已发展为广泛期SCLC(extensive stage-SCLC,ES-SCLC),中位生存期不足1年。随着免疫检查点抑制剂在多种实体瘤的成功应用,ES-SCLC的免疫治疗也出现大量的临床研究,但同时对于不同阶段的治疗策略也提出了更高的要求和挑战。本文对近年开展的初治和经治ES-SCLC患者免疫治疗相关临床研究进行综述,涉及了PD-1、PD-L1、CTLA-4抑制剂,免疫检查点抑制剂的单药治疗和联合治疗模式,以及预测疗效的生物标志物,总结最佳治疗模式,深入思考未来研究的方向,以期提高疗效,改善患者生存。

Small cell lung cancer(SCLC)is one of the most refractory tumors.Approximately two-thirds of patients have been reported to have extensive-stage small cell lung cancer(ES-SCLC)when diognosed,with a survival time of less than one year.With the successful application of immune checkpoint inhibitors to a variety of solid tumors,several clinical studies have been conducted on immunotherapy for ES-SCLC.However,this present higher requirements and challenges for application of effective strategies in different disease stages.This paper reviews the completed immune-related clinical research in naïve and treated ES-SCLC patients in recent years.In this article,PD-1 inhibitors,PD-L1 inhibitors,CTLA-4 inhibitors,immune checkpoint inhibitor monotherapy and combined immunotherapy,and biomarkers for predicting treatment efficacy have been explored.This article summarizes the best treatment model,deeply considers future research directions,and attempts to improve the efficacy and survival of patients with ES-SCLC.