免疫检查点抑制剂在EGFR突变型晚期非小细胞肺癌中的应用

Application of Immune Checkpoint Inhibitors in EGFR Mutant Advanced Non-small Cell Lung Cancer

近年来,免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)极大地提高了无驱动基因突变的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的生存率。与野生型肿瘤相比,表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的肿瘤在程序性细胞死亡配体1(programmed cell death ligand 1,PD-L1)、肿瘤突变负荷(tumor mutational burden,TMB)等免疫微环境特征上具有更大的异质性。ICIs是否适用于EGFR突变的NSCLC患者一直存在争议。临床研究显示免疫单药对于EGFR突变的NSCLC患者无显著疗效,ICIs联合化疗和抗血管生成药物则显示了良好的生存获益。本文就EGFR突变晚期NSCLC患者ICIs单药或联合治疗的临床研究及相关机制进行综述。

In recent years,immune checkpoint inhibitors(ICIs)have greatly improved the survival rate of nonsmall cell lung cancer(NSCLC)patients without driver mutation.Compared with wild-type tumors,tumors with epidermal growth factor receptor(EGFR)mutations have greater heterogeneity in immune microenvironment characteristics such as programmed cell death ligand 1(PD-L1)and tumor mutational burden(TMB).Whether ICIs is suitable for NSCLC patients with EGFR mutation has been controversial.Clinical studies have shown that immunomonotherapy has no significant effect on patients with EGFR mutant NSCLC.ICIs combined with chemotherapy and antiangiogenic drugs show good survival benefits.This paper overviews the clinical research and related mechanism of ICIs single drug or combination therapy inadvanced NSCLC patients with EGFR mutation.