浅谈胆道恶性肿瘤免疫治疗面临的挑战:治疗抵抗及超进展

A brief discussion on the challenges of immunotherapy in biliary malignant tumors:treatment resistance and hyperprogression

免疫治疗为胆道恶性肿瘤(BTC),特别是晚期患者提供了新的治疗方案,durvalumab以其可接受的药物毒性及显著的预后改善作用成为晚期BTC的一线治疗方案。不可忽视的是,免疫治疗为BTC患者带来获益的同时面临着两项挑战,即治疗抵抗及超进展,二者发生率较高,影响免疫治疗疗效甚至加速肿瘤进展。笔者从二者发生机制入手,梳理其中免疫相关生物学过程,以此为依据制定方案应对免疫治疗抵抗及超进展,以期帮助提升BTC免疫治疗疗效、完善胆道外科综合治疗策略。

Immunotherapy provides a new treatment option for biliary tract cancers(BTC),especially for patients with advanced stages.Durvalumab,with its acceptable drug toxicity and significant improvement in prognosis,has emerged as a first-line treatment for advanced BTC.However,it should not be overlooked that while immunotherapy benefits BTC patients,it also faces two challenges:treatment resistance and hyperprogression.Both of these challenges have a relatively high incidence,impacting the efficacy of immunotherapy and potentially accelerating tumor progression.Here,the authors outline the immunerelated biological processes involved by delving into the mechanisms underlying these two challenges to lay a foundation for developing regimens to tackle immunotherapy resistance and hyperprogression,to enhance the efficacy of immune therapy for BTC and refine the comprehensive strategy for surgical treatment of biliary tract conditions.