免疫检查点抑制剂在晚期胸腺上皮肿瘤中的研究进展

Advances in the study of immune checkpoint inhibitors in advanced thymic epithelial tumors

胸腺上皮肿瘤(TET)是一种罕见的纵隔恶性肿瘤,因缺乏随机对照研究,目前国内尚无标准治疗方案。早期TETs首选手术切除,对于手术难以切除、复发或转移的晚期TETs主要采取内科综合治疗,包括化疗、靶向治疗和免疫治疗。美国国立癌症综合网络(NCCN)指南推荐以铂类为基础的联合化疗方案,但疗效不尽如人意。近年来,随着对TETs生物学的深入认识,越来越多的研究开始关注免疫检查点抑制剂(ICI)如抗程序性死亡受体1(PD-1)/程序性死亡受体配体1(PD-L1)抗体在TETs中的应用,但由于TETs的独特生物学特性,免疫治疗会带来严重的免疫相关不良反应(irAE)。本文回顾了近几年国内外ICIs治疗晚期TETs的临床研究及个案报道,重点关注ICIs在TETs中的疗效及irAEs,以期为晚期TETs的治疗提供更多策略。

Thymic epithelial tumor(TET)is a rare mediastinal malignant tumor.Due to the lack of randomized con-trolled trials,there is no standard treatment in China at present.Surgical resection is the first choice for TETs in early stage,but for unresectable,recurrent or metastatic advanced TETs,comprehensive medical treatment is mainly adopted,including chemotherapy,targeted therapy and immunotherapy.National Comprehensive Cancer Network guidelines recommend plati-num-based combination chemotherapy,but the efficacy is not satisfactory.In recent years,with an in-depth understanding of biology of TETs,more and more studies have focused on the use of immune checkpoint inhibitors(ICIs)such as anti-pro-grammed death 1(PD-1)/programmed death ligand-1(PD-L1)antibodies in TETs.However,due to the unique biological characteristics of TETs,immunotherapy may bring serious immune-related adverse events(irAE).This paper reviewed the clinical studies and case reports of ICIs in the treatment of advanced TETs at home and abroad in recent years,focusing on the efficacy of ICIs and irAEs in the treatment of advanced TETs,so as to provide additional strategies for the treatment of advanced TETs.