免疫治疗在EGFR突变晚期非小细胞肺癌中的研究进展

Progress of Immunotherapy in EGFR-mutated Advanced Non-small Cell Lung Cancer

表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的一线治疗方案首选EGFR酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs),但耐药不可避免。近几年,虽然免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)改变了无驱动基因突变晚期NSCLC的治疗模式,但这些药物对EGFR突变晚期NSCLC患者的临床疗效有限。与EGFR野生型肿瘤相比,EGFR突变型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)等肿瘤微环境(tumor microenvironment,TME)的特征上更具异质性,ICIs是否适用于EGFR突变晚期NSCLC患者仍值得探讨。这篇综述总结了有关ICIs在EGFR突变晚期NSCLC患者中疗效的临床数据,并解读了EGFR突变NSCLC独特的TME。

Epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)are currently the first-line standard of care for patients with non-small cell lung cancer(NSCLC)that harbor EGFR mutations.Nevertheless,resistance to EGFR-TKIs is inevitable.In recent years,although immune checkpoint inhibitors(ICIs)have significantly shifted the treatment paradigm in advanced NSCLC without driver mutation,clinical benefits of these agents are limited in patients with EGFRmutated NSCLC.Compared with wild-type tumors,tumors with EGFR mutations show more heterogeneity in the expression level of programmed cell death ligand 1(PD-L1),tumor mutational burden(TMB),and other tumor microenvironment(TME)characteristics.Whether ICIs are suitable for NSCLC patients with EGFR mutations is still worth exploring.In this review,we summarized the clinical data with regard to the efficacy of ICIs in patients with EGFR-mutated NSCLC and deciphered the unique TME in EGFR-mutated NSCLC.