免疫检查点抑制剂在广泛期小细胞肺癌一线治疗中的进展

Progress of immune checkpoint inhibitors in first-line treatment of extensive small cell lung cancer

小细胞肺癌(SCLC)是肺癌的一种高侵袭性亚型,病情进展快,短期内易复发,预后极差。三十年来小细胞肺癌的治疗始终以化疗为主,但大多数患者都会复发,长期生存率极低。近年来免疫治疗在广泛期SCLC(ES-SCLC)的治疗上取得了突破性进展,早期IMpower133和CASPIAN研究率先证明在化疗的基础上加用免疫检查点抑制剂(ICIs)可提高ES-SCLC患者的生存期,从而确立了ICIs联合化疗的一线治疗新标准。随后CAPSTONE-1和ASTRUM-005研究也证实国产ICIs一线治疗能够延长ES-SCLC的中位生存期且显著延缓疾病进展,同时多项真实世界的临床研究也取得了相似的结果。因此,提高ES-SCLC免疫治疗的疗效和尽量筛选出从免疫治疗中受益的人群是进一步研究的方向。本文就广泛期小细胞肺癌一线免疫治疗的现状、真实世界免疫治疗的情况以及免疫治疗疗效预测的潜在生物标志物进行综述,为临床提供参考。

Objective:Small cell lung cancer(SCLC)is a highly invasive subtype of lung cancer with rapid progression,short-term recurrence,and extremely poor prognosis.The treatment of small cell lung cancer has always been based on chemotherapy in the past three decades,but most patients relapse,and the long-term survival rate is extremely low.In recent years,immunotherapy has made breakthrough progress in the treatment of extensive stage SCLC(ES-SCLC).Early IMpower133 and CASPIAN studies were the first to demonstrate that the addition of immune checkpoint inhibitors(ICIs)to chemotherapy could improve the survival of patients with ES-SCLC,thus establishing a new standard of first-line treatment with ICIs combined with chemotherapy.Subsequently,the CAPSTONE-1 and ASTRUM-005 studies also confirmed that domestic ICIs first-line therapy can prolong the median survival time of ES-SCLC patients and significantly delay disease progression,while several real-world clinical studies have also achieved similar results.Therefore,improving the efficacy of immunotherapy for ES-SCLC and maximizing the number of patients who can benefit from immunotherapy is a direction for further research.This article reviews the current situation of first-line immunotherapy for small cell lung cancer,the situation of immunotherapy in the real world,and potential biomarkers for predicting the efficacy of immunotherapy.