免疫治疗在局部进展期胃癌围手术期治疗的初步探索

Preliminary exploration of perioperative immunotherapy for locally advanced gastric cancer

基于Resolve试验和FLOT4试验的结果,胃癌新辅助化疗+D2根治术成为当前标准治疗策略之一。程序性细胞死亡蛋白1/程序性细胞死亡蛋白1配体1单抗为代表的免疫疗法显著改善了晚期胃癌病人的生存结局。近年来多项胃癌围手术期化疗+免疫治疗的研究显示,化疗+免疫治疗显著提高了病理完全缓解率。MATTERHONE研究的近期疗效较为显著,但是ATTRACTION-5和KEYNOTE-585研究未达到预期。免疫优势人群的筛选和化疗方案的选择是围手术期免疫治疗的主要问题。

Based upon the findings of Resolve and FLOT4 trials,neoadjuvant chemotherapy+D2 radical resection for gastric cancer has become one of the latest standard treatments.Immunotherapy of PD-1/PD-L1 monoclonal antibody has significantly improved the survival outcomes of patients with locally advanced gastric cancer.Perioperative chemoimmunotherapy could significantly boost the pathological complete response rate.The Matterhorn study has demonstrated significant short-term efficacy.However,the ATTRACTION-5 and KEYNOTE-585 studies failed to fulfill the expectations.Screening of immunodominant populations and a proper choice of chemotherapeutic regimen are two major issues of perioperative immunotherapy.