小细胞肺癌治疗研究进展

Research progress in small cell lung cancer treatment

小细胞肺癌(SCLC)是一种预后极差的神经内分泌恶性肿瘤。SCLC的同步放化疗及一线治疗依赖依托泊苷及铂类化疗药物,后线治疗的选择局限。近年来,免疫治疗在SCLC领域崭露头角,免疫联合化疗成为广泛期SCLC一线标准治疗方案。ASTRUM-005、CAPSTONE-1研究证实,斯鲁利单抗和阿得贝利单抗进一步延长了广泛期SCLC患者的生存期。抗血管治疗为SCLC后线治疗带来了新的选择,免疫联合抗血管治疗正在向一线治疗广泛期SCLC推进,并已在局限期SCLC中进行了探索。局限期SCLC治疗进展缓慢,胸部放疗的最佳时机、放疗剂量及分割模式的研究取得了一些进展,但预防性脑照射在局限期SCLC中的作用受到了一些临床证据的质疑。Delta样蛋白3(DLL3)特异性双抗、多腺苷二磷酸核糖聚合酶(PARP)抑制剂等药物不断涌现,有望给SCLC的治疗带来新突破;同时,SCLC分子分型的初步确定对于患者的精准治疗至关重要。目前,局限期SCLC免疫治疗模式的探索、新型免疫药物和不同的联合治疗策略正在SCLC人群中开展多项临床研究。本文综述了小细胞肺癌治疗的研究新进展。

Small cell lung cancer(SCLC)belongs to neuroendocrine malignancy and indicates an extremely poor prog-nosis.Concurrent chemoradiotherapy and first-line chemotherapy of SCLC rely on traditional medication such as etoposide and platinum,and the options after first-line treatment resistance are limited.In recent years,immunotherapy has emerged in the field of SCLC.Immunotherapy combined with chemotherapy has become the first-line standard of care for extensive-stage SCLC.ASTRUM-005 and CAPSTONE-1 studies confirmed that serplulimab and adebrelimab further prolonged the survival time of extensive-stage SCLC patients.Antivascular therapy has offered a new option for third-line or subsequent treatment of SCLC.Immunotherapy combined with antivascular therapy is advancing to the first-line treatment of exten-sive-stage SCLC,and is being explored in limited-stage SCLC.The development of limited-stage SCLC treatment has been slow.Some clinical researches on optimal timing,radiation dose and fractionation pattern of thoracic radiotherapy have made some progress.But the role of prophylactic cranial irradiation in limited-stage SCLC has been questioned by some clinical evidences.New medicine such as delta-like ligand 3(DLL3)inhibitors and poly-ADP ribose polymerase(PARP)inhibitors gradually emerged,hoping to bring new breakthroughs in the treatment of SCLC.Meanwhile,the prelimi-nary determination of molecular subtypes of SCLC is essential for precision therapy.Exploration of immunotherapy pattern in limited-stage SCLC,new immune checkpoint inhibitor medicine and different combination therapy strategies are de-signed in clinical trials for SCLC population.This review aims to summary the new advances in the treatment of SCLC.