靶向及免疫药物联合同步放化疗治疗局部晚期宫颈癌中国专家共识

Chinese expert consensus on targeted and immunotherapy combined with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer

同步放化疗是指同时接受放射及化疗药物治疗,用小剂量化疗增加放射治疗的效果,以减少肿瘤复发与转移,改善患者预后。目前,同步化疗增加放疗敏感性的主要依据为同步化疗阻止肿瘤细胞的修复;化疗和放疗作用于肿瘤细胞的不同周期,起到协同杀伤作用。但即使经过同步放化疗的局部晚期宫颈癌(LACC)患者,5年生存率也仅为60%,仍不十分理想。为了提高LACC患者同步放化疗的治疗效果,研究者们进行了一系列药物探索性研究,包括联合靶向药物、免疫药物,以及新辅助治疗等。虽然靶向或免疫药物是治疗宫颈癌的有效手段,但目前仍缺少大规模的循证医学证据,尚需开展多中心的前瞻性、随机Ⅲ期临床研究,提高循证医学等级。本共识总结了已发表的若干关键循证医学证据,尤其是靶向及免疫治疗的临床研究进展,为国内同行提供参考。

Concurrent chemoradiotherapy(CCRT)refers to the simultaneous treatment of chemotherapy and radiotherapy,and the effect of radiotherapy is enhanced with low-dose chemotherapy,which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients.At present,the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells,and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects.However,even for patients with locally advanced cervical cancer(LACC)who have undergone CCRT,the 5-year survival rate is only 60%,which is still not ideal.In order to improve the efficacy,researchers have conducted a series of exploratory studies,which consist of the combination of targeted drugs and immunodrugs,and neoadjuvant regimens before CCRT,etc.Although targeted or immunologic drugs are effective treatment of LACC,in view of the lack of large-scale evidence-based medical evidence,multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine.This consensus summarizes several key evidence-based medical studies published recently,especially the clinical research progress in targeted and immunological therapies,providing reference for domestic peers.