胃癌免疫治疗研究进展

Advances and reflections on neoadjuvant immunotherapy for advanced gastric cancer

目前,化疗联合免疫检查点抑制剂已成为进展期胃癌和食管胃结合部腺癌的重要治疗手段之一,但在局部进展期胃癌治疗中其有效性仍未得到较高级别的研究验证。分子标记与个体化检测的结合可能成为筛选胃癌免疫治疗获益人群的有效手段;新辅助免疫治疗方案应考虑肿瘤的具体类型、分子特征,以及病人的整体健康状况。新辅助治疗2~4个周期后进行常规评估,并结合多学科综合治疗组讨论,有助于在整个治疗过程中把握最佳时机;新辅助免疫治疗效果评估需综合判断,影像学和病理检查评估仍存在较大争议;新辅助免疫治疗后4~6周的手术间隔时间可能是最佳的手术时机,手术方式的选择应综合考虑肿瘤的位置、大小、病人的整体健康状况和技术可行性等因素;新辅助免疫治疗期间对不良事件的管理和有效干预将有助于改善病人结局,在治疗过程中应密切关注病人身体反应情况,并根据实际情况调整治疗方案以确保最佳平衡效果。

Currently,chemotherapy combined with immune checkpoint inhibitors(ICIs)has become one of the important treatments for advanced gastric cancer or adenocarcinoma of esophagogastric junction.However,the effectiveness of this approach in locally advanced gastric cancer has still not been validated by higher-level studies.The combination of molecular markers and personalised tests may be an effective means of screening the population for the benefits of immunotherapy in gastric cancer;The neoadjuvant immunotherapy regimen should take into account the specific type of tumour,molecular characteristics,and the patient’s overall health status.Routine evaluation after 2-4 cycles of neoadjuvant therapy combined with multidisciplinary team discussion can grasp the best timing during the whole treatment process and maintain the best interests of patients;The evaluation of the efficacy of neoadjuvant immunotherapy requires comprehensive judgment,and imaging and pathological evaluation are still subject to great controversy;The surgical interval of 4-6 weeks after neoadjuvant immunotherapy may be the optimal timing of surgery.The choice of surgery should take into account the location and size of the tumour,the patient's overall health status,and technical feasibility.Careful management and effective intervention of adverse events(IrAEs)during neoadjuvant immunotherapy will help to improve the patient’s outcome,and clinicians should closely monitor the patient’s physical response throughout the course of the treatment and adjust the treatment regimen accordingly to ensure the best-balanced outcome.