肺癌免疫治疗假性进展的临床现状及研究进展

Clinical Manifestations and Research Progression on Pseudoprogression in Lung Cancer Patients Undergoing Immunotherapy

目前肺癌的免疫治疗,尤其是免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)的应用在晚期肺癌治疗中的地位正在逐渐提升。ICIs是通过对T细胞免疫抑制信号的解除来激活肿瘤患者的自身免疫系统。在临床治疗过程中,部分患者会出现一些非传统的临床反应,被认为是假性进展。目前对于肺癌假性进展的评估主要依据免疫影像学标准,同时许多研究者也致力于寻找血清学标志物或通过基因组测序来鉴别肿瘤假性进展和真进展。肺癌的假性进展表现多样,其临床评估和治疗目前存在诸多争议,虽然大多经过对症治疗后,患者症状可得到控制,且可继续进行下一疗程的免疫治疗,但仍然需要加强对假性进展的多方位了解,也有助于对临床免疫治疗策略提供更多可靠的依据。该文主要对肺癌免疫治疗假性进展的临床现状及研究进展进行综述。

The application of immunotherapy,especially with immune check point inhibitors(ICIs)in the treatment of advanced lung cancer is gradually rising.ICIs activate the immune system of cancer patients by blocking T cell immunosuppressive signals.In the course of clinical treatment,some patients will have some unconventional clinical reactions,which are considered as pseudoprogression.At present,the evaluation of pseudoprogression of lung cancer is mainly based on immunoimaging criteria.At the same time,serological markers or genome sequencing are used to differentiate pseudoprogression from true progression of lung cancer.Pseudoprogression of lung cancer is manifested variously,and there are still controversies about its clinical evaluation and treatment.Most of the clinical manifestations can be controlled and immunotherapy can be continued.To fully understanding the multi-dimensions of pseudoprogression will provide reliable basis for clinical immunotherapy strategies.In this article,the clinical manifestation and research progression of pseudoprogression in lung cancer patients undergoing immunotherapy are reviewed.