放疗联合免疫检查点抑制剂治疗非小细胞肺癌介入时机及安全性的研究进展

Research Progress on Interventional Time and Safety of RT Combined with ICIs for NSCLCL

非小细胞肺癌(non-small lung cancer, NSCLC)是一种常见且致命的恶性肿瘤。放疗(Radiotherapy, RT)是NSCLC一种有效的局部治疗手段。免疫检查点抑制剂(immune checkpoint inhibitors, ICIs),尤其是抗程序性细胞死亡受体1 (PD-1)、程序性细胞死亡配体1 (PD-L1)抗体等药物,使NSCLC患者的无进展生存(progression-free survival, PFS)和总生存(overall survival, OS)有显著延长,为NSCLC患者带来新的希望。但由于一些患者对免疫治疗未产生应答,且很多患者在治疗后很快出现原发性或继发性耐药,因此单纯的ICIs对于治疗NSCLC的疗效仍不满意。近年来,基于RT可以调节免疫系统的原理,一些研究发现在NSCLC的ICIs治疗中加入RT会显现出更好的疗效,但临床上对于RT介入时间及加入RT后安全性仍有争议。本文就ICIs联合放疗的作用机制、介入时机以及安全性问题的研究进展进行总结和论述,为临床治疗提供参考。

Non-small cell lung cancer (NSCLC) is a common and fatal malignant tumor. Radiotherapy (RT) is an effective local treatment modality for NSCLC. Immune checkpoint inhibitors (ICIs), especially anti-programmed cell death receptor-1 (PD-1), and programmed cell death ligand 1 (PD-L1) antibodies, have significantly prolonged the progression-free survival (PFS) and overall survival (OS) of NSCLC patients. However, the efficacy of ICIs alone in the treatment of NSCLC is still unsatisfactory since some patients do not respond to immunotherapy and many patients develop primary or secondary drug resistance soon after treatment. In recent years, based on the principle that RT can modulate the immune system, some studies have found that adding RT to ICIs for NSCLC shows better efficacy in the treatment, but the timing of RT intervention and the safety of adding RT are still controversial in clinical practices. This article reviews and discusses the research progresses on the mechanism of the combined radiotherapy and ICIs therapy, the timing of RT intervention, and relevant safety issues, providing references for clinical treatment.