放疗联合免疫治疗在非小细胞肺癌中的研究进展

Research Progress of Radiotherapy Combined with Immunotherapy in Non-Small Cell Lung Cancer

肺癌(lung cancer, LC)是全球最常见的癌症之一,也是全球癌症相关死亡的主要原因,其中约80%的病例为非小细胞肺癌(non-small-cell lung cancer, NSCLC)。在过去十年中,免疫检查点抑制剂(ICIs),如程序性死亡1 (PD-1)和程序性死亡配体1 (PD-L1)抑制剂,极大地改变了NSCLC的治疗策略。近年来,事后分析和早期临床试验提供了越来越多的证据,证明放射治疗(RT)和免疫疗法在治疗从早期到转移性疾病的NSCLC方面具有协同作用。放射治疗似乎不仅能增强免疫疗法对靶病灶的作用,还能在不直接暴露于辐射的情况下对远处病灶产生抗肿瘤反应。在这篇综述中,我们将介绍免疫疗法和放射疗法的生物学基础、有关生物标志物的新证据,以及支持将放射免疫疗法用于早期、局部晚期和转移性NSCLC的临床前和临床数据。

Lung cancer is one of the most common cancers and the leading cause of cancer-related deaths worldwide, and about 80% of these cases are non-small cell lung cancer (NSCLC). Over the past decade, immune checkpoint inhibitors (ICIs), such as programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors, have dramatically altered the therapeutic strategies for NSCLC. In recent years, post-hoc analyses and early clinical trials have provided increasing evidence of the synergistic effects of radiation therapy (RT) and immunotherapy in the treatment of NSCLC from early to metastatic disease. Radiation therapy appears to not only enhance the effect of immunotherapy on the target lesion, but also produce an antitumor response on distant lesions without direct exposure to radiation. In this review, we will present the biological basis of immunotherapy and radiation therapy, new evidence regarding biomarkers, and preclinical and clinical data supporting the use of radioimmunotherapy for early, locally advanced, and metastatic NSCLC.