不可切除局部晚期非小细胞肺癌免疫治疗进展

doi:10.11904/j.issn.1002-3070.2025.01.010

摘要/Abstract

摘要： 不可切除局部晚期非小细胞肺癌目前常规的治疗方案是同步放化疗后继续免疫维持治疗1年,但由于多数患者不能耐受同步化疗,该治疗方案未能达到预期效果。对这些患者而言,放疗和免疫疗法的结合是一种更有效的治疗策略,既能提升疗效,又能确保安全。但由于Ⅲ期非小细胞肺癌患者异质性大,肿瘤负荷各不相同,且大多数患者肿瘤体积较大,故放疗所致的副反应也相应增加,从而使一部分患者无法完成后续的免疫维持治疗。对于肿瘤体积较大的患者,目前治疗方案是先进行2个周期的诱导化疗以缩小肿瘤。而近期的研究发现,在诱导化疗期间加入同步免疫治疗缩瘤效果更加明显,显示出了较有前景的治疗价值。多项研究表明,循环肿瘤DNA和外周血肿瘤突变负荷已成为多种晚期肿瘤预后和免疫治疗效果的预测指标,有望在以后指导临床医生制定个体化免疫治疗方案。本文就不可切除局部晚期非小细胞肺癌的免疫治疗进展作综述。

关键词: 局部晚期非小细胞肺癌, 同步放化疗, 不良事件, 免疫治疗

Abstract: The conventional treatment for unresectable local advanced non-small cell lung cancer (NSCLC)is concurrent chemoradiotherapy followed by continued immune maintenance therapy for one year.However,due to the fact that most patients cannot tolerate concurrent chemotherapy,this treatment regimen has not achieved the expected results.For these patients,the combination of radiotherapy and immunotherapy is a more effective treatment strategy that can improve efficacy while ensuring safety.However,due to the high heterogeneity of patients with stage Ⅲ NSCLC,their tumor burden varies,and most patients have larger tumor volumes,the side effects caused by radiotherapy also increase accordingly,making it difficult for some patients to subsequent complete the immune maintenance therapy.For patients with larger tumor volumes,the current treatment plan is to first undergo two cycles of induction chemotherapy to shrink the tumor.Recent studies have found that adding synchronous immunotherapy during induction chemotherapy has a more significant tumor reducing effect,demonstrating promising therapeutic value.Many studies have shown that circulating tumor DNA and peripheral blood tumor mutation burden have become predictive indicators for the prognosis and immunotherapy efficacy of various advanced tumors,and are expected to guide clinicians to develop individualized immunotherapy plans in the future.This article reviews the progress of immunotherapy for unresectable locally advanced NSCLC.

Key words: Locally advanced non-small cell lung cancer, Concurrent chemoradiotherapy, Adverse events, Immunotherapy

中图分类号:

R734.2

李才正, 郑婧, 苏巧俐. 不可切除局部晚期非小细胞肺癌免疫治疗进展[J]. 实用肿瘤学杂志, 2025, 39(1): 67-72.

LI Caizheng, ZHENG Jing, SU Qiaoli. Advance progress in immunotherapy for unresectable locally advanced non-small cell lung cancer[J]. Journal of Practical Oncology, 2025, 39(1): 67-72.

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