头颈癌免疫疗法（癌症免疫疗法书1）

English | 2023 | ASIN : B0CBR2979N | 254 Pages | PDF EPUB | 9.3 MB

Head and neck cancer is a biologically diverse group of cancers that bear a common hallmark - evasion of host immune surveillance through innate or acquired mechanisms. The etiological association between the Human Papilloma virus (HPV) and some squamous head and neck cancers, the Epstein-Barr virus (EBV) and nasopharyngeal cancer has provided further impetus for evaluating immunotherapy in this group of cancers. The successful development of anti-programmed cell death protein-1 (PD-1)/ ligand (PD-L1) and CTLA-4 antibodies in solid tumours has gradually brought immunotherapy into mainstream oncological practice in recent years. Besides immune-checkpoint proteins inhibitors, other forms of immunotherapy such as vaccines, EBV or HPV-targeting therapies and cellular therapies are actively being investigated in clinical trials, either alone or in combination with other conventional treatments such as radiotherapy, chemotherapy and surgery. In clinical setting, the practicing oncologist need to be familiar with some unusual patterns of immunological response such as pseudo-progression and hyper-progression in patients with head and neck cancers who are undergoing treatment with immune-checkpoint inhibitors. Furthermore, the unique side effects of immune-checkpoint inhibitors such as autoimmune toxicities need to be recognized early and treated expediently. The development of biomarkers in predicting response to immune-checkpoint inhibitors has played pivotal roles in selecting patients for immunotherapy in practice or as an enrichment strategy in clinical trials. There are now emerging data on the clinical utility of biomarkers such as PD-L1 expression (Combined Positive Score), gene signatures and tumor mutational burden.

头颈癌是一种具有生物多样性的癌症群体，它们共享一个共同特征——通过先天或获得性机制逃避宿主免疫监视。人乳头瘤病毒（HPV）与某些鳞状头颈癌之间关联以及Epstein-Barr病毒（EBV）与鼻咽癌之间的联系，进一步促使我们评估这种癌症类型中的免疫疗法。近年来，在实体肿瘤中成功开发的针对程序性细胞死亡蛋白1（PD-1）/配体（PD-L1）及CTLA-4抗体逐渐使其在主流肿瘤学实践中得以应用。除了免疫检查点蛋白抑制剂外，其他形式的免疫治疗，例如疫苗、针对EBV或HPV的疗法以及细胞疗法，在临床试验中也被积极研究，既可以单独使用也可以与其他传统治疗方法如放疗、化疗和手术结合使用。在临床上，正在接受免疫检查点抑制剂治疗的头颈癌患者需要熟悉一些罕见的免疫反应模式，例如免疫进展假象（pseudo-progression）和过度进展（hyper-progression）。此外，还需要提前识别并及时处理免疫检查点抑制剂的独特副作用，如自身免疫毒性。在实践中及临床试验中，对免疫检查点抑制剂疗效预测标志物的发展发挥了关键作用，这有助于选择适合接受免疫治疗的患者或作为临床试验中的富集策略。目前已经开始有数据表明PD-L1表达（联合阳性评分）、基因签名和肿瘤突变负荷等标志物在临床上具有实用性。

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