头颈癌免疫疗法

English | 2023 | ASIN : B0CBR2979N | 254 Pages | True 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，它们共享一个共同的特征——通过先天或获得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、EBV与鼻咽癌之间的病因关联进一步推动了在这一类癌症中评估免疫疗法的研究力度。近年来，在实体肿瘤中成功开发的抗程序性细胞死亡蛋白1（PD-1）/配体（PD-L1）和CTLA-4抗体，逐渐将其带入主流的肿瘤学实践领域。除了免疫检查点蛋白抑制剂之外，针对EB病毒或人乳头瘤病毒靶向疗法、疫苗以及细胞疗法等其他形式的免疫疗法也在临床试验中积极研究，有时单独使用，有时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，治疗头颈癌患者的肿瘤科医生需要熟悉一些特殊的免疫反应模式，例如正在接受免疫检查点抑制剂治疗的患者可能出现伪进展和超进展等不寻常现象。此外，还需要及时识别并妥善处理免疫检查点抑制剂所带来的独特副作用，如自身免疫毒性。预测免疫检查点抑制剂效果的生物标志物的发展在实践中或临床试验中选择免疫疗法患者的筛选策略方面发挥了至关重要的作用。目前已有关于PD-L1表达（联合阳性评分）、基因特征和肿瘤突变负荷等生物标志物在临床上应用数据的出现。

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