胃癌免疫治疗研究进展OA北大核心CSTPCD
Advances and reflections on neoadjuvant immunotherapy for advanced gastric cancer
目前,化疗联合免疫检查点抑制剂已成为进展期胃癌和食管胃结合部腺癌的重要治疗手段之一,但在局部进展期胃癌治疗中其有效性仍未得到较高级别的研究验证.分子标记与个体化检测的结合可能成为筛选胃癌免疫治疗获益人群的有效手段;新辅助免疫治疗方案应考虑肿瘤的具体类型、分子特征,以及病人的整体健康状况.新辅助治疗2~4个周期后进行常规评估,并结合多学科综合治疗组讨论,有助于在整个治疗过程中把握最佳时机;新辅助免疫治疗效果评估需综合判断,影像学和病理检查评估仍存在较大争议;新辅助免疫治疗后4~6周的手术间隔时间可能是最佳的手术时机,手术方式的选择应综合考虑肿瘤的位置、大小、病人的整体健康状况和技术可行性等因素;新辅助免疫治疗期间对不良事件的管理和有效干预将有助于改善病人结局,在治疗过程中应密切关注病人身体反应情况,并根据实际情况调整治疗方案以确保最佳平衡效果.
Currently,chemotherapy combined with immune checkpoint inhibitors(ICIs)has become one of the important treatments for advanced gastric cancer or adenocarcinoma of esophagogastric junction.However,the effectiveness of this ap-proach in locally advanced gastric cancer has still not been val-idated by higher-level studies.The combination of molecular markers and personalised tests may be an effective means of screening the population for the benefits of immunotherapy in gastric cancer;The neoadjuvant immunotherapy regimen should take into account the specific type of tumour,molecular characteristics,and the patient's overall health status.Rou-tine evaluation after 2-4 cycles of neoadjuvant therapy com-bined with multidisciplinary team discussion can grasp the best timing during the whole treatment process and maintain the best interests of patients;The evaluation of the efficacy of neoadjuvant immunotherapy requires comprehensive judg-ment,and imaging and pathological evaluation are still subject to great controversy;The surgical interval of 4-6 weeks after neoadjuvant immunotherapy may be the optimal timing of sur-gery.The choice of surgery should take into account the loca-tion and size of the tumour,the patient's overall health status,and technical feasibility.Careful management and effective in-tervention of adverse events(IrAEs)during neoadjuvant immu-notherapy will help to improve the patient's outcome,and cli-nicians should closely monitor the patient's physical response throughout the course of the treatment and adjust the treatment regimen accordingly to ensure the best-balanced outcome.
徐泽宽;李沣员;吴昊
南京医科大学第一附属医院胃肿瘤中心,江苏南京 210029
临床医学
胃癌免疫检查点抑制剂新辅助治疗
gastric cancerimmune checkpoint inhibitorsneoadjuvant therapy
《中国实用外科杂志》 2024 (010)
1109-1114 / 6
国家自然科学基金项目(No.81871946,No.82072708);中国国家科学技术基础研究专项基金项目(No.2019FY101104);江苏省高等教育机构重点学科建设项目(JX10231801);江苏省重点学科(普通外科学)项目(No.ZDXKA2016005);南京医科大学第一附属医院创新研究项目(No.PAPD)
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