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中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (03) : 341 -348. doi: 10.3877/cma.j.issn.1674-6902.2024.03.001

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放疗联合免疫治疗对驱动基因阴性NSCLC的困惑分析及应对策略
陈旭1, 牛凯2, 孙建国2,()   
  1. 1. 400037 重庆,陆军(第三)军医大学第二附属医院医务处
    2. 400037 重庆,陆军(第三)军医大学第二附属医院肿瘤科
  • 收稿日期:2024-04-17 出版日期:2024-06-25
  • 通信作者: 孙建国
  • 基金资助:
    国家自然科学基金面上项目(82172670); 重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX1356)

Clinical dilemmas analysis of radiotherapy combined with immunotherapy in driver negative NSCLC

Xu Chen, Kai Niu, Jianguo Sun()   

  • Received:2024-04-17 Published:2024-06-25
  • Corresponding author: Jianguo Sun
引用本文:

陈旭, 牛凯, 孙建国. 放疗联合免疫治疗对驱动基因阴性NSCLC的困惑分析及应对策略[J]. 中华肺部疾病杂志(电子版), 2024, 17(03): 341-348.

Xu Chen, Kai Niu, Jianguo Sun. Clinical dilemmas analysis of radiotherapy combined with immunotherapy in driver negative NSCLC[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(03): 341-348.

恶性肿瘤严重威胁着人类的健康,2020年全球肿瘤流行统计显示肺癌病死率排名第一,发病率位居第二[1]。肺癌分为非小细胞肺癌(non-smallcell lung cancer, NSCLC)和小细胞肺癌(smallcell lung cancer, SCLC)两大类,其中NSCLC约占80%~85%[2,3]。放射治疗(radiotherapy, RT)是NSCLC的主要治疗手段之一,主要用于不能手术切除的局部晚期患者的根治放疗、手术切除的部分患者的术后放疗(如R1切除)、晚期患者的姑息放疗,以及不能手术的早期患者的立体定向放射治疗(stereotactic body radiation therapy, SBRT)。肺癌治疗过程中,约77%病例需要接受放射治疗[4]。对于驱动基因阴性(如EGFR、ALK野生型)NSCLC患者,免疫治疗为首选。多项随机对照研究(randomized controlled trial, RCT)显示,以CTLA-4和PD-1/PD-L1抗体为代表的免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)显著延长NSCLC患者的无进展生存期(progression-free survival, PFS)和总体生存期(overall survival, OS),NCCN、ESMO、CSCO指南都推荐ICIs作为NSCLC的标准治疗[5]。放射治疗联合免疫治疗(radiotherapy was combined with immunotherapy, iRT)逐渐成为研究热点,放疗可以杀伤肿瘤细胞,释放肿瘤抗原,上调PD-L1表达,招募CD8+ T细胞,使冷肿瘤变为热肿瘤,对免疫治疗有增强作用。免疫治疗可增强放疗诱导的免疫激活,清除放射野外转移病灶,增强放疗远隔效应,出现1+1>2的效应[6,7]。放疗联合免疫治疗已在驱动基因阴性NSCLC的不同分期有所研究,但仍存在较多困惑待解决,本文进行论述如下。

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