Perioperative Immune Checkpoint Inhibitors for the Treatment of Locally Advanced Gastric and Gastroesophageal Junction Cancer: Current Status and Future Prospects.

IF 4.7 2区 医学 Q2 ONCOLOGY
Siyuan Cui, Kui Zhao, Na Wang, Yuan Meng, Cheng Zhao, Honggen Liu, Wen Xin, Fanming Kong
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引用次数: 0

Abstract

Opinion statement: Novel strategies utilizing immune checkpoint inhibitors (ICIs) have emerged over the past several years and substantially changed the treatment landscape of advanced gastric cancer (GC). Based on the encouraging results achieved, numerous clinical studies have been conducted to identify the feasibility and efficacy of integrating ICIs into the perioperative treatment of locally advanced gastric and gastroesophageal junction cancer (GC/GEJC). Initial clinical trials have indicated that the addition of immunotherapy to chemotherapy, concurrent chemoradiotherapy, or chemotherapy combined with anti-angiogenic therapy in the perioperative setting significantly improves the pathological remission of patients, thereby promising to improve the prognosis. However, in the absence of strong evidence from long-term follow-up data, these approaches have yet to be entirely translated into clinical practice. Therefore, it is recommended that the aforementioned patients be prioritized for participation in clinical trials. In addition, based on the negative results of ATTRACTION-05, current evidence does not support the use of adjuvant immunotherapy in patients without neoadjuvant immunotherapy. For patients with dMMR/MSI-H disease, neoadjuvant immunotherapy has demonstrated excellent pCR rates, and the 2024 NCCN guidelines have recommended neoadjuvant or perioperative ICIs for these patients. In HER2-positive locally advanced GC/GEJC, neoadjuvant dual PD-1 and HER2 inhibition combined with chemotherapy has also shown promising prospects. However, the development of perioperative ICIs has also posed formidable therapeutic challenges. Given the high heterogeneity of GC, there is an urgent need to select patients likely to benefit from ICIs with precision through microenvironment analysis, molecular biomarker screening, and clinical subgroup analysis. In parallel, the benefits of ICIs in locally advanced GC/GEJC should be carefully weighed against their associated adverse effects and significant financial toxicity.

围手术期免疫检查点抑制剂治疗局部晚期胃癌和胃食管结癌:现状和未来展望。
观点声明:利用免疫检查点抑制剂(ICIs)的新策略在过去几年中出现,并极大地改变了晚期胃癌(GC)的治疗前景。基于已取得的令人鼓舞的结果,许多临床研究已经开展,以确定将ICIs整合到局部进展期胃胃食管结癌(GC/GEJC)围手术期治疗中的可行性和有效性。初步临床试验表明,围手术期化疗加免疫治疗、同步放化疗或化疗联合抗血管生成治疗可显著改善患者病理缓解,从而有望改善预后。然而,由于缺乏长期随访数据的有力证据,这些方法尚未完全转化为临床实践。因此,建议优先考虑上述患者参加临床试验。此外,基于ATTRACTION-05的阴性结果,目前的证据并不支持在没有新辅助免疫治疗的患者中使用辅助免疫治疗。对于dMMR/MSI-H疾病患者,新辅助免疫治疗已显示出出色的pCR率,2024年NCCN指南推荐对这些患者进行新辅助或围手术期ICIs。在HER2阳性的局部晚期GC/GEJC中,新辅助双PD-1和HER2抑制联合化疗也显示出良好的前景。然而,围手术期ICIs的发展也带来了巨大的治疗挑战。鉴于GC的高异质性,迫切需要通过微环境分析、分子生物标志物筛选和临床亚组分析,精确选择可能受益于ICIs的患者。同时,应该仔细权衡ICIs在局部晚期GC/GEJC中的益处及其相关的副作用和显著的财务毒性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.10
自引率
0.00%
发文量
113
审稿时长
>12 weeks
期刊介绍: This journal aims to review the most important, recently published treatment option advances in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to facilitate worldwide approaches to cancer treatment. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as endocrine tumors, lymphomas, neuro-oncology, and cancers of the breast, head and neck, lung, skin, gastrointestinal tract, and genitourinary region. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. We also provide commentaries from well-known oncologists, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.
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