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Chang Woo Kim, H. Chon, C. Kim
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引用次数: 0

摘要

尽管免疫检查点抑制剂(ICIs)在治疗各种恶性肿瘤方面显示出有希望的结果,但在转移性结直肠癌(mCRC)方面的进展严重受限。ICIs对一小部分微卫星不稳定性高的mCRC患者有效,但对占95%的微卫星稳定性(MSS)型mCRC患者临床疗效甚微。MSS mccrcs被认为通过多种机制对ICI单药治疗具有内在抗性。1)由于肿瘤突变负担低,免疫原性较差;2) WNT/β-catenin信号通路的频繁激活排除了肿瘤内CD8+ T细胞免疫;3)肿瘤微环境是免疫抑制的,因为存在多种免疫抑制细胞,包括肿瘤相关巨噬细胞和调节性T细胞;4) MSS型mCRC多发肝转移可能降低ICIs的疗效。为了克服这些耐药机制,目前正在积极采用多种药物联合治疗,包括STING激动剂、MEK抑制剂、VEGF/R抑制剂、WNT/β-catenin抑制剂、溶瘤病毒和化疗/放疗。在早期临床试验中显示了一些药物的初步疗效。本文综述了最近临床前和临床研究中描述的新的联合免疫治疗策略,以克服ICI单药治疗的局限性
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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Although immune checkpoint inhibitors (ICIs) have shown promising results in the treatment of treating various malignancies, progress has been severely limited in metastatic colorectal cancer (mCRC). ICIs are effective in a fraction of patients with microsatellite instability-high mCRC but have little clinical efficacy in patients with microsatellite stable (MSS) mCRC, which accounts for 95% of mCRC cases. MSS mCRCs are considered to have intrinsic resistance to ICI monotherapy through multiple mechanisms. 1) They are poorly immunogenic because of their low tumor mutation burden; 2) frequent activation of the WNT/β-catenin signaling pathway excludes intratumoral CD8+ T cell immunity; 3) the tumor microenvironment is immunosuppressive because of the presence of various immunosuppressive cells, including tumor-associated macrophages and regulatory T cells; and 4) frequent liver metastasis in MSS mCRC may reduce the efficacy of ICIs. To overcome these resistance mechanisms, combination approaches using various agents, including STING agonists, MEK inhibitors, VEGF/R inhibitors, WNT/β-catenin inhibitors, oncolytic viruses, and chemo/radiotherapy, are actively ongoing. Preliminary evidence of the efficacy of some has been shown in early clinical trials. This review summarizes novel combination immunotherapy strategies described in recent preclinical and clinical studies to overcome the limitations of ICI monotherapy
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