中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (6): 487-498.doi: 10.19401/j.cnki.1007-3639.2022.06.003

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免疫治疗时代不可手术局部晚期非小细胞肺癌的治疗:现状与展望

虞思来1()(), 倪建佼2, 朱正飞2,3()()   

  1. 1.复旦大学上海医学院基础医学院,上海 200032
    2.复旦大学附属肿瘤医院放射治疗中心,复旦大学上海医学院肿瘤学系,上海 200032
    3.复旦大学胸部肿瘤研究所,上海 200032
  • 收稿日期:2022-04-15 修回日期:2022-05-16 出版日期:2022-06-30 发布日期:2022-07-21
  • 通信作者: 朱正飞 E-mail:nancyyusilai@163.com;fuscczzf@163.com
  • 作者简介:虞思来(ORCID:0000-0002-0293-3782),复旦大学八年制在读。E-mail: nancyyusilai@163.com
    朱正飞,复旦大学附属肿瘤医院放射治疗中心主任医师,教授,博士研究生导师。现任复旦大学附属肿瘤医院临床研究中心主任,复旦大学胸部肿瘤研究所副所长。兼任中国抗癌协会肺癌专业委员会委员,中国抗癌协会肿瘤放射治疗专业委员会委员,中华医学会放疗分会青委,中国临床肿瘤学会(CSCO)青年委员会常委,CSCO非小细胞肺癌专业委员会委员,中国医药教育学会肿瘤放疗专业委员会副主任委员,Frontiers in Oncology杂志副编辑(associate editor),《中国肺癌杂志》青年编委。主要从事胸部肿瘤放射治疗及综合治疗相关的临床与基础工作。2012年3月—2014年3月在美国MD Anderson癌症中心放疗科以访问学者身份学习两年。入选上海市浦江人才计划和上海市卫健委“医苑新星”杰出青年医学人才培养计划。以项目负责人身份承担国家自然科学基金(面上项目)、教育部留学回国人员科研启动基金、上海市自然科学基金、上海市卫健委课题(面上项目)等课题项目共10余项。以第一作者或通信作者身份发表论文60余篇,其中在SCI收录期刊上发表论文40余篇。获上海市抗癌科技奖一等奖(第一完成人)。

Treatment of unresectable locally advanced non-small cell lung cancer in the era of immunotherapy: status and prospects

YU Silai1()(), NI Jianjiao2, ZHU Zhengfei2,3()()   

  1. 1. School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China
    2. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
    3. Institute of Thoracic Oncology, Fudan University, Shanghai 200032, China
  • Received:2022-04-15 Revised:2022-05-16 Published:2022-06-30 Online:2022-07-21
  • Contact: ZHU Zhengfei E-mail:nancyyusilai@163.com;fuscczzf@163.com

摘要:

PACIFIC研究拉开了不可手术局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LA-NSCLC)免疫治疗新时代的序幕,同时也提出了如何将放化疗与免疫治疗有机整合及进一步优化的新命题。本文对不可手术LA-NSCLC的治疗进展进行综述,旨在探讨免疫治疗背景下LA-NSCLC的研究现况和未来方向。本文将汇总PACIFIC研究的更新数据和这个模式在特殊人群,如老年、程序性死亡[蛋白]配体-1(programmed death ligand-1,PD-L1)阴性、表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变的研究进展,探讨放化疗和免疫治疗的最佳时序安排。回顾放疗在剂量分割、靶区勾画、射线选择方面的技术进步和实施优化的探索,并展望其在免疫治疗时代的应用前景。

关键词: 非小细胞肺癌, 免疫治疗, 放射治疗, 化学疗法

Abstract:

The PACIFIC trial uncovered a new era of immunotherapy in the multi-disciplinary treatment of unresectable locally advanced non-small cell lung cancer (LA-NSCLC), but also proposed a new question of how to further optimize radiotherapy and chemotherapy, in order to maximize synergistic effects with immunotherapy. The treatment progress of unresectable LA-NSCLC was reviewed in the context of immunotherapy. Updated data of the PACIFIC trial along with the research progress among special populations, especially for elderly patients, programmed death ligand-1 (PD-L1) expression negative and epidermal growth factor receptor (EGFR) gene mutant were summarized. Meanwhile, the optimal sequence of radiotherapy, chemotherapy and immunotherapy, the technical advancement and implementation of radiotherapy, including dose fractionation, target delineation and ray selection, were discussed, as well as its application prospect in the era of immunotherapy.

Key words: Non-small cell lung cancer, Immunotherapy, Radiotherapy, Chemotherapy

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