抗体偶联药物联合免疫治疗用于上尿路尿路上皮癌的现状与挑战  

Antibody-drug conjugates combined with immunotherapy:a potential game changer in the treatment of upper tract urothelial carcinoma

作　　者：卢智杰 李源 Lu Zhijie;Li Yuan(Department of Urology,the Second Xiangya Hospital of Central South University,Changsha 410012,China)

机构地区：[1]中南大学湘雅二医院泌尿外科,长沙410012

出　　处：《中华外科杂志》2024年第8期737-743,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(82373435、82172878)。

摘　　要：目前上尿路尿路上皮癌(UTUC)治疗方案日新月异,但新的手术方式及全身治疗方案在实施过程中存在诸多限制,无法扭转目前UTUC的治疗现状。近年来,抗体偶联药物在癌症治疗领域中展现出巨大潜力,在精准杀灭靶向的肿瘤细胞的同时,可以激活免疫系统而增强免疫治疗效果,其与免疫治疗的联合成为目前研究的热点。EV-302研究等多项临床试验结果已证实,联合治疗可提高晚期尿路上皮癌患者的生存率,可能取代化疗成为晚期尿路上皮癌的一线治疗。但是联合治疗在UTUC中应用仍存在证据级别不高、不良反应、耐药性等一系列挑战。未来应聚焦于开展UTUC联合治疗的临床试验,进一步优化抗体偶联药物和免疫治疗药物以适应UTUC的疾病特点,同时深入研究UTUC的分子生物学特征以应对这一系列挑战。Currently,treatment strategies for upper tract urothelial carcinoma(UTUC)are changing rapidly.However,there are many limitations in the implementation of new surgical methods and systemic treatment options,which cannot reverse the current status quo of UTUC treatment.In recent years,antibody-drug conjugates have shown great potential in the field of cancer treatment,which can activate the immune system and enhance the effect of immunotherapy while accurately killing targeted tumor cells.The results of multiple clinical trials,including the EV-302 study,have confirmed that combination therapy can improve the survival rate of patients with advanced urothelial cancer,and may replace chemotherapy as the first-line treatment for advanced urothelial cancer.However,there are still a series of challenges in the application of combination therapy in UTUC,such as low level of evidence,adverse reactions,and drug resistance.In the future,it is necessary to focus on clinical trials of UTUC combination therapy,further optimize antibody drug conjugates and immunotherapy drugs to adapt to the disease characteristics of UTUC,and further study the molecular biology characteristics of UTUC to meet this series of challenges.

关 键 词：尿道肿瘤 抗体 肿瘤 上尿路尿路上皮癌 抗体偶联药物 免疫治疗 化疗 恩福妥单抗 维迪西妥单抗 

分 类 号：R737.1[医药卫生—肿瘤]