新辅助免疫联合治疗在局部晚期头颈部鳞状细胞癌的应用进展  

Application of neoadjuvant immunotherapy in locally advanced squamous cell carcinoma of head and neck

作　　者：马艺轩 李晓娟 靳晴 纪鸾 乔俏[3] MA Yixuan;LI Xiaojuan;JIN Qing;JI Luan;QIAO Qiao(China Medical University,Shenyzng,Lizoning 110122,Chinz;Department of Radiotherapy,First Hospital of China Medical University,Shenyzng,Lizoning 110001,Chinz)

机构地区：[1]中国医科大学第二临床学院,辽宁沈阳110122 [2]中国医科大学第一临床学院,辽宁沈阳110122 [3]中国医科大学附属第一医院放疗科,辽宁沈阳110001

出　　处：《中华肿瘤防治杂志》2024年第15期968-974,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的总结新辅助免疫联合治疗方式在局部晚期头颈部鳞状细胞癌(LA-HNSCC)中的最新研究成果与临床应用现状,为优化综合治疗方案、改善LA-HNSCC患者的治疗效果和生活质量提供参考依据。方法以“头颈部肿瘤、鳞状细胞癌、新辅助治疗、免疫治疗、新辅助联合治疗、生物标志物、毒副反应”为中文关键词,以“head and neck neoplasm、squamous cell carcinoma、neoadjuvant therapy、Immunotherapy、neoadjuvant combination therapy、biomarkers、toxic and side effects”为英文关键词,检索PubMed数据库和维普数据库2010年10月-2023年8月发表的关于LA-HNSCC新辅助免疫联合治疗方面的文献。纳入标准:(1)LA-HNSCC;(2)新辅助联合免疫治疗。排除标准:(1)会议性、评论类等文献;(2)鼻咽癌相关的文献。共纳入47篇文献,其中中文文献5篇,英文文献42篇。结果基于新辅助免疫治疗的联合治疗有利于LA-HNSCC患者实现病理缓解,3个周期后病理完全缓解(pCR)率为37.0%~100%,主要病理缓解(MPR)率为40%~100%。实现病理缓解的HNSCC患者较非病理缓解者的无病生存期和总生存期更长,且差异均有统计学意义。程序性死亡配体1(PD-L1)高表达和HPV相关HNSCC作用更为明显,PD-L1高表达者客观缓解率为68.2%~100%,HPV相关HNSCC患者pCR率和MPR率分别为90%和100%。从新辅助免疫联合治疗HNSCC的毒副作用来看,3~4级治疗相关不良事件偶见,未见治疗相关死亡病例,整体可控。结论新辅助免疫联合治疗LA-HNSCC可有效提高肿瘤的客观反应率,且对PD-L1高表达及HPV相关HNSCC作用更为明显。然而新辅助免疫联合治疗对LA-HNSCC长期生存的益处有待进一步研究。Objective To summarize the latest research results and clinical application of neoadjuvant immunotherapy in locally advanced head and neck squamous cell carcinoma(LA-HNSCC)in order to optimize the comprehensive treatment plan and improve the treatment effect and quality of life of LA-HNSCC patients.Methods Using"head and neck tumor,squamous cell carcinoma,neoadjuvant therapy,immunotherapy,neoadjuvant combination therapy,biomarkers,toxic and side effects"as Chinese and English keywords,we searched for literature on neoadjuvant immunotherapy combination for LA-HNSCC published in PubMed and VIP databases from October 2010 to August 2023.Inclusion criteria:(1)Locally advanced head and neck squamous cell carcinoma;(2)Neoadjuvant combined immunotherapy.Exclusion criteria:(1)Conference and commentary literature;(2)Nasopharyngeal carcinoma related literature.A total of 47 literature were included,including 5 Chinese literature and 42 English literature.Results Combination therapy based on neoadjuvant immunotherapy is beneficial in achieving pathological remission in patients with LA-HNSCC,with a pathologic complete response(pCR)rate of 37.0%-100%and major pathologic response(MPR)rate of 40%-100%after three cycles.Patients with HNSCC who achieved pathological remission have higher disease-free survival and overall survival than those without pathological remission,and the differences are statistically significant.The effect of high expression of programmed death-ligand 1(PD-L1)and human papillomavirus(HPV)-associated HNSCC is more obvious:the objective response rate of high expression of PD-L1 is 68.0%-100%.The pCR and MPR of HPV-associated HNSCC patients are 90%and100%.From the toxicities and side effects of neoadjuvant combined immunotherapy for HNSCC,Grade 3-4 treatmentrelated adverse events(TRAEs)are occasional,and no treatment-related deaths are found,indicating that the overall toxicity is controllable.Conclusions Neoadjuvant immunotherapy combination therapy of advanced LA-HNSCC can effectively improve the objectiv

关 键 词：头颈部肿瘤 鳞状细胞癌 新辅助治疗 免疫治疗 新辅助联合治疗 生物标志物 毒副作用 综述文献 

分 类 号：R739.91[医药卫生—肿瘤]