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扩大视野治疗转移性鼻咽癌

2018年01月19日

编译：肿瘤资讯

来源：肿瘤资讯

Anthony T.C. Chan

教授

香港中文大学
香港癌症研究所所长

转移性鼻咽癌的治疗标准为吉西他滨联合顺铂化疗，这一治疗反应率高，但大多数患者将随后发生进展。在铂类治疗失败的病人中，紫杉烷和氟尿嘧啶虽然仍具有活性，1年总生存率仅为30-40％，因此迫切需要新的治疗方法。

针对EGFR和VEGF的分子靶向治疗在II期临床试验中取得了显著的疾病控制率，最近发表有关全外显子组和全基因组测序的结果可为将来的生物靶向治疗中指明方向。

使用T细胞扩增法或EBV疫苗的EBV免疫疗法在特定的患者中取得了一致的免疫和临床应答。最近发表的Ib和II期临床研究中，使用免疫检查点抑制剂（ICPI）在铂类治疗失败患者中取得了令人兴奋的近期疾病控制和一年生存数据。目前正在进行的Keynote 122的III期随机研究，可以回答在这种情况下ICPI能否确立为标准治疗。未来的试验研究将致力于联合和序贯全身性化疗、免疫治疗和靶向治疗以及转化性生物标志物的研究。

英文原文

Expanding horizon in the treatment of metastatic NPC

Anthony T.C. Chan

The Chinese University of Hong Kong, Hong Kong

The standard of care for metastatic NPC is combination gemcitabine-cisplatin chemotherapy which achieves a high response rate but most patients will subsequently progress. While agents including taxanes and fluoropyrimidines are active and can offer 1 year overall survival of around 30-40 percent beyond platinum failure, there is an urgent need for new therapies.

Molecular targeted therapies against EGFR and VEGF have achieved modest activities in phase 2 studies with significant disease control rates, and recent publication of whole exome and whole genome sequencing analysis in micro-dissected NPC tissue may shed more light in biomarker directed targeted therapies in future.

EBV-directed immunotherapies for NPC using either T cell expansion approaches or EBV vaccine approaches have achieved consistent immunological responses and clinical response in selected patient cohorts. And two recently published and presented phase 1b and 2 studies using Immune checkpoint inhibitors( ICPI) have achieved impressive disease control and one year survival data in platinum failure patients. A pivotal keynote 122 phase 3 randomized study is ongoing to address whether ICPI can be established as standard of care in this setting. Future trials studying combination and sequential systemic chemotherapeutic , immunotherapeutic and targeted approaches in parallel with translational biomarker research are being planned.