Neoadjuvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer: A new era for anal preservation.
Neoadjuvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer: A new era for anal preservation.
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DOI：
10.3389/fimmu.2022.1067036
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发表时间：
2022
影响因子：
7.3
通讯作者：
Xia, Fan
中科院分区：
文献类型：
--
作者：
Wang, Yaqi;Shen, Lijun;Wan, Juefeng;Zhang, Hui;Wu, Ruiyan;Wang, Jingwen;Wang, Yan;Xu, Ye;Cai, Sanjun;Zhang, Zhen;Xia, Fan
关键词：
对于局部晚期（T3-4/N+M0）直肠癌（LARC），新辅助放化疗（nCRT）加全肠系膜切除术（TME）是标准治疗。结果表明，它可以降低局部复发率，提高肿瘤反应等级。然而，远处转移仍是一个未解决的问题。近年来，对肛门保存和提高生活质量的需求也在增加。放疗与免疫治疗可以互为补充，两者结合治疗具有良好的理论基础。最近，在LARC中，正在进行多项关于nCRT和免疫治疗联合的临床试验。据报道，这些试验在MSI-H和MSS直肠癌中均取得了良好的短期疗效，可以进一步提高临床完全缓解率（cCR）和病理完全缓解率（pCR），从而增加“观察和等待”方法的可能性。然而，cCR和pCR并不总是一致的，当nCRT与免疫治疗联合使用时，这种情况发生得更频繁。因此，新辅助治疗后的疗效评价是患者选择W&W入路的重要问题。准确评估cCR需要多种传统检查、PET-CT、ctDNA-MRD等新型检测方法和多种组学研究相结合。找到准确的生物标志物可以帮助指导风险分层和治疗决策。未来还需要进行大规模的临床试验，以证明其惊人的疗效，并探索其长期预后。
For locally advanced (T3-4/N+M0) rectal cancer (LARC), neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the standard treatment. It was demonstrated to decrease the local recurrence rate and increase the tumor response grade. However, the distant metastasis remains an unresolved issue. And the demand for anus preservation and better quality of life increases in recent years. Radiotherapy and immunotherapy can be supplement to each other and the combination of the two treatments has a good theoretical basis. Recently, multiple clinical trials are ongoing in terms of the combination of nCRT and immunotherapy in LARC. It was reported that these trials achieved promising short-term efficacy in both MSI-H and MSS rectal cancers, which could further improve the rate of clinical complete response (cCR) and pathological complete response (pCR), so that increase the possibility of ‘Watch and Wait (W&W)’ approach. However, the cCR and pCR is not always consistent, which occurs more frequent when nCRT is combined with immunotherapy. Thus, the efficacy evaluation after neoadjuvant therapy is an important issue for patient selection of W&W approach. Evaluating the cCR accurately needs the combination of multiple traditional examinations, new detective methods, such as PET-CT, ctDNA-MRD and various omics studies. And finding accurate biomarkers can help guide the risk stratification and treatment decisions. And large-scale clinical trials need to be performed in the future to demonstrate the surprising efficacy and to explore the long-term prognosis.
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DOI：
10.1158/1078-0432.ccr-09-0265
发表时间：
2009-09-01
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Dewan MZ;Galloway AE;Kawashima N;Dewyngaert JK;Babb JS;Formenti SC;Demaria S
通讯作者：
Demaria S
II 期，局部晚期直肠癌术前短程放疗随后化疗和卡瑞利珠单抗的单臂试验
影响因子：
10.9
作者：
Lin Z;Cai M;Zhang P;Li G;Liu T;Li X;Cai K;Nie X;Wang J;Liu J;Liu H;Zhang W;Gao J;Wu C;Wang L;Fan J;Zhang L;Wang Z;Hou Z;Ma C;Yang K;Wu G;Tao K;Zhang T
通讯作者：
Zhang T
影响因子：
51.1
作者：
Conroy, Thierry;Bosset, Jean-Francois;Borg, Christophe
通讯作者：
Borg, Christophe
影响因子：
28.4
作者：
Cercek, Andrea;Roxburgh, Campbell S. D.;Weiser, Martin R.
通讯作者：
Weiser, Martin R.
影响因子：
5.2
作者：
Park HJ;Kim GH;Kim KW;Lee CW;Yoon S;Chae YK;Tirumani SH;Ramaiya NH
通讯作者：
Ramaiya NH