免疫节点抑制剂在胃癌中有潜在疗效

　　谈及免疫治疗在胃癌中的现状，Sun Young Rha教授称胃癌并不适用于免疫治疗，当前一些试图验证免疫治疗在胃癌中疗效的临床实验结果都不尽如人意。最近免疫节点抑制剂在包括胃癌在内的一些肿瘤中都获得了比较理想的结果。尽管还处于1b期临床试验阶段，免疫节点抑制剂在胃癌中仍有潜在疗效。一般来说，免疫治疗适用于肿瘤负荷较小的患者，有意思的是免疫节点抑制剂对于肿瘤负荷重的晚期患者的疗效也较理想。因此，免疫治疗将开启胃癌治疗的新时代。

　　Gastric cancer has been known that is not a good target tumor for immunotherapy. Because， until now we have some of the trails to try to treat the gastric cancer patients with the immunotherapy but the results was not that good. But recently the checkpoint inhibitors show very good response in other tumors gastric cancer. So even if it is in thephase IB trial， ImmuneCheckpoint Inhibitors might have some potential for the gastric cancer treatment. The immunotherapy is usually good for small tumor burdens with all face of the disease. But interestingthing is that this immune checkpoint is showing response in advance cases with large tumor burdens. So it’s a new era for immunotherapyin the gastric cancer.

　　多项评估免疫节点抑制剂在胃癌中疗效的试验正在开展

　　目前有多项评估免疫节点抑制剂在胃癌中的疗效的I期临床试验正在进行当中，如三线治疗中，评估免疫节点抑制剂单用或与安慰剂做比较；二线治疗方面，有试验研究免疫节点抑制剂与紫杉醇或Ramucirumab联合或者比较免疫节点抑制剂与紫杉醇标准化疗方案的疗效；而一线治疗方面的临床试验则更为复杂。II期临床试验方面，有研究正在试图验证pembrolizumab单用或联合化疗在PD-L1阳性胃癌患者中的疗效。除抗PD-1抑制剂外，抗PD-L1抑制剂在胃癌中的疗效也在研究当中。

　　Nowadaysfor phase I trial we have so many clinical trials studying immune checkpoint inhibitors in gastric cancer. For the third line we evaluate immunotherapy with checkpoint inhibitors by self or comparing with the placebo. For the second line there are some studies on Paclitaxel combination or Ramucirumab combination or comparing the checkpoint inhibitors and the paclitaxel and the standard chemotherapy. For the first line there are more complicated trails， for example， there are phase II trials trying to show that efficacy of Pembrolizumabimmunotherapy inthe PD-L1 positive patients. Also based on the PD-L1expression we have some studies on chemotherapy combining with the checkpoint inhibitors such as Pembrolizumab. Besidesthe Anti-PD-1 inhibitor， the Anti-PD-L1 inhibitors also are undergoing various settings of gastric cancer.

　　免疫治疗发展的关键：加强基础研究与转化研究的协作

　　多学科综合治疗模式（MDT）在肿瘤治疗中至关重要，尤其是胃癌。目前多采用手术和化疗为主，此外放疗的价值也越来越受到重视。到现在为止，早期胃癌并不适用于免疫治疗，而对于大部分转移性胃癌患者，手术并不是最佳治疗方案，此时放化疗的作用更为重要。很多人都知道，放化疗会激发肿瘤癌胚抗原的释放，在这种情况下，免疫节点抑制剂能够使患者更为获益。初步临床试验结果表明，免疫节点抑制剂不论是单用还是与化疗联合都有助于提高胃癌患者的疗效。除此之外，免疫抑制剂的多学科远程会诊技术需要进展，我认为提高基础研究和转化研究的水平有助于胃癌免疫治疗的发展。直到现在我们尚未阐明胃癌的生物学特性，而筛选出对免疫治疗更为获益的胃癌亚型意义重大，因此加强基础研究人员与转化研究者之间的合作十分必要。

　　Multidisciplinary therapy is very important for the cancer therapy， especially for the gastric cancer， the surgery and the chemotherapy is a mainstream，now we have more potential with the radiotherapy. Until now， the immunotherapy is not developed in all stages of the cancer. For the most metastatic cases in which the surgery is not appropriate，mostly the chemotherapy or radiotherapy is the important treatment. If we treat patients with a chemotherapy or radiotherapy it releases a cancer antigen so in that case there is a chance that the checkpoint inhibitors will show more benefit. Not just treating with the immune checkpoint inhibitors but also treating with chemotherapy might be beneficial and improve efficacy. Other radio multidisciplinary approach for the checkpoint inhibitors development， I think is more important to cooperate withtranslation researchers. Until now we even don’t know much about the biology of gastric cancer. So we need to figure out which type of gastric cancer patients will get morebenefit from the immune checkpoint inhibitors. In that case the collaboration withtranslation researchers is very important in developing new checkpoint inhibitors of gastric cancer patients.

　　Sun Young Rha教授

　　韩国延世大学医学院延世癌症中心

　　延世大学健康系统西富兰斯医院

　　主要研究领域：内科肿瘤医生，胃癌和泌尿生殖系统系统肿瘤的治疗和转化性研究

　　参与多个全球性I~III期临床试验，担任韩国癌症研究组的主要研究员（PI）