A tumor with a large primary tumor or with regional lymph node metastasis is the so-called locally advanced tumor. This is a very special type of tumor patient:
First, locally advanced stage is not really stage IV. A considerable number of patients can still be cured with comprehensive treatment;
- Secondly, locally advanced stage is not an early stage, and it is difficult to pass a simple and reckless surgical operation complete cure.
Therefore, for the vast majority of locally advanced solid tumors, the current common practice is an organic combination of surgery, radiotherapy, and chemotherapy. The most suitable comprehensive treatment for the condition. Such as locally advanced esophageal cancer, head and neck squamous cell carcinoma, and rectal cancer, the current standard treatment is to receive a period of radiotherapy and chemotherapy before surgery; For locally advanced non-small cell lung cancer, the usual practice is to receive chemotherapy for a period of time, then surgery, and adjuvant radiotherapy after surgery as appropriate. However, with the continuous rise of immunotherapy such as PD-1 antibody and PD-L1 antibody, more and more surgeons are beginning to try “Neoadjuvant immunotherapy combined with chemotherapy”, that is, several (usually ranging from 2-4) courses of immunization are arranged before surgery Treatment is combined with chemotherapy, and surgery is scheduled after the tumor has regressed significantly. For example, in the CheckMate-816 study, PD-1 antibody O drug combined with chemotherapy can improve the pathological complete response rate compared with chemotherapy alone. Nearly 10x improvement (24%
vs 2.2%), for details, please refer to: Unstoppable! Immunotherapy has fully entered the early stage of cancer, and the future of complete cure for this type of cancer has come! When immunotherapy and chemotherapy were in full swing, radiotherapy doctors quit their jobs and came forward to call: radiotherapy can also increase the sensitivity of immunotherapy, Moreover, receiving neoadjuvant immunotherapy combined with radiotherapy before surgery can increase the pathological complete response rate by an order of magnitude. For example, recently the No. 1 cancer center in the United States(MD. Anderson Cancer Center)the director of the Department of Thoracic Oncology Radiotherapy, Chinese-American professor Zhang Yujiao called on Weibo to pay attention to the clinical value and therapeutic advantages of radiotherapy combined with immunotherapy. Professor Zhang said so much. What about the clinical trial data of neoadjuvant immunotherapy combined with radiotherapy? Here are 4 examples for you.
01
partialAdvanced head and necksquamous cell carcinoma of the head and neck
A prospective clinical trial showed that a 1-week period of stereotactic radiotherapy was performed prior to surgery< /span>(40Gy divided into 5 times or 24Gy divided into 3 times)combined with PD-1 antibody O drug, and then arranged for surgery, and 21 patients were enrolled. Surgical and pathological examinations show that:90% of patients have achieved pathological complete remission, that is, the cancer cells have completely disappeared – curative effect The data is amazing, here is a typical success story.
02
Localadvanced colorectal cancer
27 patients were enrolled and received a period of Stereotactic radiotherapy for 1 week(5Gy*5 times) followed by 2 courses of immunocombination chemotherapy followed by surgery. The results showed: 13 patients had complete disappearance of cancer cells, including 12 patients with stable microsatellites< /span>(originally thought to be resistant to single-drug immunotherapy). Typical successful pathology shows that the combination of immunotherapy and chemotherapy before surgery has made the tumor Resonance and colonoscopy almost disappeared, and the tumor was not visible to the naked eye on the surgically excised specimen. Under the microscope, the cancer cells disappeared completely, and the curative effect was very good.
03
LocalAdvanced esophageal cancer
20 subjects received neoadjuvant immunotherapy combined with chemoradiotherapy, using PD-1 antibody K drug, combined with a low-dose radiotherapy (1.8Gy once, 23 times; radical dose It should be 1.8Gy once, at least 28-34 times); after neoadjuvant immunotherapy combined with chemoradiotherapy, surgery will be arranged.The results show:< /span>55.6% of the patients were already in pathological complete remission.Such a pathological complete remission rate is much higher than that of immunocombination chemotherapy alone(about 20%-30%), even higher than radiotherapy combined with chemotherapy(about 30-40%) Therefore, a number of phase 3 clinical trials of neoadjuvant immunotherapy combined with chemoradiotherapy for the treatment of locally advanced esophageal cancer are currently being carried out at home and abroad.04
non-small cell lung cancer
This is a study published in < span>“The Lancet.Oncology” is a star research that the academic community is concerned about. 60 patients with early and mid-stage non-small cell lung cancer were randomly divided into 2 groups, one group received neoadjuvant immunotherapy(PD-L1 antibody I drug), the other group received neoadjuvant immunotherapy Immunization(also I drug)combined with radiotherapy(using stereotactic radiotherapy). The results showed: In the group of immunotherapy combined with radiotherapy, the pathological main response rate increased significantly, from 6.7% to 53.3%, More importantly, in the neoadjuvant immune combined radiotherapy group, 50% of patients achieved pathological complete remission and no cancer cells were seen at all. Such a phase II randomized controlled clinical trial initially showed that the addition of radiotherapy can increase the anti-cancer activity. In summary, for locally advanced solid tumors, surgery may not be urgent, and immunotherapy combined with radiotherapy can be considered(radiotherapy and chemotherapy)< /span>, more than half of the patients have the opportunity to achieve pathological complete remission. If there is a way for these patients to predict in advance through various imaging and ctDNA technologies in the future, they can even be exempted from surgery. Why not? .
References:[1].Phase
II, single-arm trial of preoperative short-course radiotherapy followed by
chemotherapy and camrelizumab in locally advanced rectal cancer. J Immunother
Cancer. 2021 Nov;9(11):e003554. doi:
10.1136/jitc-2021-003554.[2]. Neoadjuvant
durvalumab with or without stereotactic body radiotherapy in patients with
early-stage non-small-cell lung cancer: a single-centre, randomised phase 2
trial. Lancet Oncol. 2021 Jun;22(6):824-835[3]. Neoadjuvant
immunoradiotherapy results in high rate of complete pathological response and
clinical to pathological downstaging in locally advanced head and neck squamous
cell carcinoma. J Immunother Cancer. 2021 May;9(5):e002485.[4]. Preoperative
pembrolizumab combined with chemoradiotherapy for oesophageal squamous cells
carcinoma (PALACE-1). Eur J Cancer. 2021 Feb;144:232-241