免疫及靶向治疗在局部晚期宫颈癌中的应用进展

Advances in the Application of Immunotherapy and Targeted-Therapy in Locally Advanced Cervical Cancer

摘要: 宫颈癌是全球范围内女性健康的重大威胁，其发病率在女性恶性肿瘤中位居第二位，位居女性妇科恶性肿瘤首位。每年大约有53万例宫颈癌新发病例，其中80%的患者发生在发展中国家，而中国是其中发病例数最多的国家之一。对于局部晚期宫颈癌，同步放化疗是基本治疗手段，但治疗后仍有约15%的患者出现复发，基于既往的治疗手段，一旦出现复发，后期的治疗措施十分有限。因宫颈癌早期临床症状不明显，大部分患者首次就诊即为中晚期，无法进行手术治疗，且宫颈癌是为数不多可以治愈的恶性肿瘤，因此首次治疗方案的确定显得尤为重要。传统的治疗手段包括手术、放疗、化疗等，但对于局部晚期宫颈癌患者的治愈率有一定局限。近年来，多项临床试验和研究发现，免疫治疗与靶向治疗在宫颈癌治疗中取得了显著效果，且免疫及靶向治疗具有更加精准、有效，并且副作用较小等优势，目前常用的检查点抑制剂包括细胞毒性T淋巴细胞相关抗原4 (CTLA-4)、程序性死亡受体1 (PD-1)及配体1 (PD-L1)等，血管内皮生长因子(VEGF)、EGFR抑制剂、HER2抑制剂等靶点药物也批准应用于各种晚期及复发宫颈癌患者中。本文就免疫治疗及靶向治疗以及相关检查点在局部晚期宫颈癌中的应用进展进行综述，为局部晚期宫颈癌患者提供更多的希望与可能。

Abstract: Cervical cancer is a major threat to women’s health worldwide, and its incidence ranks second among female malignant tumors and first among female gynecologic malignant tumors. There are about 530,000 new cases of cervical cancer every year, 80% of which occur in developing countries, and China is one of the countries with the highest number of cases. For locally advanced cervical cancer, simultaneous chemoradiotherapy is the basic treatment, but about 15% of patients still relapse after treatment. Based on the previous treatment methods, once relapse occurs, the later treatment measures are very limited. Because the early clinical symptoms of cervical cancer are not obvious, most patients are in the middle and late stages of the first visit, and can not be treated with surgery. Cervical cancer is one of the few malignant tumors that can be cured, so the determination of the first treatment plan is particularly important. Traditional treatment methods include surgery, radiotherapy, chemotherapy, etc., but there are certain limitations in the cure rate of patients with locally advanced cervical cancer. In recent years, a number of clinical trials and studies have found that immunotherapy and targeted therapy have achieved remarkable results in the treatment of cervical cancer, and immune and targeted therapy has more accurate, effective, and fewer side effects. Currently commonly used checkpoint inhibitors include cytotoxic T lymphocyt-associated antigen 4 (CTLA-4), programmed death receptor 1 (PD-1) and ligand 1 (PD-L1), etc. Vascular endothelial growth factor (VEGF), EGFR inhibitors, HER2 inhibitors and other target drugs have also been approved for use in various advanced and recurrent cervical cancer patients. This article reviews the progress of immunotherapy, targeted therapy and related checkpoints in the application of locally advanced cervical cancer, providing more hope and possibility for patients with locally advanced cervical cancer.