特殊人群免疫检查点抑制剂疗效不佳的常见原因

近年来，免疫检查点抑制剂（ICB）在晚期非小细胞肺癌（NSCLC）的治疗中进展非常迅速，也是目前最热门的肿瘤治疗手段之一。尤其是对于驱动基因突变阴性的患者，在最新的美国国立综合癌症网络（NCCN）指南中甚至提到了一线治疗的地位。前不久国家食品药品监督管理总局（CFDA）对于ICB的批准给肿瘤治疗带来了全新的治疗理念，为肺癌患者带来了新的希望，ICB具有广阔的临床应用前景。但是，临床上仍存在许多问题有待解决，如基线使用类固醇激素是否影响ICB疗效，抗生素的累积使用对ICB疗效如何，脑转移人群ICB疗效是否不佳，ICB结合局部脑照射是否获益，烟草暴露状态是否影响免疫应答，随着这些问题的相继解决，抗程序性死亡分子1（PD-1）/PD-1配体（PD-L1）单抗将会使更多特殊人群在生存上获益。

Common Causes of Poor Efficacy of Immune Checkpoint Inhibitors in Special Populations

Recently，treatment with immune checkpoint blockers （ICB） for advanced non-small cell lung cancer （NSCLC） has progressed very rapidly.It is one of the most popular cancer treatments，and has even been listed as a first-line treatment in the latest NCCN guidelines for driver gene mutation negative patients.The recent approval of ICB by China Food and Drug Administration has brought a new treatment concept for cancer treatment and new hopes for lung cancer patients，indicating that it has a broad prospect of clinical use.However，clinical use of ICB faces many problems，such as the associations of response to ICB with steroid hormones used before ICB treatment，cumulative antibiotic use，brain metastases in NSCLC，and tobacco exposure，and efficacy of ICB in combination with local-brain radiation therapy.Along with these problems being solved successively，anti-PD-1/PD-L1 monoclonal antibodies will bring survival benefits to more special populations.