PD-1/PD-L1抑制剂在膀胱癌新辅助治疗中的应用进展

膀胱癌是一种泌尿系统常见的肿瘤,单纯根治切除手术治疗的患者面临较高复发和转移风险,5年生存率为60~80%。在减少复发、转移和延长生存期的探索中,指南推荐以顺铂为基础的化疗作为标准新辅助治疗。但部分患者无法耐受化疗或对化疗不敏感,新辅助治疗应用率较低,未广泛开展。程序性死亡因子1(PD-1)和程序性死亡因子配体1(PD-L1)是重要的免疫检验点共抑制分子,通过抑制T细胞的激活和增殖通路参与肿瘤的免疫逃逸。近年来一批PD-1/PD-L1抑制剂被批准用于局晚期膀胱癌的一线、二线治疗,疗效及安全性得到证实,因此一些最新的研究探索将PD-1/PD-L1抑制剂运用于新辅助治疗。本文主要对近年来相关研究进行了回顾与总结,探讨PD-1/PD-L1抑制剂在膀胱癌新辅助治疗应用的前景和可能发展的方向。

Application progress of PD-1/PD-L1 inhibitors in neoadjuvant treatment of bladder cancer

Bladder cancer is a common tumor of urinary system,with a high recurrence and metastasis rate after radical resection alone.The main treatment methods are surgery and adjuvant chemotherapy,and the five-year survival rate is 60%~80%.In the exploration of reducing recurrence,metastasis and prolonging survival,the guidelines recommend cisplatin-based chemotherapy as the standard neoadjuvant treatment.However,some patients cannot tolerate chemotherapy or are insensitive to chemotherapy,so the application rate of neoadjuvant therapy is low and has not been widely developed.Programmed death factor 1(PD-1)and programmed death factor ligand 1(PD-L1)are important immune checkpoint co-suppressive molecules,which participate in the immune escape of tumors by inhibiting T cell activation and proliferation pathways.In recent years,batches of PD-1/PD-L1 inhibitors have been approved for first-line and second-line treatment of locally advanced bladder cancer,and their efficacy and safety have been confirmed.Therefore,some recent studies have explored the use of PD-1/PD-L1 inhibitors for neoadjuvant therapy.This article mainly reviews and summarizes the relevant studies in recent years,and explores the prospect and possible development directions of PD-1/PD-L1 inhibitors in neoadjuvant therapy for bladder cancer.