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克服非小细胞肺癌中的免疫治疗耐药的策略——针对非癌细胞

Strategies to Overcome Immunotherapy Resistance in Non-Small Cell Lung Cancer: Targeting Non-Cancer Cells

  • 摘要: 免疫治疗的耐药机制之一是肿瘤微环境(TME)中免疫细胞的数量和功能下降。因此,开发新的抗体和小分子靶向多种共抑制分子,单独或者联合应用,可能会重新激活耗竭的T细胞,发挥抗肿瘤免疫。另一方面,还可以开发靶向共刺激分子的激动剂,上调激活T细胞的第二信号,以消除癌细胞,但需要关注这类药物的毒性。本文还介绍了癌症疫苗、溶瘤病毒、细胞治疗,以及其他有前景的药物及治疗方式,以进一步提高非小细胞肺癌(NSCLC)免疫治疗的效果。最后,文章介绍了针对肿瘤微环境中非增殖细胞,包括癌相关成纤维细胞(CAF)和细胞外基质(ECM)的药物,改善缺氧的药物和补充益生菌,以促进抗肿瘤免疫的效果。综上,本文重点强调,需要不同作用机制药物之间的联合,平衡不良反应与疗效,使NSCLC的免疫治疗达到一个新台阶。

     

    Abstract: One of the key mechanisms underlying resistance against immunotherapy is the reduction in the abundance and functional capacity of immune cells within the tumor microenvironment (TME). Accordingly, the development of novel antibodies and small-molecule agents that target multiple co-inhibitory molecules—whether employed as monotherapies or in combination—holds promise for reinvigorating exhausted T cells and restoring antitumor immune responses. In addition, exploring agonists targeting co-stimulatory molecules represents a promising strategy to enhance the secondary signals necessary for T cell activation and thereby facilitates tumor eradication. However, careful attention must be given to potential toxicities associated with these agents. Furthermore, this review highlights the emerging therapeutic potential of cancer vaccines, oncolytic viruses, diverse cellular therapies, and other innovative strategies designed to augment the efficacy of immunotherapy in non-small cell lung cancer (NSCLC). Moreover, we discuss therapeutic strategies targeting non-proliferating TME components, including cancer-associated fibroblasts (CAFs) and the extracellular matrix (ECM), and hypoxia-alleviating agents and immune homeostasis-supporting probiotics, all aimed at enhancing anti-tumor immunity. In summary, this article emphasizes the critical importance of integrating therapeutics with complementary mechanisms of action while maintaining the balance between efficacy and tolerability in the advancement of precise and effective immunotherapy in NSCLC to an unprecedented level.

     

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