Despite advances in treatment strategies and surgical approaches in recent years, improving survival outcomes in esophagogastric cancer (EGC) patients treated with curative intent remains a significant area of unmet need. The recent emergence of adjuvant immunotherapy as the standard of care for resected EGC demonstrates the impact of immunotherapy in improving recurrence-free survival. Neoadjuvant and perioperative immunotherapies represent another promising approach with potential advantages over adjuvant therapy. Despite the promising results of early neoadjuvant immunotherapy studies, there are several challenges and future research needs. The optimal timing, duration and number of doses in relation to surgery and the optimal combination of immunotherapies are still unclear. In addition, rigorous correlative studies need to be performed to identify biomarkers for patient selection and treatment response prediction to maximize the benefits of neoadjuvant immunotherapy. In this review, we provide a concise summary of the current standard of care for resectable EGC and discuss the rationale for the use of immune checkpoint inhibitors in this setting and the pre-clinical and early clinical data of these novel therapies. Finally, we will examine the potential role and future direction of immunotherapy in the treatment paradigm and the perceived challenges and opportunities that lay ahead.
尽管近年来治疗策略和手术方法不断进步，对于接受根治性治疗的食管胃结合部癌患者而言，改善其生存结局仍是亟待解决的重要领域。近期辅助免疫疗法成为切除术后食管胃结合部癌的标准治疗方案，这体现了免疫疗法在改善无复发生存期方面的显著作用。新辅助及围手术期免疫疗法作为另一种前景广阔的治疗策略，较辅助疗法可能更具优势。尽管早期新辅助免疫治疗研究已显示出积极成果，但仍面临诸多挑战与未来研究需求。关于手术时机、治疗持续时间、给药剂量与手术的最佳配合方案，以及免疫疗法的最佳联合策略等问题尚未明确。此外，需要开展严谨的相关性研究以确定用于患者筛选和治疗反应预测的生物标志物，从而最大化新辅助免疫治疗的临床获益。本综述将简要总结当前可切除食管胃结合部癌的标准治疗方案，探讨在该领域应用免疫检查点抑制剂的理论依据，并分析这些新型疗法的临床前及早期临床数据。最后，我们将审视免疫疗法在治疗体系中的潜在作用与发展方向，以及当前面临的挑战与机遇。
The Evolving Landscape of Neoadjuvant Immunotherapy in Gastroesophageal Cancer
肿瘤(癌症)患者之家