抗血管生成联合免疫治疗在非小细胞肺癌中的增效机制

Synergistic Mechanisms of Combined Anti-Angiogenic Therapy and Immunotherapy in Non-Small Cell Lung Cancer

  • 摘要: 肿瘤微环境中,异常血管生成与抗肿瘤免疫之间存在双向反馈调控,是抗血管生成治疗与免疫治疗发挥协同作用的基础,其机制涵盖解除免疫抑制、诱导血管正常化及形成免疫-血管正向环路。基于此,该联合方案已在晚期非小细胞肺癌中显示出协同增效,并正逐步前移至新辅助治疗阶段。然而在可切除肺癌围术期治疗中,该联合治疗方案仍面临原发耐药、血管正常化窗口期短暂及空间互作机制不清等挑战。本综述系统阐述抗血管生成药物联合免疫治疗在非小细胞肺癌中的协同增效机制及其在新辅助治疗领域的最新进展,以期为临床实践提供参考。

     

    Abstract: In the tumor microenvironment, a bidirectional feedback regulation exists between aberrant an- giogenesis and antitumor immunity, which provides a basis for the synergistic effects of antiangiogenic therapy and immunotherapy. The underlying mechanisms include relief of immunosuppression mediated by proangiogenic fac- tors, induction of vascular normalization to reshape the immune microenvironment, and formation of a positive im- mune-vascular feedback loop. Based on these mechanisms, the combination of antiangiogenic therapy and immu- notherapy has demonstrated synergistic efficacy in advanced non-small cell lung cancer (NSCLC) and is gradually being moved forward to the neoadjuvant setting. However, in the perioperative treatment of resectable lung cancer, this regimen still faces challenges, including primary resistance, a brief window of vascular normalization, and an unclear understanding of spatial interaction mechanisms. This review systematically elucidates the synergistic mechanisms of antiangiogenic agents combined with immunotherapy in NSCLC and the latest advances of this combination strategy in the neoadjuvant therapy setting, aiming to provide a reference for clinical practice.

     

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