臨床婦人科産科72巻6号

2018年06月発行

今月の臨床 がん免疫療法の新展開─「知らない」ではすまない今のトレンド がん免疫療法の応用と問題点─婦人科腫瘍を中心に

抗がん剤・放射線・分子標的薬を免疫療法とどのように併用するか？

著者： 村上幸祐¹ 松村謙臣¹

所属機関： ¹近畿大学医学部産科婦人科学教室

ページ範囲：P.572 - P.577

●免疫療法単独では治療効果に限界があり，現在，免疫療法と従来の治療法を組み合わせたさまざまな臨床試験が行われている．

●免疫療法と抗がん剤，分子標的薬についてもさまざまな組み合わせで検討がなされているが，医療経済に与える影響も大きく，治療の個別化が重要である．

●放射線療法により，腫瘍抗原が放出されて免疫機構が活性化され，免疫療法の効果を高める可能性がある．

参考文献

1）Hamanishi J, et al : Safety and antitumor activity of anti-PD-1 antibody, nivolumab, in patients with platinum-resistant ovarian cancer. J Clin Oncol 33 : 4015─4022, 2015

2）Tewari KS, et al : Bevacizumab for advanced cervical cancer : final overall survival and adverse event analysis of a randomized, controlled, open-label, phase 3 trial（Gynecologic Oncology Group 240）. Lancet 390 : 1654─1663, 2017

3）Kang TH, et al : Chemotherapy acts as an adjuvant to convert the tumor microenvironment into a highly permissive state for vaccination-induced antitumor immunity. Cancer Res 73 : 2493─2504, 2013

4）van der Sluis TC, et al : Vaccine-induced tumor necrosis factor-producing T cells synergize with cisplatin to promote tumor cell death. Clin Cancer Res 21 : 781─794, 2015

5）Rajeev K, et al : Antiangiogenic agents can increase lymphocyte infiltration into tumor and enhance the effectiveness of adoptive immunotherapy of cancer. Cancer Res 70 : 6171─6180, 2010

6）Du Four S, et al : Combined VEGFR and CTLA-4 blockade increases the antigen-presenting function of intratumoral DCs and reduces the suppressive capacity of intratumoral MDSCs. Am J Cancer Res 6 : 2514─2531, 2016

7）Frenel JS, et al : Safety and efficacy of pembrolizumab in advanced, programmed death ligand 1-positive cervical cancer : results from the phase 1b KEYNOTE-028 trial. J Clin Oncol 35 : 4050─4056, 2017

8）Howitt BE, et al : Association of Polymerase e-mutated and microsatellite-instable endometrial cencers with neoantigen load, number of tumor-infiltrating lymphocytes, and expression of PD-1 and PD-L1. JAMA Oncol 9 : 1319─1323, 2015

9）Garguilo P, et al : Tumor genotype and immune microenvironment in POLE-ultramutated and MSI-hypermutated endometrial cancers : new candidates for checkpoint blockade immunotherapy? Cancer Treat Rev 48 : 61─68, 2016

10）Ott PA, et al : Safety and antitumor activity of pembrolizumab in advanced programmed death ligand 1-positive endometrial cancer : results from the KEYNOTE-028 study. J Clin Oncol 35 : 2535─2541, 2017

11）Borcoman E, et al : Pembrolizumab in cervical cancer : latest evidence and clinical usefulness. Ther Adv Med Oncol 9 : 431─439, 2017

12）Bernier J : Allying forces radio- and immune-therapy to enhance cancer cell killing. Crit Rev Oncol Hematol 108 : 97─108, 2016