进展期胃癌的免疫治疗

　　Immunotherapy of Advanced Gastric Cancer

　　——韩国首尔国立大学Yung-Jue Bang教授访谈

　　进展期胃癌患者的治疗措施

　　在韩国和日本正在进行早期检测的全国筛查项目，约一半患者在早期阶段得到了诊断。尽管如此，在包括美国和西欧在内的其他国家和地区，大多数病例在晚期阶段才被诊断。对于进展期胃癌患者，可实施手术治疗是至关重要的。如果可以手术（或局限性肿瘤），我推荐行治愈性手术（D2切除术）并在这之后根据患者状态和疾病阶段行XELOX或S-1辅助化疗。如果无法手术（转移性肿瘤），进行HER2检测是最重要的。对于HER2阳性的进展期胃癌患者，XP或FP化疗联合曲妥单抗是标准治疗。对于HER2阴性的AGC患者，化疗是标准治疗，目前我推荐氟嘧啶与铂类药物联合。

　　进展期胃癌患者免疫治疗的发展历程

　　在包括进展期胃癌在内的实体肿瘤中，各种免疫疗法均被检验过。除了黑色素瘤和肾细胞癌之外，大多数试验结果为阴性。尽管如此，一种新型的免疫疗法——免疫反制点抑制剂（immune check-point inhibitors）似乎对肺癌和胃癌等各种实体肿瘤有效。目前，数项胃癌Ⅲ期临床试验正在对抗PD-1抗体或抗PD-L1抗体进行检测。

　　Oncology Frontier:  Early gastric cancer is common in Japan and South Korea， but in developing countries like China， advanced gastric cancer is more commonly diagnosed. What are the treatment methods for patients with advanced gastric cancer?

　　Prof. Bang: In Korea and Japan， National Screening Program for early detection is ongoing， and about half of patients are diagnosed at early stage. However， in other countries including USA and Western Europe， most of cases are diagnosed at advanced stage. For advanced gastric cancer (AGC)， operability is the most important. If operable (or localized)， I recommend curative surgery (D2 resection) followed by adjuvant chemotherapy with XELOX or S-1 depending on patient’s status and the disease stage. If inoperable (metastatic)， HER2 testing is the most important. For HER2-positive AGC， chemotherapy (XP or FP) plus trastuzumab is the standard of care. For HER2-negative AGC， chemotherapy is the standard of care. At present， I recommend the combination of fluoropyrimidine and platinum.

　　Oncology Frontier: For patients with advanced gastric cancer， immunotherapy is a current hot topic， and highlighted at this year’s ASCO Annual Meeting. Can you introduce the development course of immunotherapy to us?

　　Prof. Bang: Various kinds of immunotherapy has been tested in solid tumors including AGC. Most of these trials are negative， except for melanoma and renal cell cancer. However， a new form of the immunotherapy， immune check-point inhibitors seem to be effective in numerous kinds of solid tumors including lung cancer and gastric cancer. These anti-PD-1 antibodies or anti-PD-L1 antibodies are been tested in a couple of phase III trials for AGC.