免疫检查点抑制剂治疗转移性结直肠癌的研究进展
涂娟娟, 金志明

Research progress of immune checkpoint inhibitors in the treatment of metastatic colorectal cancer
TU Juanjuan, JIN Zhiming
表1 近年来针对成年mCRC患者的ICI治疗临床试验汇总
Tab 1 Summary of recent clinical trials of ICI therapy in adult patients with mCRC
Trial (stage)Target populationRegimen (total)Key-outcomeTRAE of grade≥3
NCT0327480410 (Ⅰ)MSS/pMMR mCRCPembrolizumab+maraviroc (20)

ORR: 5.3%;

mPFS: 2.10 months;

mOS: 9.83 months

5% (hyperglycemia)
NCT0240799013 (Ⅰ)Advanced CRCTislelizumab (21)ORR: 14.3%
NCT0371294312 (Ⅰ/Ⅰb)Refractory, MSS/pMMR mCRCNivolumab+regorafenib (51)

mPFS: 4.3 months;

mOS: 11.1 months

51% (hypertension 16%, rash 10% and lymphopenia 8%)
CheckMate14211 (NCT02060188) (Ⅱ)First-line treatment intolerance or disease progression, MSI-H/dMMR mCRCNivolumab (74)

ORR: 31.1%; PFS rate: 50%;

OS rate: 73% (median follow-up was 60.9 months);

DDC≥12 weeks: 69%

20% (lipase elevation 8%, amylase elevation 3%)
NCT031507067 (Ⅱ)Age≥20 years, failure of first-line chemotherapy, MSI-H/dMMR or POLE-mutated mCRCAvelumab (33)

ORR: 28.6%; DCR: 90.5%;

mPFS: 3.9 months;

mOS: 13.2 months

18.20%
NCT0287319516 (Ⅱ)Disease progression, 89.4% were MSS/pMMR mCRCCapecitabine+bevacizumab+atezolizumab (87) vs capecitabine+bevacizumab+placebo (46)

mPFS: 4.4 vs 3.6 months;

mOS: 10.2 vs 10.3 months

61.6% vs 58.7% (skeptical)
NCT0318632617 (Ⅱ)Age 18‒75 years, failure of first-line therapy, MSI-H/dMMR mCRCAvelumab vs second-line theray±targeted therapyOngoing
NCT0456133618 (Ⅱ)Chemotherapy-refractory, wild-type RAS, 92.2% were MSS/pMMR mCRCAvelumab+cetuximab (77)

mPFS: 3.6 months;

mOS: 11.6 months

Rash 14% and diarrhea 4% included
NCT0360804619 (Ⅱ)Wild-type BRAFV600E, MSS/pMMR mCRCAvelumab+cetuximab+irinotecan (10)

mPFS: 4.2 months;

mOS: 12.7 months

0
CheckMate14222 (NCT04008030) (Ⅱ)MSI-H/dMMR mCRCNivolumab+low-dose ipilimumab (45)OS rate at 12, 18 and 24 months were 84.1%, 81.7% and 79.4%; PFS rate at 12, 18 and 24 months were 76.4%, 76.4% and 73.6%22% (colitis 4%, respiratory failure 2%)
NCT0287092024 (Ⅱ)Refractory CRCDurvalumab+tremelimumab (118) vs best supportive care (61)

mPFS: 1.8 vs 1.9 months;

mOS: 6.6 vs 4.1 months

62% vs 20%
NCT0312250925 (Ⅱ)Chemotherapy-refractory, MSS/pMMR mCRCDurvalumab+tremelimumab+radiotherapy (24)

ORR: 8.3%; mPFS: 1.8 months;

mOS: 11.4 months (median follow-up was 21.8 months)

25% (diarrhea 13%, colitis 8% and hyperglycemia 8%)

KEYNOTE-1778

(NCT02563002)(Ⅲ)

MSI-H/dMMR mCRCPembrolizumab (153) vs mFOLFOX6 or FOLFIRI (±bevacizumab/cetuximab) (154)

mPFS: 16.5 months;

mOS: 8.2 months

22% (colitis 3%, hepatitis 3%) vs 66%
IMblaze37015 (NCT02788279)(Ⅲ)Have received other treatmentsAtezolizumab+cobimetinib (183) vs atezolizumab (90) vs regorafenib (90)mOS: 8.87 vs 7.10 vs 8.51 months61% vs 31% vs 58%