![]() |
¿¬°£Á¤º¸ ¼ºñ½º
»óÇ°ÄÚµå
1349830
µÎ°æºÎ ÆíÆò»óÇǾÏ(HNSCC) : Tumour DeckHead and Neck Squamous Cell Carcinoma (HNSCC) - Tumour Deck |
µÎ°æºÎ(H&N)¾ÏÀÇ ÁÖ¿ä Ç¥ÀûÀº ÀÔ¼ú Á¡¸·, ÀεÎ, ÈĵÎ, ºÎºñµ¿ µî ±¸°¿¡¼ ¹ß»ýÇÏ´Â Á¾¾çÀÔ´Ï´Ù. À̵é Á¾¾çÀÇ 95% ÀÌ»óÀÌ ÆíÆò»óÇǾÏÀÔ´Ï´Ù. ±¸°¾Ï, ÀεξÏ, ÈĵξÏ, ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º(HPV) ºñ°ü·Ã ÁßÀεξÏÀÇ °¡Àå ÈçÇÑ ¿øÀÎÀº ´ã¹è¿Í ¾ËÄÚ¿Ã »ç¿ë Àå¾ÖÀÔ´Ï´Ù. µÎ°æºÎ¾Ï, ƯÈ÷ ´ã¹è¿Í ¾ËÄڿ÷ΠÀÎÇÑ µÎ°æºÎ¾Ï ȯÀÚ´Â µÎ°æºÎ, Æó, ½Äµµ, ¹æ±¤ ¹× ÀÌ·¯ÇÑ ¹ß¾Ï ¹°Áú¿¡ ³ëÃâµÈ ´Ù¸¥ ºÎÀ§¿¡ ¿ø¹ß¼º Á¾¾çÀÌ µ¿½Ã¿¡ ¹ß»ýÇÏ¿© ÀÌÂ÷ ¿ø¹ß¼º ½Å»ý¹°ÀÌ ¹ß»ýÇÒ À§ÇèÀÌ ÀÖ½À´Ï´Ù.
ÀüÀ̼º µÎ°æºÎ¾ÏÀº ƯÈ÷ ¹æ»ç¼±°ú ÈÇпä¹ýÀ» Æ÷ÇÔÇÑ ¼±ÇàÄ¡·á·Î º´ÀÌ ÁøÇàµÈ ÈÄÀÇ Ä¡·á°¡ ¹®Á¦ÀÔ´Ï´Ù. Áö³ 4³â°£ ¸é¿ª¿ä¹ýÀÌ ½ÂÀεǰí, µÎ °³ÀÇ PD-1 ¾ïÁ¦Á¦°¡ Àç¹ß ÀüÀÌ Ä¡·áÁ¦·Î ½ÂÀÎµÇ¸é¼ Å« È°±â¸¦ ¶ì°í ÀÖ½À´Ï´Ù. ÇöÀç ÀÓ»ó½ÃÇèÀÌ ÁøÇà ÁßÀÌ°í, ÀÌ°ÍÀÌ ÃÖÁ¾ Ä¡·áÁ¦·Î ÀüȯµÇ°í ÀÖ½À´Ï´Ù.
µÎ°æºÎ ÆíÆò»óÇǾÏÀº ¾Ï¼¼Æ÷¸¸À¸·Î ±¸¼ºµÈ °ÍÀÌ ¾Æ´Ï¶ó, Á¾¾ç¼¼Æ÷°¡ ¹Ì¼¼È¯°æÀÇ ´Ù¾çÇÑ ÄÄÆ÷³ÍÆ®¿Í »óÈ£ÀÛ¿ëÇÏ´Â ¿ªµ¿ÀûÀÎ »ýÅ°èÀÔ´Ï´Ù. ÀÌ »ýÅ°迡´Â ¸é¿ª¼¼Æ÷, ¾Ï °ü·Ã ¼¶À¯¾Æ¼¼Æ÷(CAF), ¾Ï Áٱ⼼Æ÷(CSC), Ç÷°ü°è, ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º(HPV)¿Í °°Àº ¹ÙÀÌ·¯½º ÀÎÀÚ°¡ Æ÷ÇԵ˴ϴÙ. ÀÌ·¯ÇÑ ÄÄÆ÷³ÍÆ® °£ÀÇ »óÈ£ ÀÛ¿ë°ú »óÈ£ ÀÛ¿ëÀ» ÀÌÇØÇÏ´Â °ÍÀº È¿°úÀûÀÎ Ä¡·á Àü·«À» °³¹ßÇÏ´Â µ¥ ÇʼöÀûÀÔ´Ï´Ù.
ÁøÇà±â Á¾¾çÀÇ ¹ß»ý·üÀÌ »ó´ëÀûÀ¸·Î ³ôÀº °ÍÀº HNSCC Á¾¾ç¿¡¼ Ãʱâ ȯÀÚÀÇ Áõ»óÀÌ Á¦ÇÑÀûÀ̰ųª Ãʱ⿡¼ ÁøÇà±â·Î ºü¸£°Ô ÁøÇàµÇ´Â °Í°ú °ü·ÃÀÌ ÀÖÀ» ¼ö ÀÖ½À´Ï´Ù. µû¶ó¼ ÀüÀ̸¦ Á¶±â¿¡ ¹ß°ßÇÒ ¼ö ÀÖ´Â Á¾¾ç ¹ÙÀÌ¿À¸¶Ä¿ÀÇ °³¹ßÀÌ ÇʼöÀûÀÔ´Ï´Ù. Á¾¾ç ¸¶Ä¿´Â ÀÌÂ÷ ¿¹¹æ¿¡ Áß¿äÇÑ ¿ªÇÒÀ» ÇÕ´Ï´Ù. Á¾¾ç ¸¶Ä¿´Â »ýÈÇÐÀû ¹× ¸é¿ªÇÐÀû Ç¥ÇöÀ» »ç¿ëÇÏ¿© Á¾¾çÀÇ ºÐȸ¦ Á¤·®ÈÇÒ ¼ö ÀÖ½À´Ï´Ù. ÇöÀç FDA´Â 28°³ÀÇ ¹ÙÀÌ¿À¸¶Ä¿¸¦ ü¿Ü¿¡¼ È®½ÇÇÑ ½ÃÇèÀ» °ÅÃÄ ÀÓ»ó »ç¿ëÀ» ½ÂÀÎÇß½À´Ï´Ù. ±×·¯³ª HNSCCÀÇ Áø´Ü ¹× ¿¹Èĸ¦ À§ÇØ FDA°¡ ½ÂÀÎÇÑ ´Ü¹éÁúÀ̳ª µ¹¿¬º¯ÀÌ ¸¶Ä¿´Â ¾ÆÁ÷ ¾ø½À´Ï´Ù.
´ÙÁ¦ º´¿ë¿ä¹ýÀ» ¹ÞÀº ±¹¼Ò ÁøÇ༺ HNSCC ȯÀÚÀÇ 50% ÀÌ»óÀÌ ¿ÏÄ¡¸¦ ¸ñÇ¥·Î ÇÑ Ä¡·á¸¦ ¸¶Ä£ ÈÄ 3³â À̳»¿¡ Àç¹ß ¹× ÀüÀÌ°¡ ¹ß»ýÇÕ´Ï´Ù. ÇöÀç Á¶±â ¹ß°ßÀ» À§ÇÑ È¿°úÀûÀÎ ½ºÅ©¸®´× ¹æ¹ýÀÌ ¾ø±â ¶§¹®¿¡ »ó´ç¼öÀÇ È¯ÀÚ°¡ ÁøÇàµÈ »óÅ¿¡¼ Áø´ÜÀ» ¹Þ°í ÀÖ½À´Ï´Ù.
¼¼°èÀÇ µÎ°æºÎ ÆíÆò»óÇǾÏ(HNSCC) ½ÃÀå¿¡ ´ëÇØ Á¶»çÇßÀ¸¸ç, ½ÃÀå ÇöȲ°ú ÇÔ²² Áõ·Ê¼öÀÇ µ¿Çâ, ȯÀÚ µ¿Çâ, °æÀï Á¦Ç° ½ÃÀå Æ÷Áö¼Å´×, ½ÃÀåÀÇ ±âȸ µîÀ» Á¦°øÇÏ°í ÀÖ½À´Ï´Ù.
Head and Neck (H&N) cancers primarily targets tumors originating from the oral cavity, including the mucosal lip, pharynx, larynx, and paranasal sinuses. More than 95% of these tumors are squamous cell carcinomas. The most common causes for oral cavity, hypopharynx, larynx, and Human Papillomavirus (HPV)-unrelated oropharynx cancers are tobacco and alcohol use disorders. Patients with H&N cancers, particularly those caused by tobacco and alcohol, risk synchronous primary tumors and developing second primary neoplasms in the H&N, lung, esophagus, bladder, and other sites exposed to these carcinogens.
"Metastatic head and neck cancer is a challenging disease to treat particularly after disease progression on prior therapy, which usually includes radiation and chemotherapy. Over the last 4 years, we've seen the big excitement with immunotherapy being approved, with 2 PD-1 inhibitors approved in the recurrent metastatic setting. We're seeing this moving now to the definitive therapy setting with trials that are accruing."
Head and neck squamous cell carcinoma is not solely composed of cancer cells but is rather a dynamic ecosystem where tumor cells interact with various components in their microenvironment. This ecosystem includes immune cells, cancer-associated fibroblasts (CAFs), cancer stem cells (CSCs), vasculature, and viral factors such as human papillomavirus (HPV). Understanding the interactions and crosstalk between these components is essential for developing effective treatment strategies.
The relative higher incidence of advanced stage tumours could be related to limited symptomatology in patients with early stage or swift progression from early to advanced stage in HNSCC tumours. Up to 40% of cN0 necks harbor occult metastatic disease. Hence, developing tumour biomarkers to detect metastasis at early stage is essential. Tumour markers play a significant role in secondary prevention. Tumour differentiation can be quantified using biochemical and immunological representation as tumour markers. Currently, the FDA has approved 28 biomarkers after robust in vitro tests for clinical use. However, there is no protein or mutation marker approved for diagnosis or prognosis in HNSCC by the FDA
Source: Bai et al, 2020.
For LA HNSCC, the primary treatment modality is often a combination of surgery and RT. In some cases, multimodal approach is considered in which chemotherapy may also be administered concurrently with RT to enhance its effectiveness.
For R/M HNSCC, the treatment options are more limited. Systemic therapy, which includes chemotherapy and targeted therapy, is the mainstay of treatment. Chemotherapy drugs such as cisplatin, carboplatin, and 5-fluorouracil are commonly used. Targeted therapies, such as cetuximab (an anti-EGFR monoclonal antibody), may also be used in combination with chemotherapy.
Immunotherapy has emerged as a promising treatment option for R/M HNSCC. Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, have shown significant efficacy in improving overall survival in patients with R/M HNSCC.
"Management of early-stage locoregional HNSCC primarily rests on a combination of chemotherapy and radiation therapy. However, the therapeutic trajectory becomes intricate for patients experiencing local or regional recurrence due to radiation field overlaps. Additionally, the management of recurrent or second primary HNSCC has become more complex due to the increased incidence of HPV-associated HNSCC compared to non-HPV HNSCC. This change in disease profile has led to a wider range of treatment options available to practicing oncologists, further complicating the decision-making process."
"Use of immunotherapy in the treatment of [HNSCC] is still evolving, with a continued unmet need for first-line regimens that provide durable clinical benefit with tolerable safety, further research is needed to determine the utility of dual immunotherapy as a treatment option for [HNSCC] and identify novel biomarkers to predict benefit with immunotherapy."