目前的临床研究显示，免疫治疗对EGFR突变NSCLC人群的疗效差强人意，这与基础的细胞学研究有所不同，也说明了机体的复杂性。

EGFR突变造成免疫治疗疗效不佳的原因与EGFR突变造成免疫逃逸和耐药有关，具体机制可能是重塑肿瘤细胞周围的环境形成“冷肿瘤”、PD-L1低表达、淋巴细胞浸润减少、低TMB等共同造成。

校对：小全  2019年10月25日

参考文献：

1.  Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med, 2015, 373(17): 1627-1639. doi: 10.1056/NEJMoa1507643

2.  Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet, 2016, 387(10027): 1540-1550. doi: 10.1016/S0140-6736(15)01281-7

3.  Ma BBY, Cervantes A, Huseni M A. Preliminary safety and clinical activity of erlotinib plus atezolizumab from a phase Ib study in advanced NSCLC. Ann Oncol, 2016, 27(9Suppl): mdw594.005.

4.  Ahn M J, Yang J, Yu H, et al. 136O Osi mer t in ib combined w it h durvalumab in EGFR-mutant non-small cell lung cancer: Results from the TATTON phase Ib trial. J Thorac Oncol, 2016, 11: S115.

5.  Mazieres JDA, Mhanna L, Milia J, et al. Efficacy of immune-checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC) patients harboring activating molecular alterations(ImmunoTarget) [abstract]. J Clin Oncol, 2018, 36(15 suppl): 9010.

6.  Lisberg A, Cummings A, Goldman J W, et al. A phase II study of pembrolizumab in EGFR-mutant, PD-L1+, tyrosine kinase inhibitor naive patients with advanced NSCLC. J Thorac Oncol, 2018, 13(8): 1138-1145. doi: 10.1016/j.jtho.2018.03.035