Different immune drugs are mainly different in the following aspects: Target of action • PD-1 inhibitor: It acts on programmed death receptor 1 on the surface of T cells, blocks its binding with PD-L1 and PD-L2 of tumor cells, relieves immunosuppression, and restores the activity of T cells, such as Pabolizumab and Navuliumab. • PD-L1 inhibitors: directly act on PD-L1 on the surface of tumor cells or immune cells in the tumor microenvironment, prevent it from binding to PD-1, and play a role similar to PD-1 inhibitors, such as Atilizumab and Duvalizumab. • CTLA-4 inhibitor: It acts on cytotoxic T lymphocyte-associated antigen 4 on the surface of T cells, inhibits its negative regulatory effect on T cell activation, and enhances the activation and proliferation of T cells. Ipilimumab is the representative drug of this kind. PD-1/PD-L1 inhibitors are widely used in the treatment of a variety of cancers, such as melanoma, non-small cell lung cancer, renal cancer, lymphoma, etc., and have significant effects in the treatment of melanoma and lung cancer. • At present, CTLA-4 inhibitors are mainly used for melanoma, renal cancer, etc., and have been used earlier in the treatment of melanoma with definite effect. They are often used in combination with PD-1 inhibitors for patients with advanced melanoma. Efficacy and adverse reactions • Efficacy: Different immune drugs have different effective rates in monotherapy. Generally speaking, PD-1 inhibitors have relatively high effective rates in some cancers, while CTLA-4 inhibitors have relatively low effective rates in monotherapy, but combination therapy can improve the efficacy. • Adverse reactions: The adverse reactions of PD-1/PD-L1 inhibitors are relatively mild, mostly fatigue, rash, pruritus, diarrhea, etc., which can usually be relieved by symptomatic treatment. The incidence and severity of adverse reactions of CTLA-4 inhibitors are relatively high, and immune-related enteritis, hepatitis and endocrine diseases may occur, which need closer monitoring and more active management. Usage and Dosage • Route of Administration: Most immune drugs are administered intravenously, such as Pabolizumab, Navuliumab, etc., but there are also individual drugs that can be administered subcutaneously, such as the subcutaneous dosage form of Duvalizumab. • Medication frequency: Different drugs have different dosing cycles and frequencies. For example, Pabolizumab is generally administered once every 3 weeks, Navuliumab is administered once every 2 weeks, and Atilizumab is administered once every 3 weeks or once every 2 weeks. • Dosage adjustment: According to the adverse reactions and physical conditions of patients, the dosage adjustment methods of different immune drugs are also different, and doctors need to make individualized adjustments according to the specific situation.
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selection of appropriate immunotherapy drugs requires a comprehensive consideration of various factors. The following are some suggestions: Tumor type and stage • Different immunotherapy drugs have different effects on different tumor types. Such as non-small cell lung cancer, PD-1/PD-L1 inhibitors are commonly used in immunotherapy, and for melanoma, in addition to PD-1/PD-L1 inhibitors, CTLA-4 inhibitors also have a better application. • Patients with early-stage tumors who have a high risk of recurrence after surgery can choose immunotherapy drugs for adjuvant therapy, while patients with advanced stage tumors are often treated with immunotherapy combined with other therapies. Biomarker • PD-L1 expression level is an important reference index. In general, patients with high PD-L1 expression may have better efficacy with PD-1/PD-L1 inhibitors. • Patients with high tumor mutation burden (TMB) may be more sensitive to immunotherapy because their tumor cells have more gene mutations and produce more new antigens, so immunotherapy drugs should be preferred. • Microsatellite instability (MSI) is also an important marker, and patients with solid tumors with MSI-H/dMMR respond well to immunotherapeutic drugs. Patient’s physical condition and underlying disease • The patient’s general physical condition, age, organ function, etc. Will affect the choice of drugs. Patients with good health and strong tolerance can choose a regimen with relatively good efficacy but slightly more adverse reactions; patients with poor health and multiple underlying disease need to choose a drug with higher safety and relatively mild adverse reactions. • For patients with autoimmune diseases, the use of immunotherapeutic drugs may aggravate the disease, which requires careful risk assessment before selection. The efficacy and safety of drugs can refer to the clinical research data and the efficacy in practical application to understand the objective remission rate, progression-free survival, overall survival and other indicators of different drugs in the corresponding tumors, and select the drugs with better efficacy. • Pay attention to the adverse reactions of drugs, such as the adverse reactions of CTLA-4 inhibitors are relatively serious, while the adverse reactions of PD-1/PD-L1 inhibitors are relatively mild. For patients who can not tolerate serious adverse reactions, PD-1/PD-L1 inhibitors can be preferred. Treatment cost and accessibility • The price of different immunotherapy drugs is different, and the medical insurance reimbursement policy is different, which will affect the economic burden of patients. It can be chosen by considering drug prices, medical insurance reimbursement and family economic conditions. • Also consider the availability of medicines, including their availability at local hospitals or pharmacies.
