头颈癌一线免疫治疗首次获得CSCO指南I级推荐,听听专家怎么说

2021-04-25 MedSci MedSci

近日,中国临床肿瘤学会(CSCO)头颈部肿瘤诊疗指南迎来重要更新,免疫治疗用于复发或转移头颈癌患者一线治疗更新为I级专家推荐,这也是头颈癌一线治疗首次将免疫治疗纳入I级专家推荐。

近日,中国临床肿瘤学会(CSCO)头颈部肿瘤诊疗指南迎来重要更新,免疫治疗用于复发或转移头颈癌患者一线治疗更新为I级专家推荐,这也是头颈癌一线治疗首次将免疫治疗纳入I级专家推荐。《CSCO头颈部肿瘤诊疗指南》自2018年首次发布以来,每年专家组都会基于最前沿的国内外循证医学研究进展和中国临床实践进行调整和更新。

CSCO头颈肿瘤专委会主委、上海市东方医院的郭晔教授表示,“CSCO头颈部肿瘤诊疗指南通过3年多的运行已取得广泛的影响力,特别是对于基层具有非常好的临床借鉴价值。指南是肿瘤治疗中的基石,而且近年来肿瘤治疗进展的步伐加快,及时根据最新的循证医学证据和国内可及性等情况更新指南相关内容,有助于提高基层规范化诊疗的水平,让每一位中国头颈癌患者都得到规范化治疗获益。

不可忽视的头颈癌,早诊早治是关键

头颈癌是颈部肿瘤、耳鼻喉科肿瘤和口腔颌面部肿瘤的总称,也是国内较为高发的恶性肿瘤之一。根据国际癌症研究机构最新报告,2020年中国新确诊头颈癌患者数预估超过14.2万,因头颈癌死亡的病例数将近7.5万,呈现稳定上涨趋势。

尽管头颈癌的发病率不断上升,不过对于普通人而言,却远不如肺癌、乳腺癌和胃癌等癌症被人熟知,70%~80%头颈癌患者确诊时已是局部晚期或晚期,即使经过传统综合治疗方案后仍较易复发,复发或转移性头颈癌瘤5年生存率仅为3.6%

头颈癌是常见的恶性肿瘤之一,最常见的病理类型为鳞癌,除了鼻咽癌主要由EB病毒引起,烟草和酒精是导致其他头颈部鳞癌的主要原因。郭晔教授强调,头颈癌很多早期症状不典型,很容易被人们忽视,等到患者发现患有头颈癌时,病情往往已发展到了晚期,错过了最佳治疗时机。对于长期抽烟,口腔溃疡经久不愈,持续声音嘶哑以及鼻咽出血等症状,一定要尽早到医院就诊。早期的头颈癌外科手术的治愈率在70%80%,如果一旦到了中晚期,治愈率只有30~40%

免疫治疗刷新头颈癌患者5年生存率

目前,头颈癌治疗强调综合治疗的理念,以手术为主,放化疗和靶向治疗作为辅助,但是患者5年生存率并没有显著提高。202012月,帕博利珠单抗获得中国国家药品监督管理局(NMPA)批准,成为部分复发或转移头颈癌患者一线治疗的新选择,自此刷新了头颈癌患者生存率。

相对放化疗,免疫治疗的安全性更好,其运作机制是通过调动自身免疫细胞来攻击肿瘤细胞,并利用其免疫记忆功能让患者肿瘤保持长期退缩的状态,让一部分患者达到长期生存。临床研究数据显示,帕博利珠单抗单药对比靶向治疗联合化疗方案,PD-L1阳性的患者的4年生存率从8%提升至21.6%,实现了近乎3倍的突破。而帕博利珠单抗联合化疗,更是将整体患者的4年生存率提高了4倍,从4.5%提升到了19.4%

凭借临床试验的优异表现以及一线治疗适应证的获批,此次CSCO指南更新也将帕博利珠单抗单药用于肿瘤表达PD-L1表达阳性以及帕博利珠单抗联合化疗一并纳入为I级专家推荐!这也是头颈癌一线免疫治疗首次获得I级专家推荐,预示着未来有更多头颈癌患者将从免疫治疗中获益,迎来长生存的希望。

郭晔教授表示:头颈癌早发现可以极大地改善患者的预后,而且复发转移头颈癌也进入了全新的免疫治疗时代。CSCO指南头颈肿瘤专委会十分关心头颈癌肿瘤患者的治疗现状,希望能够为他们带来更多生存希望。我也希望通过专家呼吁,大家能够更加重视头颈癌的预防和早诊早治。

随着免疫治疗和规范化诊疗理念的不断普及,将有更多头颈癌患者从中受益,也有助于推动大众对头颈癌认知的提高,重视预防和早诊早治。在不久将来,我们将有望看到中国头颈癌发病和死亡的下降。最后,郭晔教授强调到。

参考文献

1IARC. China Fact Sheet (2020).

2 Argiris A , Li Y , Forastiere A . Prognostic factors and long-term survivorship in patients with recurrent or metastatic head and neck cancer (HNC): An analysis of two Eastern Cooperative Oncology Group (ECOG) randomized trials[J]. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, 2004, 22(14_suppl):5514.

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    2022-02-15 薛鹏

    期待精准治疗和规范治疗的下文

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1193796, encodeId=b82f1193e96b0, content=期待精准治疗和规范治疗的下文, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201024/67558ad1510145499d4ffbb4720a49f0/db11b160e7384fb99f31c2853d79dc4c.jpg, createdBy=74815279084, createdName=薛鹏, createdTime=Tue Feb 15 22:26:11 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1083123, encodeId=cd48108312386, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=805c2608140, createdName=15025efc3fm, createdTime=Wed Dec 22 17:21:46 CST 2021, time=2021-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=972143, encodeId=c87f9e2143e6, content=:), beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/11/17/36053201f7a42f90a20bde74b92d8751.jpg, createdBy=a53a2351551, createdName=甜甜猫, createdTime=Wed Jun 09 14:23:56 CST 2021, time=2021-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1295914, encodeId=1e7e129591401, content=<a href='/topic/show?id=f30a4441598' target=_blank style='color:#2F92EE;'>#头颈癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44415, encryptionId=f30a4441598, topicName=头颈癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6c32257, createdName=DEXTER3139, createdTime=Tue Apr 27 03:57:09 CST 2021, time=2021-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960600, encodeId=36ee96060009, content=CSCO的内容更新越来越快啦,我国医疗越来越好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210426/daab3c5be6604abb94d08d39241f88db/5cd996b318154b7a95ed08c3ff532a64.jpg, createdBy=1be71966039, createdName=1e14b412m40(暂无匿称), createdTime=Mon Apr 26 12:41:05 CST 2021, time=2021-04-26, status=1, ipAttribution=)]
    2021-12-22 15025efc3fm

    不错!

    0

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    2021-06-09 甜甜猫

    :)

    0

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    2021-04-26 1e14b412m40(暂无匿称)

    CSCO的内容更新越来越快啦,我国医疗越来越好!

    0

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屋尘螨(HDM)舌下免疫疗法(SLIT)对过敏性鼻炎(AR)是有效的,但不同患者的疗效不同。目前尚无用于预测对SLIT响应的候选生物标志物。Periostin是一种基质细胞蛋白,参与了AR的病理生理学

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虽然过敏性疾病自古就有,但对其认识和系统学都是后来才有的。过敏性鼻炎(AR)是鼻炎(NN,鼻炎)最重要的临床疾病之一。AR明显降低生活质量且趋于增加,其后果可能是危及生命的疾病。

Eur J Cancer:肿瘤浸润淋巴细胞密度与免疫治疗的NSCLC患者预后正相关!

免疫检查点抑制剂(ICI)是癌症治疗最重要的里程碑之一。对于非小细胞肺癌(NSCLC),ICI单药或与化疗或其他ICI联合使用均可较单用化疗提高患者存活率,现已成为NSCLC的标准治疗方案。

Science Immunology:细胞自噬的黑暗面,帮助癌细胞逃脱免疫系统杀伤

肿瘤免疫治疗的兴起,为人类彻底攻克“万病之王”——癌症带来了新的曙光。其中,免疫检查点阻断疗法已成为当今最热门的免疫疗法之一。

Int Arch Allergy Immunol:皮下过敏原特异性免疫治疗对小儿过敏性鼻炎患者是安全的

皮下过敏原特异性免疫治疗(SCIT)是治疗儿童过敏性鼻炎的主要疗法之一,其能够改善症状和生活质量,但也不能排除不良反应(ADVrs)。尽管如此,也有一些报告对其安全性进行了评价。

Communications Biology:肌层侵袭性膀胱癌的多组学综合分析确定前线化疗和免疫治疗的预后生物标志物

只有一部分肌层浸润性膀胱癌(MIBC)患者对基于顺铂的化疗和PD-L1阻断免疫治疗有反应。临床上需要确定MIBC分子亚型和生物标志物,以便对患者进行分层和治疗。