外周T细胞淋巴瘤治疗——晚期难治挑战尚存,各方新药疗效可期

2020-07-29 Amiee 肿瘤资讯

T细胞淋巴瘤在非霍奇金淋巴瘤(NHL)中占比不高,欧美国家约占10%,中国的数据大概为21%。由于T细胞淋巴瘤分型较多,每种亚型患病人数相对较少,导致目前大家对疾病的了解、研究以及新药的研发相对较少。

2020年POST—ASCO会议信息交流会隆重召开。本次会议线上线下相结合,各瘤种大咖齐聚一堂,开启了一场干活满满的学术盛宴。广东省人民医院李文瑜教授对外周T细胞淋巴瘤当前的发病情况、治疗策略及新药研发等话题进行了解说。

临床挑战尚存,需求亟待满足

T细胞淋巴瘤在非霍奇金淋巴瘤(NHL)中占比不高,欧美国家约占10%,中国的数据大概为21%,在我们医院(广东省人民医院)约为28%,发病率相对较低。其中,T细胞淋巴瘤在欧美国家中发病最多的亚型即为外周T细胞淋巴瘤(PTCL),约为20%。由于T细胞淋巴瘤分型较多,每种亚型患病人数相对较少,导致目前大家对疾病的了解、研究以及新药的研发相对较少。

总体而言,PTCL以淋巴结肿大或脏器侵犯为主,患者常伴有有发热,且整体治疗效果不佳。患者经过一线治疗后,5年生存率仅为30%左右。除了ALK阳性ALCL亚型外,其余亚型的长期生存极低。大部分患者经一线治疗后会在1年内复发,应用常规化疗后,其生存期往往不足半年。因此,PTCL有表现复杂、常规难治、患者生存期短的特点,其临床治愈的需求远未被满足,也是淋巴瘤临床治疗中的一大挑战。

早期治疗尚佳,晚期困难重重

早在20年前,PTCL借鉴B细胞淋巴瘤的CHOP方案进行治疗。该方案对于B细胞淋巴瘤治愈率约为50%,对T细胞淋巴瘤单独划分统计显示长期生存仅为20%~30%。但在今年EHA和ASCO会议报道的研究进展中,一项回顾性研究通过分析经CHOP方案治疗后的250例患者,结果提示Ⅰ~Ⅱ期患者的5年无进展生存(PFS)为52%,5年总生存(OS)为58%。因此,早期年轻患者使用CHOP方案疗效是相对较好的。然而,晚期患者在整个PTCL患者人群中的比例达75%~80%,疗效不佳,仍是临床上亟待解决的问题。

新药带来希望,受益人群仍需拓展

在PTCL新药研发领域,突破性进展主要有两类。一类是组蛋白去乙酰化酶(HDAC)抑制剂,该类新药在国内外均已上市,其总体有效率20%左右,OS可达到1年以上,为部分复发难治的患者带来了新的突破。但整体而言,HDAC治疗有效的患者比例偏小,具体哪些患者是受益人群目前还在探讨当中。另一类为CD30单抗SGN-35,从结构上分析,SGN-35不是单纯的抗体,同时还偶联了微管抑制剂药物。CD30单抗对PTCL患者治疗的有效率较高,但其主要针对CD30阳性的部分患者,因此应用具有一定的局限性。总之,各类新药均为PTCL患者的治疗带来了新的希望,但同时也存在各自的局限性。PTCL的治疗目前仍然是困难重重,还需继续探索。

李文瑜,主任医师、硕士生导师、医学博士,广东省人民医院肿瘤中心-淋巴瘤科-行政主任,广东省女医师协会淋巴瘤专业委员会主任委员,广东省医学会肿瘤内科分会副主任委员 ,广州市血液肿瘤专业委员会副主任委员 ,广州市抗癌协会淋巴瘤专业委员会副主委,美国血液协会会员,CACA青年委员会委员。

 

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    2022-06-28 ms5000000603743593

    说明还是有进步的

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    2020-07-29 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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