林根教授谈新冠肺炎疫情逐步控制下肺癌患者的诊疗建议,推荐合适的患者接受口服抗肿瘤药物治疗

2020-03-17 佚名 肿瘤资讯

一场突如其来的新型冠状病毒疫情席卷中华大地,给肺癌患者的诊疗带来了极大不便。在国家强有力领导下,疫情得以逐步控制,多地出现连续零新增病例的情况。在疫情得到逐步控制的情况下,相信肺癌患者的诊疗也会进入正

一场突如其来的新型冠状病毒疫情席卷中华大地,给肺癌患者的诊疗带来了极大不便。在国家强有力领导下,疫情得以逐步控制,多地出现连续零新增病例的情况。在疫情得到逐步控制的情况下,相信肺癌患者的诊疗也会进入正常的状态。

疫情期间医院诊疗安排情况介绍

新冠肺炎疫情发生之初,形势十分严峻,福建省肿瘤医院根据国家和福建省工作建议出台了一系列严格措施,尽量减少患者不必要的就诊。采取诸多措施包括量体温、疫区病史询问等。作为胸部肿瘤内科,多数情况下,比其他科室更高危,有可能会接触到感染患者。首先,考虑到肺癌患者经常需要复查胸部CT,病区规定,凡是住院患者,入院之前必须完成血常规、C反应蛋白和胸部CT检查。与此同时,有无发热及疫区接触史将作为初步筛查手段,比其他科室更加严格。第二,医院还致力规范就诊秩序,所有患者必须采取预约制度。此次疫情在某种程度上能够改变国人的一些观念,就医预约制度有助于规范医疗秩序。第三,在治疗方面,尽量减少不必要的就医,让患者尽量少来医院。举例来讲,以往规定靶向药物最多开具一个星期用量,而疫情期间已经延长到两个星期甚至是一个月,以此来减少患者就医次数。在治疗方案设定时,以前主要考虑疗效,对于一般情况良好,能够耐受联合治疗的患者,会采用靶向药物联合化疗或者靶向药物联合抗血管生成的治疗方案,每3周为一治疗周期。在疫情之下,为了尽可能减少患者来医院就诊次数,在治疗策略上推荐调整为选择靶向单药进行治疗。

在疫情期间,免疫治疗处于暂停应用状态。患者接受免疫治疗期间若发生免疫相关性肺炎,很难与新冠肺炎相鉴别。新冠肺炎必须依靠病源学诊断,在疫情初期,全国新冠病毒核酸检测试剂供应非常紧张,同时拥有检测资质的实验室也较为有限,怀疑感染新冠肺炎的患者只能排队等待进行核酸的检测,只有上报疑似病例才能得到及时的检测。基于风险考虑,因此决定暂停免疫治疗的应用。

总体而言,在疫情发生早期,采取的主要措施有以下几点:第一,严格排查;第二,尽量减少不必要的就医;第三,治疗方案调整;第四,规范就诊秩序;第五,疫情初期,限制床位开放数量。

尽管当前疫情不断趋于缓和,但全国各个省份疫情程度并不一样,因此需要区别对待。而且现在对新冠肺炎的认识也在不断深入,恐惧心理逐渐变淡,在疫情趋于缓和的情况下,医院也做了相关调整,包括床位的不断开放等。当然在床位开放的同时,也要更加严格的把控疫情,同时兼顾患者的就医权利和诊治及时性。

疫情期间肿瘤患者的自我防护

此次疫情是以非常沉重的代价来进行科普,告诉公众什么是传染病,以及如何做好防护。简而言之,即不要去人群密集的地方。相比于其他人群,肿瘤患者是更高危的易感人群。广州医科大学附属第一医院开展的一项调查研究发现,肿瘤患者发病率和死亡率均高于其他人群。肿瘤患者首先在心理上一定要高度重视,做好充分防护。第二,戴口罩、勤洗手,保证充足的休息和营养状态。对专业人员来讲,做好防护没有问题。但是大众很难区分污染和洁净物品,拿戴口罩举例,大众会觉得随便摘口罩并无大碍,口罩随便摘或者摘中间范围即可,因此洁净和污染观念仍有待于提高,尽量不要做无用功。

疫情期间肿瘤患者就诊及疾病管理建议

医疗是双方面的问题,包括医生和患者两个方面。首先,从医生角度来讲,疫情期间,应该制定一些便捷或者副作用较低的治疗方案,能口服尽量口服,能够不打针就不打针,在同样疗效情况下,选用副作用稍低、容易处理的治疗方案。患者可以通过网络、微信或者医疗平台与医生进行沟通,尽量减少不必要的就医。第二,患者对常用药物可能发生的一些副作用的基本处理措施,需要做到心中有数。轻症患者,很多情况下可以自己处理,对于重症或需要及时处理的毒副反应,还是要及时就医。

疫情期间安罗替尼等口服抗肿瘤药物的应用建议

肿瘤综合治疗策略的制定要考虑患者的身体状况、病理类型、疾病分期、基因突变状态等多个因素,并且还要符合指南推荐。因为病情需要接受化疗的患者,还是要进行化疗,疫情之下,一方面要做好防护,另一方面也要兼顾到患者自身的生命利益,不然对患者同样是一种伤害。因此需要强调,不能把所有有效的治疗方案全部降阶梯改为方便患者的治疗,因为这样有可能会伤害到患者的根本。

安罗替尼有明确的适应证,目前也得到指南推荐,对于既往接受2种化疗方案失败的小细胞肺癌或非小细胞肺癌患者,后续治疗可以选择安罗替尼。安罗替尼作为国内自主研发的小分子多靶点药物,目前也在一线、二线治疗方面进行探索,初步结果表明,安罗替尼联合化疗、靶向药物或免疫治疗起到非常好的协同抗癌作用。以安罗替尼联合免疫治疗为例,在2019年世界肺癌大会上公布的安罗替尼联合信迪利单抗一线治疗驱动基因(EGFR/ALK/ROS1)阴性晚期非小细胞肺癌(NSCLC) 的Ⅰ期临床研究结果,联合方案初步观察安全、可耐受,主要研究终点客观缓解率(ORR)高达72.7%,同时疾病控制率(DCR)达100%。

在疫情特殊背景下,如果患者需要用到口服药物,同时满足安罗替尼适应证,从患者利益出发,要使用安罗替尼治疗。在安罗替尼使用过程中,绝大多数患者耐受性良好,主要不良反应有高血压、血脂升高、蛋白尿等,风险相对好把控。在应用过程中,要问清楚患者病史,如有无高血压、心脑血管病史等,从药物的副作用方面进行把控,这是非常重要的。

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    2020-03-17 公卫新人

    新冠肺炎,疫情何时才能消失

    0

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Critical Care Medicine:巴瑞替尼与c治疗重症新冠肺炎的疗效与不良反应

我们对重症新冠肺炎住院患者进行的倾向性得分匹配的回顾性观察研究显示,与托珠单抗相比,巴瑞替尼的病死率没有差异,但不良反应显著减少。

Critical Care Medicine:肾素-血管紧张素系统途径疗法与改善新冠肺炎男性住院患者预后相关

男性使用ARB与较低的机械通气和血管活性药物的使用率有关,而在女性中没有观察到该现象。RAS系统失调的性别差异可能导致COVID-19患者预后和对ARB药物反应性的性别差异。

2023年度巨献:中国中药领域十大医学研究出炉

2023年梅斯年终巨献:中国重磅级医学研究成果解读!

重磅!钟南山团队最新发表,连花清瘟的双盲、随机对照临床试验的结果出炉!

《病毒学》:与对照组相比,连花清瘟能够加速缓解多种临床症状,包括鼻塞、喉咙痛、咳嗽、发烧等等,从而促进轻至中度新冠肺炎患者的恢复。且两组安全性相当。

Lancet Respir Med:英国新冠肺炎住院后的多器官MRI发现

因新冠肺炎住院后,人们中期面临多器官异常的风险,本文发现强调了积极主动的多学科护理途径的必要性,并有可能进行成像来指导监测频率和治疗分层。