2020 POST-ASCO:胶质母细胞瘤治疗的现状与未来

2020-07-27 Nathan 肿瘤资讯

神经胶质瘤是中枢神经系统中最常见的原发性脑肿瘤,其中半数以上为胶质母细胞瘤。那么,在肿瘤领域治疗理念不断革新的今天,胶质母细胞瘤的治疗现状以及进展为何呢?

神经胶质瘤是中枢神经系统中最常见的原发性脑肿瘤,其中半数以上为胶质母细胞瘤。那么,在肿瘤领域治疗理念不断革新的今天,胶质母细胞瘤的治疗现状以及进展为何呢?邀请到中山大学附属肿瘤医院牟永告教授予以解答。

牟永告,主任医师、主诊教授、医学博士、博士生导师,中山大学附属肿瘤医院神经外科主任,中国临床肿瘤学会(CSCO)神经系统肿瘤专家委员会主任委员,广东省抗癌协会神经肿瘤专业委员会主任委员,中国抗癌协会胶质瘤专业委员会常务委员,中国抗癌协会胶质瘤专业委员会脑转移瘤学组副组长,中国神经科学学会神经外科学基础与临床分会委员,中国医药技术协会3D打印技术分会委员,中国医师协会胶质瘤专业委员会委员,中国研究型医院学会脑功能研究与转化专业委员会委员,广东省胸部肿瘤脑转移专业委员会副主任委员。

TTF电场治疗为胶质母细胞瘤患者带来曙光

由于胶质母细胞瘤呈浸润式生长,没有包膜。因此,手术难以达到根治目的。当然,在术后还可以采取放化疗等进一步的治疗手段,但是,不论放化疗,可能产生的疗效都有限。原因是该瘤种的部分细胞属于放疗、化疗抵抗类型,而且放疗剂量过大还可能导致脑细胞坏死,从而影响脑功能,同时,大脑具备血脑屏障,药物很难在脑中达到能够杀灭肿瘤细胞的浓度。因此,现在胶质母细胞瘤的五年生存率仅有5%左右,只有极少的超过10%。尽管,新兴的免疫、靶向治疗都在研究之中,但是从研究趋势而言,这些药物的疗效亦有限,只能在一定程度上延长患者的生存期。最新的研究显示,使用TTF电场治疗,可以为脑胶质瘤的患者带来一线生机。若患者依从性好,遵循指引进行电场治疗,患者的中位生存期将超过20个月,这是目前对于脑胶质瘤治疗较为理想的方法。

胶质母细胞瘤手术:推崇En bolc resection

尽管,在未来电场治疗可能替代手术治疗的地位,但是,目前,手术是最根本的方法。通过手术可以切除肿瘤,降低颅内压,还可以明确病理和分子诊断,并为后续治疗提供一定的指导和帮助。现阶段,术中磁共振、唤醒手术、功能区肿瘤等方式,已最大限度的帮助肿瘤的切除。目前,需要明确到底应该采取怎样的方式去切除肿瘤。既往大家认为脑胶质瘤属于恶性肿瘤,切除多少都一样,然而,这种理念并不正确。脑胶质瘤的切除程度决定着患者预后,因此,近年来,我提出非功能区胶质瘤En bloc切除的方式,这是我提出的胶质瘤手术“无瘤”理念的核心,明显提高了患者的生存期,患者得到明显生存获益,在相应的临床研究中,106例患者的中位生存期可以超过20个月。所以,对于脑胶质瘤患者,应该强调尽可能的切除,否则,若出现残留,放、化疗的疗效有限,造成患者的生存获益下降。作为外科医生,现阶段应该把Enbloc resection尽可能的做好。

胶质母细胞瘤治疗:多手段联合是未来

尽管在ASCO以及NCCN指南上,均出现了可以治疗脑胶质瘤的靶向药物,例如,贝伐珠单抗应用于复发的胶质母细胞瘤。但是,由于肿瘤的异质性极强,单一靶点的抑制剂难以应对,所以单一的靶向药物很难从根本上控制住肿瘤。针对胶质母细胞瘤需要采取多靶点、多治疗手段联合的方法进行治疗。此外,目前针对复发胶质母细胞瘤患者,亦采取过利用其新生抗原制成疫苗,刺激患者的DC细胞的临床研究。尽管,鉴于试验成本太高,只能免费给有限的患者群体进行尝试,但是,在德国、英国的患者群体中,均观察到了患者获益的趋势。因此,个人认为免疫治疗是胶质母细胞瘤的一种治疗方法,包括主动免疫和被动免疫的联合,亦可进行尝试。还有一种新的治疗方式,即是方才所提及的电场治疗。在2018年,该治疗已被写入指南。过去传统的治疗手段是手术序贯同步放化疗以及辅助化疗,如今,在术后的同步放化疗结束时,即可使用电场治疗。电场治疗可以与放疗、化疗,甚至靶向、免疫治疗相结合,起到1+1>2的效果。随着电场治疗在国内上市,价格进一步降低,还可能惠及更多的患者。

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    2020-11-06 quxin068
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    2021-01-25 lg.zhao
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不论是《中国临床肿瘤学会(CSCO)免疫检查点抑制剂临床应用2020版》,还是《CSCO胃癌诊疗指南2020版》,胃癌的免疫治疗推荐均成为了备受瞩目的亮点。

Brit J Cancer:使用剪接寡核苷酸靶向ERG致瘤基因来治疗前列腺癌的研究

ERG致瘤基因是ETS转录因子家族的一个成员,是前列腺癌的遗传驱使因子。在50%的案例中通过与雄激素响应的TMPRSS2启动子融合被激活。因此,在开发靶向ERG的药物上研究较热。最近,有研究人员通过反

盘点:前列腺癌治疗进展盘点

【1】Prostate Cancer P D:镭-223和恩杂鲁胺或阿比特龙/强的松同时或分层治疗转移去势抵抗性前列腺癌

Clin Cancer Res:非转移去势抵抗性前列腺癌中阿帕鲁胺治疗效果和安全性的暴露-响应关系研究

最近,有研究人员在高风险非转移去势抵抗性前列腺癌男性中评估了阿帕鲁胺暴露与其活性代谢物,N-去甲基-阿帕鲁胺和选择性的临床疗效和安全参数之间的关系。

JAMA:急性心梗合并的亚临床甲减或无需治疗!随机临床试验

甲状腺激素在调节心肌收缩的过程中发挥关键的作用。既往研究表明,急性心梗患者如果合并亚临床甲减(促甲状腺激素水平升高、而甲状腺素水平正常),预后较差。

Eur Urol:保留Retzius的机器人辅助根治性前列腺切除术可持久地改善泌尿功能和生活质量且不会减弱肿瘤疗效

之前的研究表明,保留Retzius的机器人辅助根治性前列腺切除(RS-RARP)能够改善尿失禁。然而,关于技术和结果和可行性和普遍性仍旧存在问题。最近,有研究人员比较了140例连续的标准机器人辅助根治