1fy07h 发表于 2024-6-26 16:02:49

吴鸣教授专访:时间的礼物-怎么样优化晚期卵巢癌病人的没铂间期管理


    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/jibB0G2KdfM8JWKC5JDLw7uxdvEFERCj8ConMDUwAqVFHFNW96CXQLEbaAdRzCibXN4ykmibonic2lLlG40g5lNfrg/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">编者按</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">卵巢癌的治疗<span style="color: black;">始终</span>是妇科肿瘤治疗<span style="color: black;">行业</span>的难点,绝大<span style="color: black;">都数</span>卵巢癌<span style="color: black;">病人</span>经初始治疗缓解后会再次复发。在复发性卵巢癌的治疗过程中,<span style="color: black;">没</span>铂间期(PFI)是影响治疗效果和<span style="color: black;">病人</span>预后的一个<span style="color: black;">要紧</span>指标。<span style="color: black;">那样</span>,<span style="color: black;">怎样</span>优化晚期卵巢癌<span style="color: black;">病人</span>的<span style="color: black;">没</span>铂间期管理呢?中国妇产科在线对此采访了北京协和医院吴鸣教授,吴鸣教授就<span style="color: black;">没</span>铂间期的长短对卵巢癌<span style="color: black;">病人</span>预后的影响、以及<span style="color: black;">怎样</span>延长<span style="color: black;">病人</span><span style="color: black;">没</span>铂间期等做出了<span style="color: black;">仔细</span>介绍。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBdqvesgrZ8z5ln9Ct6icMicbMqa6T02B1HWppNhMq8joaN1RibRls8Ukmg/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">专家简介</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">吴鸣,教授,北京协和医院,妇产科<span style="color: black;">专家</span>医师。卫生部内镜专业委员会副主委,卫生部内镜监察委员会副总干事,中国抗癌协会家族遗传性肿瘤专业委员会副<span style="color: black;">专家</span>委员,中国抗癌协会腔镜与<span style="color: black;">设备</span>人分会副<span style="color: black;">专家</span>委员,北京妇科内镜协会副<span style="color: black;">专家</span>委员,多本杂志编委和多个医学院校客座教授。</span></p><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBzoyjLKrWlns8JibO8DZKiaLq1szq94FeEaPsfnIT20ECnVyma4WqAu3w/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">吴鸣教授&nbsp;</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">北京协和医院</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、中国妇产科在线:吴教授,您好!大<span style="color: black;">都数</span>晚期卵巢癌<span style="color: black;">病人</span>最初接受铂类化疗能够<span style="color: black;">得到</span>临床缓解,但<span style="color: black;">最后</span>会<span style="color: black;">显现</span>复发,而卵巢癌<span style="color: black;">病人</span>多次复发过程中<span style="color: black;">没</span>铂间期会<span style="color: black;">逐步</span>缩短,请您谈一下<span style="color: black;">没</span>铂间期的长短对卵巢癌<span style="color: black;">病人</span>的预后有<span style="color: black;">那些</span>影响?</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">吴鸣教授:</strong>卵巢癌的治疗<span style="color: black;">始终</span>是妇科肿瘤治疗<span style="color: black;">行业</span>的难点,绝大<span style="color: black;">都数</span>卵巢癌<span style="color: black;">病人</span>经初始治疗缓解后会再次复发。在复发性卵巢癌的治疗过程中,<span style="color: black;">没</span>铂间期(PFI)是影响治疗效果和<span style="color: black;">病人</span>预后的一个<span style="color: black;">要紧</span>指标。临床用药<span style="color: black;">发掘</span>,<span style="color: black;">没</span>铂间期的长短<span style="color: black;">明显</span>影响卵巢癌<span style="color: black;">病人</span>对再次含铂化疗的应答和<span style="color: black;">病人</span><span style="color: black;">存活</span>时间,<span style="color: black;">没</span>铂间期越长,再次应用铂类<span style="color: black;">药品</span>的治疗效果越好,<span style="color: black;">没</span>铂间期越短,再次应用铂类<span style="color: black;">药品</span>的治疗效果越差,且可<span style="color: black;">显现</span><span style="color: black;">药品</span>副反应的叠加,<span style="color: black;">引起</span><span style="color: black;">病人</span>治疗依从性差。<span style="color: black;">因此呢</span>,<span style="color: black;">没</span>铂间期是影响复发性卵巢癌治疗效果的非常<span style="color: black;">要紧</span>的指标。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">按照</span><span style="color: black;">病人</span>对初次含铂化疗的响应、<span style="color: black;">没</span>铂间期的长短,临床上分为铂<span style="color: black;">敏锐</span>、铂耐药及铂难治复发性卵巢癌。铂耐药复发指<span style="color: black;">没</span>铂间期短于6个月的复发,铂<span style="color: black;">敏锐</span>复发指<span style="color: black;">没</span>铂间期超过6个月的复发。如此一来,复发性卵巢癌的治疗便有了<span style="color: black;">知道</span>的临床用药标准,如<span style="color: black;">针对</span>铂耐药复发性卵巢癌<span style="color: black;">病人</span>,<span style="color: black;">再也不</span>首选含铂类化疗<span style="color: black;">药品</span>,而<span style="color: black;">针对</span>铂<span style="color: black;">敏锐</span>复发性卵巢癌<span style="color: black;">病人</span>,则首选含铂联合化疗。既往的<span style="color: black;">科研</span><span style="color: black;">发掘</span>,<span style="color: black;">没</span>铂间期为6个月时,再次应用铂类<span style="color: black;">药品</span>化疗,有效率约20%-30%;若<span style="color: black;">没</span>铂间期为12个月,有效率<span style="color: black;">达到</span>40%;若<span style="color: black;">没</span>铂间期为2年,有效率则达60%;若<span style="color: black;">没</span>铂间期为3年,含铂化疗治疗效果等同于卵巢癌初始应用铂类<span style="color: black;">药品</span>治疗的效果。<span style="color: black;">因此呢</span>,<span style="color: black;">针对</span>晚期卵巢癌<span style="color: black;">病人</span>应尽可能延长<span style="color: black;">没</span>铂间期,推迟复发和铂耐药的<span style="color: black;">显现</span>,且在复发性卵巢癌的治疗过程中,延长<span style="color: black;">没</span>铂间期是永恒的主题。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBdSETujJas3RPugc8Nic2AmDzac14fWXQcFc8N4icjJ58B4OPT57hIqJA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBUEbFTG0ZnUbiawBKU7fMKW1tk0f6GjwPeyBiaBic7blGLgf3UibiajIia0ug/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/Ljib4So7yuWj8kR7OpE7hRPxfW4ic19DJ4WyHWBUCfUVPaRyn1ibafibPfibF2mgricAIiahNqia9nKKKVLFfEicdorWAQw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、中国妇产科在线:如您所言,<span style="color: black;">没</span>铂间期对晚期卵巢癌<span style="color: black;">病人</span>的预后和<span style="color: black;">存活</span><span style="color: black;">拥有</span><span style="color: black;">要紧</span><span style="color: black;">道理</span>,那<span style="color: black;">怎样</span><span style="color: black;">才可</span>延长<span style="color: black;">病人</span><span style="color: black;">没</span>铂间期,推迟卵巢癌的复发和铂耐药的<span style="color: black;">显现</span>呢?</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">吴鸣教授:</strong>正<span style="color: black;">由于</span>延长<span style="color: black;">没</span>铂间期是治疗复发性卵巢癌的<span style="color: black;">要紧</span>环节,<span style="color: black;">因此呢</span>,<span style="color: black;">怎样</span>延长<span style="color: black;">没</span>铂间期贯穿<span style="color: black;">全部</span>卵巢癌的治疗过程。<span style="color: black;">针对</span>铂耐药复发性卵巢癌<span style="color: black;">病人</span>,临床上首选<span style="color: black;">没</span>铂单药化疗,<span style="color: black;">期盼</span>在治疗肿瘤的<span style="color: black;">同期</span>,尽可能的延长<span style="color: black;">没</span>铂间期,当<span style="color: black;">没</span>铂间期达到足够长时,可再<span style="color: black;">根据</span>铂<span style="color: black;">敏锐</span>复发的<span style="color: black;">办法</span>进行治疗。随着<span style="color: black;">没</span>铂间期的延长,<span style="color: black;">病人</span>对铂类<span style="color: black;">药品</span>的抵抗可能会慢慢消退,随着<span style="color: black;">没</span>铂间期的延长,再次<span style="color: black;">运用</span>铂类<span style="color: black;">药品</span>的有效性可能会<span style="color: black;">增多</span>。这是复发性卵巢癌治疗中非常<span style="color: black;">要紧</span><span style="color: black;">亦</span>非常传统的<span style="color: black;">办法</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>,指南<span style="color: black;">举荐</span>的延长<span style="color: black;">病人</span><span style="color: black;">没</span>铂间期的<span style="color: black;">药品</span><span style="color: black;">重点</span>有以下两种,维持治疗是延长晚期卵巢癌<span style="color: black;">病人</span>PFS的<span style="color: black;">要紧</span>手段。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(1)抗血管生成<span style="color: black;">药品</span>的维持:<span style="color: black;">日前</span>NCCN指南<span style="color: black;">举荐</span>贝伐单抗或帕唑帕尼用于初治卵巢癌<span style="color: black;">病人</span>的维持治疗,贝伐单抗用于铂<span style="color: black;">敏锐</span>复发性卵巢癌<span style="color: black;">病人</span>维持治疗;但抗血管生成<span style="color: black;">药品</span>的维持,仅仅使<span style="color: black;">病人</span>的PFS<span style="color: black;">加强</span>2-5个月,OS未改善,<span style="color: black;">病人</span>非常有限;并且化疗结束后需应用十多个疗程,总共二十多个疗程。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">(2)PARP<span style="color: black;">控制</span>剂的维持:</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近年来PARP<span style="color: black;">控制</span>剂的应用,为延长<span style="color: black;">没</span>铂间期带来了<span style="color: black;">更加多</span>的曙光。PARP<span style="color: black;">控制</span>剂尼拉帕利NOVA<span style="color: black;">科研</span><span style="color: black;">显示</span>,<span style="color: black;">没</span>论<span style="color: black;">病人</span>gBRCA突变与否,尼拉帕利均<span style="color: black;">明显</span>延长<span style="color: black;">病人</span>PFS。<span style="color: black;">另外</span>,尼拉帕利的治疗使得gBRCAmut<span style="color: black;">病人</span>的<span style="color: black;">没</span>铂间期长达22.8个月,而安慰剂组仅有9.4个月;non-gBRCAmut<span style="color: black;">病人</span><span style="color: black;">没</span>铂间期长达12.7个月(安慰剂组8.6个月)。<span style="color: black;">日前</span>尼拉帕利、奥拉帕利及卢卡帕利<span style="color: black;">已然</span><span style="color: black;">得到</span>FDA<span style="color: black;">准许</span>及NCCN指南的<span style="color: black;">举荐</span>,用于铂<span style="color: black;">敏锐</span>复发性卵巢癌<span style="color: black;">病人</span>的维持治疗。以尼拉帕利为<span style="color: black;">表率</span>的PARP<span style="color: black;">控制</span>剂彻底改变了铂<span style="color: black;">敏锐</span>复发性卵巢癌的治疗模式。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBJ7xNo7DSyn3jibesicOWWMOniaicRIibhy2daicQ2JshgtqqjpnDfr4U5RDg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/Ljib4So7yuWjvENZz3BdXIhicMshcOZIxUY600sv8cXibgCrvXeyKlI0swdvpPsSOy2gUrv5tT74Mf3vJA3TVgNug/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、中国妇产科在线:以尼拉帕利为<span style="color: black;">表率</span>PARP<span style="color: black;">控制</span>剂的<span style="color: black;">显现</span>,改变了现有的卵巢癌治疗模式吗?</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">吴鸣教授:</span></strong><span style="color: black;">PARP<span style="color: black;">控制</span>剂的<span style="color: black;">显现</span>,使传统卵巢癌的治疗模式受到了巨大的冲击,<span style="color: black;">咱们</span>从来<span style="color: black;">无</span>取得<span style="color: black;">日前</span>PARP<span style="color: black;">控制</span>剂带来的巨大的PFS延长,过往只能<span style="color: black;">选取</span>贝伐单抗维持或等待<span style="color: black;">疾患</span>复发,大部分铂<span style="color: black;">敏锐</span><span style="color: black;">病人</span><span style="color: black;">火速</span>发展为铂耐药,治疗手段非常有限。以尼拉帕利为<span style="color: black;">表率</span>的PARP<span style="color: black;">控制</span>剂的<span style="color: black;">显现</span>,使铂<span style="color: black;">敏锐</span>复发性卵巢癌的治疗模式<span style="color: black;">出现</span>天翻地覆的变化。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">第1</span>个关于PARP<span style="color: black;">控制</span>剂的临床<span style="color: black;">实验</span>,<span style="color: black;">已然</span>证明PARP<span style="color: black;">控制</span>剂能够<span style="color: black;">显著</span>延长复发性卵巢癌的<span style="color: black;">没</span><span style="color: black;">发展</span><span style="color: black;">存活</span>(PFS)。而尼拉帕利的NOVA<span style="color: black;">实验</span><span style="color: black;">科研</span>结果则更令人震撼,NOVA<span style="color: black;">科研</span>设计的最大特点是将复发性卵巢癌<span style="color: black;">病人</span>有<span style="color: black;">没</span>gBRCA基因突变区分,<span style="color: black;">而后</span>随机分组应用尼拉帕利与安慰剂,再进行对照<span style="color: black;">科研</span>。结果<span style="color: black;">发掘</span>,存在gBRCA基因突变的<span style="color: black;">病人</span>的PFS可显著延长,可超过20个月,<span style="color: black;">没</span>gBRCA基因突变的<span style="color: black;">病人</span><span style="color: black;">亦</span><span style="color: black;">得到</span>了非常理想的结果,<span style="color: black;">表示</span>其效果<span style="color: black;">显著</span>优于应用抗血管生成<span style="color: black;">药品</span>。<span style="color: black;">因此呢</span>,应用PARP<span style="color: black;">控制</span>剂<span style="color: black;">能够</span><span style="color: black;">显著</span>改善复发性卵巢癌<span style="color: black;">病人</span>的预后,从而延长<span style="color: black;">没</span>铂间期,推迟<span style="color: black;">疾患</span>的再次复发和铂耐药的<span style="color: black;">显现</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">同期</span>今年ESMO会议上亮相的一线维持结果<span style="color: black;">亦</span>是令人震撼。<span style="color: black;">然则</span><span style="color: black;">实验</span>只入组了有突变的病人,而<span style="color: black;">无</span>入组<span style="color: black;">没</span>突变的病人。<span style="color: black;">科研</span><span style="color: black;">表示</span>,与安慰剂组相比,PARP<span style="color: black;">控制</span>剂一线维持治疗<span style="color: black;">能够</span>使PFS延长3年多,这<span style="color: black;">亦</span>是对卵巢癌传统治疗模式的又一冲击。<span style="color: black;">因此呢</span>,<span style="color: black;">咱们</span><span style="color: black;">是不是</span><span style="color: black;">能够</span>如此预想,PARP<span style="color: black;">控制</span>剂<span style="color: black;">做为</span>一线维持治疗,延长<span style="color: black;">没</span>铂间期,几乎<span style="color: black;">能够</span>使所有的卵巢癌复发<span style="color: black;">病人</span>均<span style="color: black;">作为</span>铂<span style="color: black;">敏锐</span>复发,从而<span style="color: black;">加强</span>含铂化疗的临床应用率和临床治疗效果,化疗完成后再次应用PARP<span style="color: black;">控制</span>剂维持治疗,进一步延长<span style="color: black;">没</span>铂间期,等到下一次复发时,绝大部分<span style="color: black;">病人</span>仍是铂<span style="color: black;">敏锐</span>复发,如此继续延伸,可能会从本质上改变<span style="color: black;">咱们</span>对卵巢癌复发的认识。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/jibB0G2KdfM9YEicPjtBXuUiagyBM1AnnvBRfQziaF8SE1cjiaZUcjgTBquicPqwL352NBY4DQtOicZGwMxfD09hqSwiaQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">另一</span>,尼拉帕利正在国际和国内分别开展的一线维持<span style="color: black;">科研</span>——PRIMA和PRIME<span style="color: black;">科研</span>非常值得期待,这是两个前瞻性、多中心的临床试验,<span style="color: black;">包含</span>安慰剂组和尼拉帕利一线维持治疗组两组,不区分<span style="color: black;">病人</span>BRCA基因突变状态,随机入组。<span style="color: black;">因为</span>,临床<span style="color: black;">发掘</span>的所有卵巢癌<span style="color: black;">病人</span>中,存在BRCA基因突变者只占1/4<span style="color: black;">上下</span>,另有3/4的卵巢癌<span style="color: black;">病人</span>的靶点基因是未知的,<span style="color: black;">因此呢</span>,<span style="color: black;">咱们</span>相信<span style="color: black;">倘若</span>这两个临床<span style="color: black;">实验</span>可取得好的结果,将会使<span style="color: black;">更加多</span><span style="color: black;">病人</span>获益,且改变卵巢癌治疗的基本理念与基本原则。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">总之,</span><span style="color: black;">以尼拉帕利为<span style="color: black;">表率</span></span><span style="color: black;">的PARP<span style="color: black;">控制</span>剂为卵巢癌的治疗带来了曙光,使卵巢癌治疗的<span style="color: black;">将来</span>充满光明。</span></p>
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