北京大学肿瘤医院赵军专家解析：初期肺癌莫要当晚期来治疗，不要盲试靶向药
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">丨铭医严选团队编辑</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">北京大学肿瘤医院的赵军<span style="color: black;">专家</span><a style="color: black;"></a>前几天分享了一个病例：一位82岁的老年<span style="color: black;">病人</span>，在当地医院<span style="color: black;">检测</span>提示左上肺占位和右肺占位，左肺穿刺活检后提示肺腺癌，做了射频消融得到了根除，右肺并未活检，准备<span style="color: black;">亦</span>行射频消融术，<span style="color: black;">同期</span><span style="color: black;">亦</span>在盲试靶向药。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那样</span>这位<span style="color: black;">病人</span>有必要<span style="color: black;">运用</span>靶向药吗？<span style="color: black;">茫然</span><span style="color: black;">运用</span>靶向药会有用吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">赵军分析<span style="color: black;">暗示</span>，有<span style="color: black;">非常多</span>当地的<span style="color: black;">大夫</span>会跟<span style="color: black;">病人</span>讲，岁数大了，不管靶向药有<span style="color: black;">无</span>用先吃上再说。但<span style="color: black;">实质</span>上，这位<span style="color: black;">病人</span>，结合PETCT<span style="color: black;">检测</span>，<span style="color: black;">日前</span>应该还是原发性的<span style="color: black;">初期</span>肺癌<span style="color: black;">病人</span>，左肺病灶经射频消融以得到根治，<span style="color: black;">倘若</span>右肺的结节<span style="color: black;">亦</span>确诊为癌症的话，<span style="color: black;">能够</span>再次做射频消融，基本上双肺都<span style="color: black;">能够</span>达到根治的<span style="color: black;">功效</span>了。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">1、<span style="color: black;">初期</span><span style="color: black;">病人</span>不要当晚期<span style="color: black;">病人</span>来治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤的治疗分期是非常<span style="color: black;">要紧</span>的，<span style="color: black;">倘若</span>是类似这种<span style="color: black;">初期</span>的<span style="color: black;">病人</span>，即使<span style="color: black;">不可</span>耐受手术，局部治疗的手段<span style="color: black;">亦</span>有<span style="color: black;">非常多</span>，<span style="color: black;">包含</span>SBRT放疗，又或是射频消融，都<span style="color: black;">能够</span>针对这种病灶使<span style="color: black;">病人</span>根治。<span style="color: black;">仅有</span>针对晚期<span style="color: black;">病人</span>，才<span style="color: black;">思虑</span>全身<span style="color: black;">药品</span>治疗。</p>注：射频消融是一种微创介入性治疗<span style="color: black;">办法</span>，<span style="color: black;">经过</span>高频电磁波产生热量灼烧肿瘤，已被证实安全有效。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这位老年<span style="color: black;">病人</span>有左侧腋窝<span style="color: black;">病痛</span>的症状，家属担心是转移，但其实PETCT<span style="color: black;">检测</span>上并<span style="color: black;">无</span>提示转移，<span style="color: black;">因此</span>有<span style="color: black;">有些</span>症状并不<span style="color: black;">必定</span><span style="color: black;">便是</span>转移，不要胡乱猜疑。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">2、盲试靶向药<span style="color: black;">为何</span><span style="color: black;">欠好</span></h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这位<span style="color: black;">病人</span><span style="color: black;">此刻</span>盲用靶向药还不如<span style="color: black;">吃下</span>止痛药。靶向药本身不知痛，<span style="color: black;">倘若</span>吃错了，不仅不止痛还会带来相应的副<span style="color: black;">功效</span>，<span style="color: black;">例如</span>这位<span style="color: black;">病人</span><span style="color: black;">已然</span><span style="color: black;">显现</span>食欲<span style="color: black;">不良</span>的副反应。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">靶向药效果虽好，却不是人人都适合，就好比钥匙和锁，你拿着钥匙（靶向药）但并<span style="color: black;">无</span>相应的锁（靶点），<span style="color: black;">这般</span>的话，胡乱喂钥匙<span style="color: black;">亦</span>不会有效果。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">非小细胞肺癌<span style="color: black;">平常</span>的基因突变有表皮生长因子受体（EGFR）、间变性淋巴瘤激酶（ALK）、C-ros原癌基因1酪氨酸激酶（ROS-1）等。<span style="color: black;">仅有</span><span style="color: black;">经过</span>检测<span style="color: black;">病人</span>基因突变的类型，<span style="color: black;">大夫</span>才有办法给<span style="color: black;">病人</span>个体化用药，<span style="color: black;">加强</span><span style="color: black;">药品</span>的有效性。<span style="color: black;">倘若</span><span style="color: black;">茫然</span><span style="color: black;">运用</span>，不仅<span style="color: black;">无</span>用，还肯能会耽误治疗的最佳<span style="color: black;">机会</span>。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">3、<span style="color: black;">怎样</span><span style="color: black;">选取</span>有效的靶向<span style="color: black;">药品</span><span style="color: black;">方法</span>？肺癌<span style="color: black;">病人</span><span style="color: black;">无</span>基因突变怎么办</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">面对不同的<span style="color: black;">病人</span>，会<span style="color: black;">选取</span>不同的治疗<span style="color: black;">方法</span>。<span style="color: black;">针对</span>单一基因突变的<span style="color: black;">病人</span>会<span style="color: black;">选取</span>一种靶向<span style="color: black;">药品</span>治疗，<span style="color: black;">针对</span>多基因突变的<span style="color: black;">病人</span>还会联合其他<span style="color: black;">药品</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而<span style="color: black;">针对</span><span style="color: black;">无</span>检测出基因突变的<span style="color: black;">病人</span>，</p>会<span style="color: black;">思虑</span>基因检测的结果<span style="color: black;">可否</span>规范，<span style="color: black;">此刻</span>基因检测<span style="color: black;">机构</span><span style="color: black;">非常多</span>，但水平却参差不齐，有<span style="color: black;">有些</span>不<span style="color: black;">必定</span>准确；会<span style="color: black;">思虑</span><span style="color: black;">病人</span><span style="color: black;">可否</span>为基因突变的高发人群，<span style="color: black;">例如</span><span style="color: black;">青春</span>不吸烟的女性，所患的<span style="color: black;">一般</span>都为肺腺癌，这种基因突变的概率较高，单纯的EGFR突变的概率大约为50%-60%；再分析靶向治疗能否为<span style="color: black;">病人</span>带来更长的<span style="color: black;">存活</span>期。<span style="color: black;">按照</span>这三个<span style="color: black;">原因</span>，为<span style="color: black;">病人</span><span style="color: black;">意见</span>更有效的治疗<span style="color: black;">方法</span>。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，靶向药针对不同的靶点还被分为一代、二代、三代<span style="color: black;">药品</span>，适应的人群都不同，<span style="color: black;">况且</span>并不是简单地<span style="color: black;">根据</span>一二三的<span style="color: black;">次序</span><span style="color: black;">选择</span>。一代<span style="color: black;">药品</span>与靶点结合并不<span style="color: black;">牢靠</span>，二代会永久锁住靶点，且<span style="color: black;">功效</span>的靶点更广泛，三代<span style="color: black;">重点</span>是<span style="color: black;">功效</span>于一代、二代靶向药耐药后<span style="color: black;">显现</span>的特定基因。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">晚期肺癌<span style="color: black;">病人</span><span style="color: black;">药品</span>治疗<span style="color: black;">方法</span>的<span style="color: black;">选取</span>是一件<span style="color: black;">繁杂</span>的事情，很多效果很好的<span style="color: black;">药品</span><span style="color: black;">倘若</span><span style="color: black;">无</span>用对人群，不仅有效率会大大降低，还会耽误<span style="color: black;">病人</span>的最佳治疗<span style="color: black;">机会</span>。<span style="color: black;">因此</span><span style="color: black;">必定</span>不要<span style="color: black;">茫然</span><span style="color: black;">运用</span><span style="color: black;">药品</span>，<span style="color: black;">包含</span>靶向药、化疗药、免疫<span style="color: black;">检测</span>点<span style="color: black;">控制</span>剂都不要<span style="color: black;">茫然</span><span style="color: black;">运用</span>，<span style="color: black;">必定</span>要找专业的<span style="color: black;">大夫</span>，在综合<span style="color: black;">评定</span>后抉择。以及在面对<span style="color: black;">疾患</span>时，尤其是会危及生命的重疾，<span style="color: black;">必定</span>要保持冷静，不要把<span style="color: black;">初期</span>肿瘤当做晚期去治疗，不要<span style="color: black;">茫然</span>用药，错失根治机会。<span style="color: black;">倘若</span>拿不定主意，或是对当地<span style="color: black;">大夫</span>的<span style="color: black;">方法</span>有质疑，找三甲医院权威专家寻求第二意见<span style="color: black;">亦</span>是不错的<span style="color: black;">选取</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">版权声明：本文由铭医严选原创，版权归铭医严选所有！欢迎转发，任何平台或<span style="color: black;">媒介</span>转载需联系后台授权。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">参考</h2><a style="color: black;">^</a><span style="color: black;">北京大学肿瘤医院官网</span>
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