除了化疗，胰腺癌还有什么好的治疗方式？
<h2 style="color: black; text-align: left; margin-bottom: 10px;">胰腺癌的治疗<span style="color: black;">状况</span></h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胰腺癌因其<span style="color: black;">初期</span>诊断困难，发病后<span style="color: black;">发展</span><span style="color: black;">快速</span>，<span style="color: black;">存活</span>期短，被<span style="color: black;">叫作</span>为“癌中之王”，<span style="color: black;">日前</span>仍缺乏有效的治疗<span style="color: black;">办法</span>。<span style="color: black;">初期</span>胰腺癌<span style="color: black;">无</span><span style="color: black;">显著</span>症状，<span style="color: black;">非常多</span><span style="color: black;">病人</span><span style="color: black;">发掘</span>时<span style="color: black;">已经是</span>晚期，<span style="color: black;">无</span>手术治疗机会，只能<span style="color: black;">运用</span>化疗，五年的总<span style="color: black;">存活</span>率仅为6%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽管免疫<span style="color: black;">检测</span>点<span style="color: black;">控制</span>剂在肿瘤治疗<span style="color: black;">行业</span>的应用相对广泛，但在胰腺癌里的效果却始终未达到预期。<span style="color: black;">关联</span>的<span style="color: black;">科研</span>数据<span style="color: black;">显示</span>，单独<span style="color: black;">运用</span>PD-1<span style="color: black;">控制</span>剂，<span style="color: black;">病人</span>的<span style="color: black;">存活</span>获益不尽人意。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌度<span style="color: black;">博主</span>查阅最新肿瘤治疗<span style="color: black;">发展</span>时，看到一篇<span style="color: black;">颁布</span>在《Immunotherapy》期刊的回顾性<span style="color: black;">科研</span>分析，探索免疫治疗联合化疗<span style="color: black;">针对</span>胰腺癌的效果。虽然<span style="color: black;">病人</span>数量不多，<span style="color: black;">然则</span>治疗效果还是不错的，<span style="color: black;">咱们</span><span style="color: black;">一块</span>来<span style="color: black;">瞧瞧</span>其中相应的治疗经验和知识。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">胰腺癌<span style="color: black;">病人</span>从联合治疗中获益</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2018年1月至2022年4月，山西省白求恩医院肿瘤中心收治了18名晚期胰腺癌<span style="color: black;">病人</span>。<span style="color: black;">科研</span>者对这些<span style="color: black;">病人</span>的肿瘤进行了PD-L1表达、微卫星不稳定性MSI、肿瘤突变负荷TMB等数据分析。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-b7fd2a9651de73afcb2bbb681a8d9411_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>图1.肿瘤病人的特点和治疗<span style="color: black;">方法</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">如上图所示，<span style="color: black;">病人</span>肿瘤<span style="color: black;">都数</span>都有KRAS基因突变，微卫星属于稳定型。针对这些<span style="color: black;">病人</span>的治疗<span style="color: black;">办法</span>是化疗联合PD-1<span style="color: black;">控制</span>剂，但<span style="color: black;">运用</span>的PD-1<span style="color: black;">控制</span>剂不同，有的是帕博利珠单抗（K药，图1标识的K），有的是信迪利单抗。化疗<span style="color: black;">药品</span>则是白蛋白结合型紫杉醇联合吉西他滨（图1标识的AG）。每两个治疗周期<span style="color: black;">评定</span>一次疗效，直到病情<span style="color: black;">发展</span>或因不良反应而停药。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-36efb89e149aa7566d0a93972d7b97aa_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>图2. 肿瘤病灶的治疗效果<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗结果<span style="color: black;">显示</span>，1名<span style="color: black;">病人</span>可见病灶消失，达到了完全缓解。9名<span style="color: black;">病人</span>病灶<span style="color: black;">明显</span>缩小，达到了部分缓解。5名<span style="color: black;">病人</span>病情稳定，<span style="color: black;">另一</span>3名<span style="color: black;">病人</span>病情<span style="color: black;">发展</span>。<span style="color: black;">倘若</span><span style="color: black;">病人</span>PD-L1高表达，<span style="color: black;">或</span>是微卫星高度不稳定性，则从治疗中获益最大。在治疗中可见病灶完全消失，达到完全缓解的那名<span style="color: black;">病人</span>，微卫星不稳定性属于稳定型，<span style="color: black;">不外</span>PD-L1高表达。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">期待免疫联合化疗<span style="color: black;">早点</span><span style="color: black;">获准</span>用于胰腺癌</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>统计这项<span style="color: black;">科研</span>中的治疗数据，18名<span style="color: black;">病人</span><span style="color: black;">运用</span>化疗联合PD-1<span style="color: black;">控制</span>剂，治疗应答率是55.6%，而<span style="color: black;">疾患</span><span style="color: black;">掌控</span>率达到了83.4%。<span style="color: black;">针对</span>缺乏治疗<span style="color: black;">办法</span>的胰腺癌，这是很可观的治疗数据了。但<span style="color: black;">因为</span><span style="color: black;">病人</span>数量较少，还<span style="color: black;">必须</span>进一步的数据来证实治疗的可行性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>胰腺癌的治疗，<span style="color: black;">运用</span>免疫联合化疗<span style="color: black;">已然</span>开展了多项临床<span style="color: black;">实验</span>，只是暂时没达到相应的治疗预期，还不具备将这项治疗<span style="color: black;">办法</span>运用到临床的<span style="color: black;">前提</span>。<span style="color: black;">那样</span>胰腺癌<span style="color: black;">病人</span><span style="color: black;">到底</span>能<span style="color: black;">不可</span>用这个治疗<span style="color: black;">办法</span>呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胰腺癌<span style="color: black;">日前</span>一线标准治疗是化疗，治疗效果<span style="color: black;">不良</span>，后期会<span style="color: black;">显现</span>耐药和<span style="color: black;">发展</span>。<span style="color: black;">那样</span>，<span style="color: black;">倘若</span>一<span style="color: black;">起始</span>将化疗和PD-1<span style="color: black;">控制</span>剂联合<span style="color: black;">运用</span>，相较于单独<span style="color: black;">运用</span>化疗，<span style="color: black;">病人</span>的获益应该是<span style="color: black;">更加多</span>的。即便联合治疗<span style="color: black;">发展</span>了<span style="color: black;">亦</span><span style="color: black;">能够</span>参加第二代免疫治疗<span style="color: black;">药品</span>的临床<span style="color: black;">实验</span>，<span style="color: black;">或</span>参加肿瘤浸润淋巴细胞TILS的临床<span style="color: black;">实验</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，<span style="color: black;">意见</span>有<span style="color: black;">必须</span>的<span style="color: black;">病人</span><span style="color: black;">能够</span><span style="color: black;">思虑</span>检测免疫治疗的<span style="color: black;">关联</span>指标，<span style="color: black;">例如</span>PD-L1表达，以及微卫星高度不稳定性，这些检测会在后期的治疗过程中给予<span style="color: black;">必定</span>的参考。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">更加多</span>胰腺癌治疗知识和<span style="color: black;">科研</span><span style="color: black;">发展</span>，欢迎<span style="color: black;">大众</span>加入癌度胰腺癌交流群。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Dong Song et al, Safety and efficacy analysis of PD-1 inhibitors in combination with chemotherapy for advanced pancreatic cancer, Immunotherapy (2022).</p>
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