双磷酸盐在实体肿瘤中的应用进展

双磷酸盐是恶性肿瘤骨转移治疗中被广泛应用的药物。体外实验表明双磷酸盐对乳腺癌、肺癌、肾癌、黑色素瘤、结肠癌、胰腺癌有直接或间接抗肿瘤作用。临床研究显示双磷酸盐联合内分泌治疗或细胞毒性药物治疗可对乳腺癌起协同抗肿瘤作用,但对绝经期女性使用双磷酸盐预防乳腺癌尚存在争议。去势抵抗前列腺癌患者使用双磷酸盐可减少骨相关事件（skeletal-related events,SRE）发生风险,但在激素敏感性前列腺癌预防中未能显示出优势。双磷酸盐能够减少肺癌患者SRE发生概率,但其对患者总生存期无明显改善。对肾癌、膀胱癌骨转移患者使用双磷酸盐治疗可减少SRE发生风险,双磷酸盐可延长膀胱癌延长患者生存期。肾癌患者在双磷酸盐联合靶向药物治疗中获益与否尚待进一步研究证实。     

早期应用双磷酸盐在晚期前列腺癌治疗中的作用

[目的]探讨早期静脉应用双磷酸盐对晚期前列腺癌进展及骨转移发生时间的影响。[方法]晚期前列腺癌患者48例,将骨密度T-Score≤-2.5作为双磷酸盐应用指征。在确诊骨转移之前即开始应用双磷酸盐定义为早期使用,归入治疗组（24例）;在确诊骨转移之前未应用双磷酸盐者归入对照组（24例）。比较两组无进展生存期（PFS）、总生存期（OS）、骨转移发生率及发生时间。[结果]治疗组与照组相比较,中位PFS延长5个月（20个月vs 15个月）,有统计学差异（χ2=114.03,P〈0.001）;中位OS较比对照组无明显延长（38个月vs 39个月,χ2=2.14,P=0.14）。治疗组骨转移发生率明显低于对照组（25.0%vs 62.5%,χ2=6.86,P〈0.01）。治疗组平均确诊骨转移时间较对照组延迟4个月（21个月vs 17个月）,差异有统计学意义（21±3.5个月vs 17±1.5个月,t=3.75,P〈0.01）。[结论]早期应用双磷酸盐治疗晚期前列腺癌,可以明显延缓疾病进展,减少并推迟骨转移发生。     

应用微创治疗乳腺癌的临床新进展

随着社会的进步和科学技术的发展,20世纪末以来微创治疗的理论和技术是外科学重要的发展成果之一。微创是近年来逐渐应用的一种新的手术技术,微创外科的概念是1983年由英国Wickhanm首先提出来的,1987年Mouret成功进行电视腹腔镜下胆囊的切除。乳腺癌是一种全身性疾病,其诊断和治疗正向微     

双膦酸盐在乳腺癌辅助治疗中的作用

双膦酸盐能减少乳腺癌骨转移中骨相关事件的发生,预防早期乳腺癌治疗引起的骨丢失、增加骨密度;清除骨髓播散肿瘤细胞和循环中的肿瘤细胞,防止乳腺癌复发和转移;减轻早期乳腺癌新辅助化疗的肿瘤负荷,改善病理完全缓解率.双膦酸盐在早期乳腺癌辅助治疗的研究结果中存在差异,主要获益亚组为绝经后低雌激素水平患者.     

氨羟丙双磷酸盐治疗骨转移癌疼痛的疗效观察

晚期恶性肿瘤常可发生骨转移,并由此产生难以忍受的骨痛甚或溶骨性破坏导致骨折,其疼痛的折磨,严重影响了患者的生活质量。我们自１９９７年１月以来应用氨羟丙双磷酸盐（通用名称：Ｐａｍｉｄｒｏｎａｔｅｄｉｓｏｄｉｕｍ,帕米磷酸钠,商品名：阿可达）,治疗骨转移...     

乳腺癌诊治研究新进展

乳腺癌作为女性最常见的恶性肿瘤,发病率仍在不断上升。虽然目前还没有一种能够有效控制乳腺癌发生的一级预防措施,但随着其诊治水平的不断提高,乳腺癌的死亡率呈下降趋势。现就目前在乳腺癌诊治领域的研究状况作一概述。     

新辅助治疗在局部晚期乳腺癌中的应用

目的：探讨新辅助治疗在局部晚期乳腺癌治疗中的应用。方法：回顾性分析36例局部晚期乳腺癌患者进行新辅助治疗的临床资料：结果：36例患者中29例(80％)经新辅助治疗后病情缓解，可以手术。其中27例由化疗获得，2例由内分泌治疗获得。结论：大多数局部晚期乳腺癌患者可以在1—2个疗程的新辅助治疗后病情缓解，便于手术治疗，从而改善预后。     

MicroRNA在乳腺癌内分泌耐药中的研究新进展

内分泌治疗可显著改善雌激素受体阳性的乳腺癌患者的无病生存期和总生存期,但内分泌耐药是导致治疗失败的重要原因。微小RNA（microRNA,miRNA）是肿瘤研究领域中的热点,新近研究证实miRNA的表达变化是乳腺癌耐药机制之一。miRNA通过上调药物外排转运、抗凋亡蛋白、调节多药耐药信号传导网络等方式促成上皮 间质转化并形成肿瘤干细胞。miRNA亦可能通过调节雌激素受体α表达、受体酪氨酸激酶信号传导、细胞生存信号及细胞凋亡等途径引发耐药。miRNA可能成为激素受体阳性乳腺癌的预后因子、内分泌治疗疗效评估的预测因子以及新的靶点。     

乳腺癌治疗研究新进展

乳腺癌的治疗研究一直是乳腺癌研究中最为活跃的领域，近年来取得了飞速发展。本文结合2003年第26届圣安东尼奥乳腺癌会议报道，对过去一年来乳腺癌的治疗研究进展予以介绍。     

双磷酸盐与抗肿瘤性骨溶解

双磷酸盐与抗肿瘤性骨溶解张群喜肿瘤性骨溶解引起的骨结构破坏，每每导致骨疼痛、病理性骨折、高钙血症等一系列临床症状，临床处理颇为困难。我们结合有关文献，讨论双磷酸盐用于抗骨溶解治疗。双磷酸盐最初被用来治疗骨质疏松症。由于化学结构不断改进，在抗骨溶解治疗...     

纳米炭在乳腺癌治疗中的临床应用进展

摘 要：随着乳腺癌前哨淋巴结活检术在临床的广泛开展,纳米炭因在前哨淋巴结示踪方面展现了特异性淋巴结染色、显影迅速、检出率高等独特优势而在乳腺癌临床治疗方面广泛应用。研究表明纳米炭可吸附化疗药物进行靶向化疗,提高化疗疗效同时减少全身副反应,展现了其在药物治疗方面的应用前景。全文就纳米炭在乳腺癌临床治疗中的应用情况予以综述。     

Radiochemotherapy in the Treatment of Breast Cancer

Radiotherapy and chemotherapy have established roles in the multidisciplinary management of early breast cancer. The optimal integration of these treatment modalities is controversial. The most common approach is to deliver each treatment modality sequentially. For patients with close surgical margins or with other risk factors for local recurrences, initiation of adjuvant treatment with radiotherapy is recommended. A sandwich regimen is not the preferred schedule because of a decreased dose density for anthracyline- and taxane-based regimens. However, it can be an option for patients receiving adjuvant cyclophosphamide, methotrexate and fluorouracil (CMF). Concomitant radio- and chemotherapy remain in principle an attractive treatment schedule to provide an additive interaction of tumour control and shortening the duration of the overall treatment of time. However, it should be avoided due to the potential risk of augmented cardiac and skin toxicity for anthracyclines. Recent studies revealed an increased locoregional control and a slight toxicity when radiotherapy was given concurrently with cyclophosphamide, mitoxantrone and fluorouracil (CNF). On the other hand, CNF is no longer considered as standard adjuvant chemotherapy in breast cancer because of reports of secondary acute myeloid leukaemias.     

艾本联合放疗治疗骨转移癌的疗效观察

 恶性肿瘤一旦发生骨转移后，常出现顽固性疼痛、运动功能障碍、病理性骨折等，严重者影响生存质量。过去常行单纯放疗和／或化疗及姑息性麻醉止痛治疗，疗效差，持续时间短。选择我院及汉口空军医院住院及门诊骨转移癌患者42例，其中22例应用第三代双膦酸制剂-伊班磷酸纳(艾本)联合放疗，疗效较好，现报告如下。     

生存质量评价在乳腺癌治疗中的应用

生存质量(quality oflife,QOL)是一个多维的概念,包括生理、心理、社会的满意程度,以及疾病或治疗有关的症状.在肿瘤治疗领域中,QOL评价被广泛应用于·临床治疗决策、治疗效果评价、疾病严重程度评定、肿瘤药物效应评价等方面,成为肿瘤治疗研究终点之一.乳腺癌患者由于其发病率高、生存期长、病损部位特殊等原因,QOLL往往严重下降.本文综述了常用的乳腺癌患者QOL评价工具,如线性模拟自我评价量表、癌症患者生活功能指标、乳腺癌化疗问卷、癌症生存者生存质量量表、欧洲癌症研究与治疗组织生存质量量表、肿瘤治疗功能评价量表、国际乳腺癌协作组生存质量量表、癌症患者生存质量测定量表等,并分析影响乳腺癌患者QOL的主要因素,这将有助于乳腺癌患者的-临床治疗决策和QOL的提高.     

Checkpoint Inhibitors in the Treatment of Breast Cancer

Purpose of Review

The treatment landscape for many cancers has dramatically changed with the development of checkpoint inhibitors. This article will review the literature concerning the use of checkpoint inhibitors in breast cancer.

Recent Findings

The histological subtype of BC with the strongest signal of efficacy has been triple-negative breast cancer (TNBC). Early trials of single-agent checkpoint inhibitors did not demonstrate a uniformly positive signal. Clinical studies suggest response rates between 5 and 10% in pretreated patients and roughly 20–25% for untreated advanced TNBC. However, in the small subset of patients who do respond, the response is often durable. More encouraging results have been reported with their use in combination with chemotherapy in the neoadjuvant setting. Larger phase III studies are underway to confirm these earlier findings.

Summary

An immune-directed therapeutic approach for the management of BC is underway, and it is likely that combination therapy will be required to achieve a level of efficacy worthy of use in the BC treatment paradigm. These agents are not without both economic and clinical toxicity; therefore, it is imperative that we identify patients most likely to benefit from these therapies through well-designed biologically plausible clinical studies and by evaluating novel combinatorial approaches with informative biomarker driven correlative studies.

     

Bisphosphonates in the Adjuvant Treatment of Breast Cancer

Bisphosphonates, as potent inhibitors of osteoclast-mediated bone resorption, significantly reduce the risk of skeletal complications in metastatic bone disease and also prevent cancer treatment-induced bone loss (CTIBL). However, more recently, there has been increasing data indicating that bisphosphonates exhibit anti-tumour activity, possibly via both indirect and direct effects, and can potentially modify the metastatic disease process providing more than just supportive care. The evidence from previous studies of an anti-tumour effect of bisphosphonates was inconclusive, with conflicting evidence from adjuvant oral clodronate trials. However, more recent trials using zoledronic acid have shown benefits in terms of disease-free and overall survival outcomes in certain subgroups, most evidently in older premenopausal women with hormone-sensitive disease treated with ovarian suppression, and in women in established menopause at trial entry. In the adjuvant setting, the use of bisphosphonates has also been focused on the prevention and treatment of CTIBL and recent guidelines have defined treatment strategies for CTIBL. The role of bisphosphonates in CTIBL in early breast cancer is well defined. There have been mixed results from large adjuvant metastasis-prevention studies of bisphosphonates, but there are strong signals from large subgroups analyses of randomised phase III trials suggesting significant anti-tumour beneficial effects in specific patient populations.     

Intensity-modulated Radiotherapy in the Treatment of Breast Cancer

Intensity-modulated radiotherapy (IMRT) is a newer method of radiotherapy that uses beams with multiple intensity levels for any single beam, allowing concave dose distributions and tighter margins than those possible using conventional radiotherapy. IMRT is ideal for treating complex treatment volumes and avoiding close proximity organs at risk that may be dose limiting and provides increased tumour control through an escalated dose and reduces normal tissue complications through organ at risk sparing. Given the potential advantages of IMRT and the availability of IMRT-enabled treatment planning systems and linear accelerators, IMRT has been introduced in a number of disease sites. This systematic review examined the evidence for IMRT in the treatment of breast cancer to quantify the potential benefits of this new technology and to make recommendations for radiation treatment programmes considering adopting this technique. Providing that avoidance of acute adverse effects associated with radiation is an outcome of interest, then IMRT is recommended over tangential radiotherapy after breast-conserving surgery, based on a review of six published reports including 2012 patients. There were insufficient data to recommend IMRT over standard tangential radiotherapy for reasons of oncological outcomes or late toxicity. Future research should focus on studies with longer follow-up and provide data on late toxicity and disease recurrence rates.     

Treatment of Anthracycline-Resistant Breast Cancer

The anthracyclines are commonly used for the treatment of early stage and advanced stage breast cancer, but many patients develop resistance to therapy. The definition of anthracycline resistance varies considerably in the literature, but in most cases includes disease progression during or within 6–12 months after completion of anthracycline therapy. Some authors have distinguished true anthracycline resistance (defined as progression during anthracycline therapy) from anthracycline pretreatment (defined as progression after completion of therapy). Single agents that have demonstrated response rates of at least 15–20% in anthracycline pretreated or resistant disease include the antitubulin agents (docetaxel, paclitaxel, vinorelbine), antimetabolites (capecitabine, fluorouracil), nucleoside analogues (gemcitabine), and trastuzumab (for HER2/neu positive disease only). Phase III studies have demonstrated that docetaxel is more effective than paclitaxel, mitomycin/vinblastine, and methotrexate/fluorouracil, and that the docetaxel/capecitabine combination is more effective than docetaxel alone. The decision regarding which agent(s) to use should be based upon the patient’s prior treatment history, tumor biology (HER2/neu and hormone receptor expression), comorbid conditions (e.g. neuropathy, heart disease), and other considerations (e.g. insurance coverage for oral medication). The choice of a specific treatment regimen must be individualized based upon these considerations.