子宫内膜癌的靶向治疗研究进展

子宫内膜癌是常见的妇科恶性肿瘤之一。早期子宫内膜癌患者经过全面分期手术,必要时辅助放化疗,多预后良好,但晚期及复发性子宫内膜癌患者的预后较差,可采取的治疗方式有限。近年来,子宫内膜癌分子分型和基因检测显示出良好的应用前景,为预测患者预后和制定靶向治疗策略提供了重要信息。此外,针对特定靶点的药物研究在子宫内膜癌中取得一定的成果,靶向治疗可能成为晚期或复发性子宫内膜癌患者首选的治疗方式,缓解其临床症状,改善预后和减轻社会负担。     

子宫内膜癌免疫治疗：近期研究及未来前景

子宫内膜癌由于其独特的基因及分子特征,很有可能通过免疫治疗获益。免疫检查点抑制剂（ICIs）可以逆转肿瘤的免疫逃逸机制,恢复对肿瘤细胞的免疫应答,从而增强识别和杀伤肿瘤的能力。目前已有大量试验结果证明免疫治疗在子宫内膜癌的安全性和有效性。ICIs单药治疗疗效有限,联合治疗有望改善治疗前景。本文介绍了ICIs单药和联合治疗子宫内膜癌的最新临床进展,并从筛选免疫治疗优势人群、提高免疫耐受、明确免疫治疗耐药机制和接种高度免疫原性疫苗几方面探讨了未来发展前景。     

子宫内膜癌的激素治疗

子宫内膜癌作为常见的妇科生殖道恶性肿瘤,好发于中老年女性,发病年龄高峰在50 ～ 65岁.近年来研究表明,子宫内膜癌的发病率呈现年轻化的趋势,有25％的患者发生在绝经前,有3％～5％的患者是小于40岁的[1].许多研究表明,应用雌激素替代治疗(HRT)子宫内膜癌的危险性与雌激素应用时间和剂量有关.     

子宫内膜癌激素治疗的临床观察

<正>子宫内膜癌是较常见的妇科恶性肿癌,近年发病率有上升趋势,随着对疾病认识的不断提高,子宫内膜癌的诊断和治疗模式也出现了变化,除了以手术为主,并进行精确的手术——病理分期外,还需辅助激素化疗和放疗等治疗,孕激素因毒性低,可转化内膜而常用     

子宫内膜癌的药物治疗进展

子宫内膜癌近年发病率明显上升，其治疗方法包括手术治疗、放疗及药物治疗。对于晚期或子宫内膜癌复发患者及要求保留生育能力的年轻患者，临床以激素治疗、化疗和分子靶向治疗等药物治疗为主。本文综述子宫内膜癌药物治疗的研究进展。     

子宫内膜癌靶向药物治疗研究进展

子宫内膜癌的化疗耐药性问题显著,迫切需要新的治疗方案。随着对肿瘤发病机制和信号传导通路的深入研究,以及表观遗传修饰作用机制的阐明,靶向药物研究为子宫内膜癌的治疗提供了新的方法和手段。本文综述了表皮生长因子受体拮抗剂、血管内皮生长因子抑制剂、PI3K/Akt/mTOR通路抑制剂、PD-1/PD-L1抑制剂和表观遗传修饰抑制剂等靶向药物在子宫内膜癌治疗领域的研究进展,为临床用药提供新思路。     

晚期子宫内膜癌的治疗效果及预后研究

目的探讨晚期子宫内膜癌保守治疗不同治疗方法的疗效及预后情况。方法收集确诊为Ⅲ、Ⅳ期子宫内膜癌患者60例,按照术后辅助治疗方法分为3组,分别为化疗组,放疗组,激素治疗组,每组20例。统计分析3组的1、3、5年生存率及局部或远处复发情况。结果化疗组的1、3、5年生存率较其他组高,分别为85%、70%及35%,而激素治疗组的生存率最低,分别为55%、20%、0。1年生存率3组间差异无统计学意义（P〉0.05）;而3、5年生存率3组间差异有统计学意义（P〈0.05）。化疗组的局部或远处复发率较其他组低,分别为5%、15%、25%,而放疗组最高,分别为15%、35%、45%。3组间第1、3年局部或远处复发率差异无统计学意义（P〉0.05）;而第5年局部或远处复发率差异有统计学意义（P〈0.05）。结论术后辅助化疗对晚期子宫内膜癌有确切的疗效,能更有效的延长生存周期及降低复发率,而且其治疗方法简单,容易推广,值得在临床广泛应用。     

芳香化酶抑制剂治疗子宫内膜癌的研究进展

子宫内膜癌是较常见的妇科肿瘤,其发病率有逐年升高的趋势,子宫内膜癌的治疗手术为主,但是,对于晚期和复发的患者以及合并有高危因素的早期患者,需辅助放疗、化疗或激素治疗。激素治疗主要包括孕激素、选择性雌激素受体调节剂（SERM）、促性腺激素释放激素激动剂（GnRH—a）、芳香化酶抑制剂（AIs）及其他（如达那唑）。近年来,用芳香化酶抑制剂治疗各种雌激素依赖性妇科疾病及肿瘤的报道逐渐增多。现就AIs与子宫内膜癌的关系最新研究作一综述。     

子宫内膜癌的内分泌治疗研究进展

随着生活质量的提高与生活压力的增加,子宫内膜癌的发病率逐年升高。手术治疗是子宫内膜癌最主要的治疗手段,内分泌治疗作为辅助治疗方法之一也发挥着重要作用,但目前其用药方案与治疗机制仍待进一步探究。因此,本文综合国内外文献,对子宫内膜癌的内分泌治疗药物种类及作用机制、应用范围、疗效检测指标及未来发展方向进行阐述。     

子宫内膜癌激素治疗进展

子宫内膜癌为女性生殖系统常见的恶性肿瘤之一,且近年的发病率呈上升趋势.目前,临床治疗以手术治疗为主,辅以激素治疗、化疗、放疗等.早期子宫内膜癌以手术治疗为主,治愈率达70%,晚期复发或伴有高危因素的子宫内膜癌以激素及化疗等姑息治疗为主.近年来,由于40岁以下患者逐年增加,其中年轻有生育要求的患者要求保留子宫.因此,激素治疗越来越受到更多的关注和研究,临床应用也取得较大进展.     

An update on the current pharmacotherapy for endometrial cancer

Introduction: Endometrial cancer (EC) is the most common gynecologic malignancy in the developed world and is increasing in incidence. While the mainstay of treatment for EC is surgery followed by chemotherapy and/or radiation therapy, the available pharmacotherapies are rapidly and constantly evolving. Understanding these new therapies is an important part of the research and clinical care of women with EC. A review of available literature from MEDLINE (1879–2015) was conducted for the historic treatments and current therapies available for endometrial tumors.

Areas covered: This article reviews the current conventional therapies and discusses novel therapeutic agents, some of which are available to clinicians while others are currently being investigated in the preclinical setting.

Expert opinion: Genomic and immunohistochemical characterization of endometrial cancer may soon be the best approach for the identification of aggressive forms of tumor. Targeted therapies will soon be standard in the management of endometrial cancer.     

Novel strategies for systemic treatment of endometrial cancer

The median survival of women with advanced or recurrent endometrial cancer is less than one year. Of the women with early stage endometrial cancer and poor prognostic factors like high grade or deep myometrial invasion, 40% will recur. Over the last decade, incredible strides have been taken in evaluating systemic therapy for this disease, however, survival rates remain poor. Progestin therapy offers a 10 - 20% response rate and survival of less than one year. Progestins are most effective in women with well-differentiated tumours and long disease-free interval. There is no role for adjuvant progestin therapy in early stage disease. Single-agent chemotherapy with most activity include ifosfamide, cisplatin/carboplatin, doxorubicin and paclitaxel. Combination chemotherapy provides a response rate of 40 - 60%, however, median survival is still less than a year. New areas of research include the identification and evaluation of new active endocrine therapies (i.e., LY-353381.HCl and letrozole), chemotherapeutics (i.e., paclitaxel), evaluating chemotherapeutic agents in combination (i.e., paclitaxel, doxorubicin and platinum), in addition to radiation or instead of radiation. New avenues under development involve the specific molecules and pathways responsible for the initiation and growth of endometrial carcinoma (i.e., Herceptin?). Exciting developments in the understanding of the molecules involved in tumour development and metastasis will allow the development of specific and selective inhibitors.     

放疗联合靶向药物治疗食管癌的研究进展

在我国,食道癌是癌症死亡的第四大最常见的原因,严重威胁人类的健康。手术是食管癌治疗的重要方式,但对于不可手术的进展期食管癌患者,放化疗是其标准的治疗方式。然而目前的治疗方式预后仍然欠佳。因此,有必要开发更有效的新药融入该综合治疗模式中。靶向药物联合放疗在头颈部肿瘤治疗中已被证实能使患者获益。本综述集中阐述了在食管癌治疗中靶向药物的安全性及有效性,同时指出靶向药物与放射治疗相结合显示了良好的耐受性及令人满意的近期疗效,值得更深入的临床试验进一步研究。     

PD-1/PD-L1抑制剂联合其他免疫检查点抑制剂治疗三阴性乳腺癌的研究进展#br#

三阴性乳腺癌（TNBC）具有全身转移率高、对常规治疗不敏感以及容易产生耐药性等特点,导致患者的预后较差。随着对机体免疫系统抗肿瘤机制及TNBC免疫特点的不断探究,以程序性细胞死亡蛋白1（PD-1）和程序性死亡蛋白配体1（PD-L1）为代表的免疫检查点抑制剂为TNBC提供了新的治疗方案,但PD-1/PD-L1抑制剂单药治疗的效果不甚理想。本文就PD-1/PD-L1抑制剂联合其他具有不同机制的免疫检查点抑制剂在TNBC患者中的应用进行综述。     

Emerging drugs in endometrial cancers

Importance of the field: Endometrial cancer remains the most common gynecologic malignancy. The treatment of endometrial cancer is rapidly evolving.

Areas covered in this review: In this article, we aim to review current and future treatment options in the medical treatment of endometrial cancers.

What the reader will gain: The cornerstone of curative therapy for patients with endometrial cancer is surgical treatment. Cytotoxic chemotherapy is the mainstay of therapy for metastatic and advanced endometrial cancer. The most active chemotherapy agents are anthracyclines, platinum compounds and taxanes. Combination chemotherapy has produced higher response rates than single agent therapy. Cisplatin and doxorubicin combination chemotherapy has served as the control arm in many trials. Three-drug combination regimen has shown the highest response rate but with increased toxicity. Despite the lack of published data supporting the superiority of the paclitaxel plus carboplatin combination over doxorubicin and cisplatin, many centers prefer this regimen as a standard of care. Hormonal therapy should be considered in patients with low grade tumors and in those with a poor performance status. Recent advances in the understanding of the molecular biology of endometrial cancer have led to development of targeted therapies. Among these the more promising ones are mTOR inhibitors and antiangiogenic agents.

Take home message: Clinical trials are planned to further explore how to best incorporate novel agents into the current treatment algorithm with the aim to improve outcome for women with endometrial adenocarcinomas.     

Pharmacotherapy of endometrial cancer

Background: Endometrial cancer is the seventh most common malignancy among women worldwide. Despite most cases being diagnosed at an early stage, the death rate has increased steadily over the past 20 years. The lack of an effective, standardized adjuvant treatment for women at a high risk of recurrence has contributed to these disappointing results. Objectives: The goal of this review was to assess the role of hormonal and cytotoxic therapies in the adjuvant treatment of endometrial cancer. Once defined, an evidence-based management algorithm for this neoplasm was proposed. Methods: A thorough literature search was undertaken using the Cochrane and Pubmed databases. Systematic reviews, meta-analyses, and randomized controlled trials were first collected and critically analyzed. Other study types were secondarily considered when pertinent. Conclusions: The choice of the adjuvant therapy in early-stage endometrial cancer must be a patient-specific decision. Preliminary data suggest a role for chemotherapy in high-risk subgroups. However, further research is necessary to confirm this. To date, hormonal therapy has not been widely used in the management of early-stage disease, other than for conservative treatment in a fertility-sparing setting. Both hormonal and chemotherapy represent valuable therapeutic tools for the management of patients affected by advanced disease.     

Systemic therapy for the treatment of endometrial cancer

ABSTRACT

Introduction: Endometrial cancer (EC) is one of the most frequent gynecological cancers worldwide. The gold standard treatment of EC is most certainly surgery and may very well be the only therapy in the early stages of disease. To improve outcomes in non-early EC, adjuvant therapy is often employed but this is not standardized. Adjuvant options can include radiotherapy, chemotherapy or a combination of both. Adjuvant chemotherapy could be indicated in high-risk stage I and II or advanced stage EC. Several clinical trials are ongoing in an attempt to define the optimal adjuvant treatment. Furthermore, chemotherapy is the front-line therapy in advanced unresectable, metastatic or recurrent endometrial cancer.

Areas covered: Herein, the authors review the first-line chemotherapy for the treatment of endometrial cancer and provide their expert perspectives on these therapies.

Expert opinion: Chemotherapy is fundamental in advanced/recurrent EC. Further evidence is needed to characterize the role of adjuvant chemotherapy. Future studies should consider genomic and molecular heterogeneities to identify even more efficient tailored therapies.     

肌层浸润性膀胱癌药物治疗进展

肌层浸润性膀胱癌分为局部进展性膀胱癌和转移性膀胱癌,对于前者,以根治性膀胱切除为主,药物化疗为辅;后者以化疗为主。肌层浸润性膀胱癌药物化疗分为新辅助化疗、辅助化疗和分子靶向治疗。本文综述肌层浸润性膀胱癌药物治疗进展。