肺癌生物及分子靶向治疗临床研究进展

世界卫生组织(WHO)2003年4月3日发表《世界癌症报告》说，根据目前癌症的发病趋势，2020年全世界癌症发病率将比现在增加50％，全球每年新增癌症患人数将达到1500万人。该报告还指出，现全世界发病率最高的癌症是肺癌，每年新增患为120万人。由于大多数肺癌患在诊断明确时已经失去了手术机会或术后出现复发和转移，放化疗又会产生明显的毒副作用及治疗抗性，     

晚期非小细胞肺癌靶向治疗的研究进展

随着测序技术的发展,不同分子靶点药物的研发,实体肿瘤的靶向治疗水平不断提高,给非小细胞肺癌(NSCLC)患者尤其是晚期患者带来希望。分子靶向治疗精确作用于肿瘤组织,减轻对正常组织的损伤,抗肿瘤作用准确,不良反应少,可明显改善患者预后,延长其生存期。目前,已有5类NSCLC靶向药物经美国食品药品管理局批准上市,分别为表皮生长因子受体抑制剂吉非替尼、埃克替尼及阿法替尼等,血管内皮生长因子抑制剂贝伐珠单抗和重组人血管内皮抑制素等,间变性淋巴瘤激酶抑制剂克唑替尼、色瑞替尼及艾乐替尼等,免疫靶向治疗药物派姆单抗和阿特朱单抗,     

非小细胞肺癌药物治疗的基因及分子生物学研究

随着肺癌的病因学研究进展,针对肺癌的药物研究也进入基因分子生物学时代.非小细胞肺癌的治疗提倡个体化治疗,即针对不同个体及致病基因,采用相应的分子靶向或化疗药物才能获得更大收益.本文总结了近年来关于非小细胞肺癌靶向基因和化疗的分子预测标志物以及相应药物的研究进展.     

非小细胞肺癌的治疗进展

目前,肺癌依然是导致人类癌性死亡的首位疾病,全球每年因肺癌死亡人数超过100万,其中80％～90％的患者为非小细胞肺癌（non—small cell lung cancer,NSCLC）。肺癌的治疗包括手术、化疗、放疗、分子靶向治疗及生物免疫治疗等多种方法。治疗方法的选择主要根据肺癌的病理类型、分期以及患者身体状况等。随着肺癌研究的进展,化疗和分子靶向药物的开发应用,治疗方法的不断改进,以及多学科综合治疗模式的开展,近年来肺癌的疗效有了明显的提高,现就NSCLC的治疗进展综述如下。     

肿瘤生物治疗

上世纪80年代中叶,Rosenberg等建立了现代肿瘤生物治疗的理论和基础。至今生物治疗已经成为肿瘤综合治疗中的第4种模式。肿瘤生物治疗目前主要包括：过继细胞免疫疗法与细胞因子疗法、肿瘤疫苗与树突状细胞、肿瘤分子靶向治疗、放射免疫靶向治疗、肿瘤基因治疗和生物化疗等。     

肺癌分子靶向治疗的现状与挑战

进入21世纪，分子靶向治疗已成为“点击率”最高的肿瘤相关新名词，时至今日，靶向治疗药物显示了有效性甚至是奇迹般的疗效，其中有些靶向治疗药物已成为国际肿瘤学界公认的标准治疗方案和规范。所有这些都使我们有理由相信：目前肿瘤内科治疗正处于从单纯细胞毒药物到分子靶向治疗的过渡时期，靶向治疗药物日新月异，围绕分子靶向药物的各种新的治疗方案、治疗策略层出不穷，这将为改善肺癌患者长期生存和总体疗效提供有效手段，并使肺癌变成“慢性病”的短期目标成为现实。作为21世纪肺癌治疗最具希望的治疗策略，靶向治疗以其独特的疗效和安全方便的应用方法引起了广泛关注，同时也遇到了许多传统治疗未出现的问题和挑战。现对近来肺癌分子靶向治疗的现状和问题谈一点看法，希望对肺癌临床研究工作者有所帮助．     

脑胶质瘤的生物治疗

随着基因工程技术和细胞工程技术的不断提高 ,肿瘤的生物疗法亦得到迅速发展 ,目前已开始用于临床 ,并取得一定疗效。现就生物疗法在脑胶质瘤中的应用情况作一介绍。1　脑胶质瘤的细胞因子疗法IL- 2是已知抗肿瘤细胞因子中最有效的细胞因子之一 ,具有广泛的生物学活性 ,如刺激细胞毒性 T细胞、辅助 T细胞和 L AK细胞扩增。 Merchant等将重组白细胞介素 2 (r IL -2 )用于 期临床试验 ,共治疗 9例复发性脑胶质瘤患者 ,均取得一定的疗效。近 10年来 ,随着肿瘤坏死因子 (TNF)的c DNA相继克隆成功 ,目前已进入 、 期临床试验 ,并取得了…     

肺癌药物靶向治疗的研究进展

<正>越来越多的肿瘤标志物使得肿瘤筛选性高的靶向治疗药物成为可能,并为肿瘤治疗做出了极大贡献。靶向治疗包括靶向基因治疗和靶向药物治疗。肺癌基因治疗主要是直接杀死肺癌细胞或抑制其生长,如miRNA突变可激活相关癌基因的表达或引发抑癌基因的缺失导致肿瘤发生,如miR-23a。在CD8+T淋巴细胞中,靶向miR-23可预防肺癌依赖的免疫抑制[1]。再如细胞因子信号传导抑制蛋白(SOCS)-1具有潜在抗     

分子靶向药物联合放疗治疗非小细胞肺癌的研究进展

分子靶向药物与放疗都是非小细胞肺癌的重要治疗方式,然而当前非小细胞肺癌的治疗现状仍不容乐观,我们试想分子靶向药物联合放疗是否能够协同作用,从而提高非小细胞肺癌的治疗效果,已有许多临床及临床前期研究探索了联合治疗的效果,本文就联合治疗的研究结果及合理性作一综述.     

非小细胞肺癌的分子靶向治疗进展

近年来分子靶向治疗药物成了肿瘤治疗领域的研究热点之一,目前研究最为广泛的靶向治疗药物主要有表皮生长因子受体（EGFR）家族抑制剂、血管生成抑制剂、多靶点抑制剂、信号传导抑制剂等。现将非小细胞肺癌（NSCLC）分子靶向治疗的研究进展情况综述如下。     

Postoperative radiotherapy in lung cancer: comments on several randomized trials or the contribution of well-conducted radiotherapy

Postoperative radiotherapy is classically proposed after surgical resection in case of a high risk of local recurrence (incomplete resection and nodal invasion especially mediastinal). Its interest was shown by non-randomized trials. Nevertheless, several randomized trials and one meta-analysis of them have recently questioned the contribution of radiotherapy. We analyze here these trials then the meta-analysis, emphasizing certain methodology problems such as the noninclusion of certain therapeutic trials and differences in radiotherapy dosages and techniques. In our opinion, excessive toxicity observed in certain trials can be attributed to technical errors; if well conducted, postoperative radiotherapy improves survival in operated patients when there is a high risk of local reccurence. This affirmation is based on a comparison of long term results of 347 non randomized cases with Port Meta-Analysis randomized cases and GETCB trial randomized cases.     

肺癌生物标记检测的研究

对 5 9例确诊的肺癌患者及健康对照者 2 72例分别进行 13种肺癌生物标记检测 ,并对 13种肺癌血清生物标记分别计算了相应的指标。结果 13种生物标记中 ,有些标记的特异性较高 ,而有些标记的敏感性较好。根据五项均值排列出 13种生物标记对肺癌诊断价值的大小。认为以五项均值为标准对肺癌常用生物标记临床诊断价值的大小进行排序 ,有助于肺癌的早期诊断、病情监测及预后判断。     

Update on screening for lung cancer

Prognosis of lung cancer is markedly improved when cancers are resected in early stages (particularly in stage I). Previous investigations failed to show benefit with use of chest radiographs or sputum cytologies to screen for lung cancer among high-risk populations. More recently, computed tomography (CT) has been used as a screening technique and appears to detect lung cancer at earlier stages (e.g., stage I) compared with usual clinical practice. However, whether screening CT reduces death from lung cancer has not been clarified. This review examines the problem presented by lung cancer, the issues presented by screening, and the results of past and recent studies of lung cancer screening.     

COPD影像学表型与肺癌关系的研究进展

COPD是一种可预防和治疗的呼吸系统疾病,以气流受限不完全可逆、进行性发展为特征,高分辨率CT能够定量显示早期的肺气肿并进行分级,且能先于肺功能检查发现肺部解剖结构异常。肺癌是最常见的恶性肿瘤之一,研究发现COPD影像学表型可能会增加肺癌的发病风险。该文就COPD影像学表型与肺癌的关系研究进展予以综述,为肺癌的早期预防、诊断提供帮助。     

肺癌在男性吸烟者与非吸烟者间差异性的临床研究

目的 研究吸烟对男性人群中肺癌的影响.方法 收集经组织学或细胞学诊断明确患有肺癌的644例男性患者的临床资料,按吸烟与否分为吸烟组和非吸烟组,并进行回顺性分析.结果 吸烟组鳞癌患者所占比例明显高于非吸烟组(40.08% vs 20.67%,P＜0.01),非吸烟组腺癌患者比例高于吸烟组(68.00% vs 44.53%,P＜0.01).非吸烟组作小细胞肺癌晚期患者的比例高于吸烟组(P=0.016).吸烟组咳嗽与咯血症状较非吸烟组明显(P值分别为0.032、0.008).非吸烟组无症状患者多于吸烟组(P=0.003).结论 吸烟男性肺痈患者中鳞癌比例较高,咳嗽和咯血症状明显;非吸烟男性肺癌患者以腺癌常见,临床表现不明显;非吸烟男性患者非小细胞肺癌晚期病例较吸烟男性患者多.     

Cryosurgery for lung cancer

Cryosurgery is suited for patients with lung cancer who are not considered for lung resection because of the advanced stage of the disease or the patient's poor general condition or poor respiratory function and with tumor recurrence following radiotherapy, chemotherapy or lung resection, and those patients who have localized lung cancer but refuse to receive operative therapy. Procedures of cryosurgery for lung cancer can be performed through endobronchial, direct intrathoracic (at exploratory thoracotomy) or percutaneous routes depending upon location and size of tumor. Six hundred and twenty-five patients with Non-small cell lung cancer (NSCLC) received percutaneous cryoablation in Fuda Cancer Hospital Guangzhou, China. One hundred and fifty patients were followed-up for 12 to 38 months. Results showed that 1-, 2-, and 3-year survival rates were 64%, 45% and 32%, respectively. The adverse effects after cryosurgery of lung cancer include haemoptysis, pneumothorax, bloody thorax, pleural effusion and pulmonary infection which are generally mild, transient, and recovery with symptomatic management. In vitro studies have shown cryotherapy of lung cancer cells can improve the immune system to trigger the specific anti-tumor response. In the future, comparative studies between this modality and other therapies should be conducted for the treatment of lung cancer. In addition, more attention needs to be put on the immunomodulators that enhance the cryoimmunology.     

Screening for lung cancer

The National Lung Screening Study has demonstrated that screening with low-dose spiral computed tomography results in fewer deaths from lung cancer compared with screening with chest radiography (CXR). Previous trials of screening with CXR and sputum cytology failed to exhibit fewer deaths compared with no screening intervention. Early computed tomography (CT) studies showed promise for CT to be a more sensitive test, yet were unable to demonstrate sufficient evidence of efficacy. This review examines the problem of early lung cancer detection, the issues presented by screening, and results of past and recent studies of lung cancer screening.