ATC是一种死亡率较高的甲状腺肿瘤,约占甲状腺恶性肿瘤的1%~2%。目前虽以手术、放疗、化疗、靶向治疗、免疫治疗等综合治疗为主,然而治疗现状堪忧。提高ATC患者生活质量和总生存期成为我们临床工作者重点及难点。本文就靶向药物治疗方案、治疗效果、近期临床试验结果等进行综述,为ATC的靶向药物治疗方案的选择提供参考。
ATC is a thyroid tumor with high mortality, accounting for about 1%~2% of thyroid malignant tumors. At present, although surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy and other comprehensive treatments are mainly used, the current situation of treatment is worrying. Improving the quality of life and overall survival of ATC patients has become the focus and difficulty for our clinical workers. This paper reviews the targeted drug treatment scheme, therapeutic effect and recent clinical trial results, so as to provide reference for the selection of targeted drug treatment scheme of ATC.
未分化甲状腺癌,靶向治疗,甲状腺癌,联合治疗, Undifferentiated Thyroid Cancer Targeted Therapy Thyroid Cancer Combined
Treatment摘要
ATC is a thyroid tumor with high mortality, accounting for about 1%~2% of thyroid malignant tumors. At present, although surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy and other comprehensive treatments are mainly used, the current situation of treatment is worrying. Improving the quality of life and overall survival of ATC patients has become the focus and difficulty for our clinical workers. This paper reviews the targeted drug treatment scheme, therapeutic effect and recent clinical trial results, so as to provide reference for the selection of targeted drug treatment scheme of ATC.
帕唑帕尼是一种单靶点TKI。主要针对VEGFR、PDGFR、FGFR等靶点。Crescent R. Isham等人 [10] 在体外研究中,帕唑帕尼/紫杉醇联合治疗在相对于紫杉醇或帕唑帕尼单一治疗减少肿瘤体积 > 50%。Crescent R. Keith C. Bible等 [11] 在一项二期多中心临床实验中,纳入15名ATC患者,由于帕唑帕尼抗肿瘤活性差,试验提前停止。虽然在一些患者中观察到短暂的疾病消退,但没有证实的RECIST反应。中位OS为111天,表明帕唑帕尼用以单一药物治疗ATC效果不佳;Teresa Di Desidero等人 [12] 在体外研究中帕唑帕尼联合拓扑替康或者单独同时处理ATC细胞72小时后,结果提示帕唑帕尼联合拓扑替康高度协同作用,表明了将该方案成为治疗ATC的新可能。
维罗非尼已经FDA批准用于治疗由BRAF v600突变导致的黑色素瘤。Kristen A Marten等 [21] 报告的1例BRAF变异的ATC患者,每周接受紫杉醇和卡铂辅助化疗,并接受放射治疗7周后,发生肺转移的患者随后口服威罗替尼,未发现药物毒性,发现早期治疗效果显著,但治疗2个月后,疾病在一步进展。另一个研究者Gerald W. Prager等 [22] 也报道了一例BRAF突变的患者,经化疗及放疗治疗后,颈部疾病仍然进展,并发生肺部转移,口服威罗替尼,7周后,用正电子断层扫描进行了第一次评估,以评估治疗效果,并显示出几乎完全的反应,同时临床症状(包括吞咽困难、疼痛和肿胀)大幅减轻,患者的一般状况显著改善至几乎正常。
李守博,张生军. 未分化甲状腺癌靶向治疗现状Current Status of Targeted Therapy for Undifferentiated Thyroid Cancer[J]. 临床医学进展, 2022, 12(02): 804-809. https://doi.org/10.12677/ACM.2022.122117
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