晚期肿瘤维持治疗疗效评判的研究进展
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摘要
晚期肿瘤维持治疗即一线治疗得到临床获益病情稳定后,继续采用药物治疗达到改善生活质量、延缓肿瘤进展、提高存活率的目的。维持治疗的停药指征为疾病进展或出现不可耐受的不良反应。及时调整二线治疗方案以延长患者生存期的方式已经得到认可。因此,临床上迫切需要一种判断维持治疗疗效、确定更换二线治疗时机的预测指征。全文就影像学、肿瘤标志物、临床表现和分子检测等常见的疗效评价手段作一综述。
When the clinical benefit and stable condition are achieved for patients with advanced cancer,the purpose of maintenance treatment is to improve the quantity of life,to delay tumor progression,and to prolong the survival of patients. The terminal point of maintenance treatment is the progression of disease or intolerable adverse effects. It has been generally recognized that to early discover the progression and to adjust second-line therapeutic protocol can prolong the survival. So it is necessary to have indicators for evaluating the efficacy of maintenance treatment and the time of scheduling second-line chemotherapy. In this review,the commonly used evaluation means are discussed,including imaging,tumor markers,molecular detection and clinical features.
When the clinical benefit and stable condition are achieved for patients with advanced cancer,the purpose of maintenance treatment is to improve the quantity of life,to delay tumor progression,and to prolong the survival of patients. The terminal point of maintenance treatment is the progression of disease or intolerable adverse effects. It has been generally recognized that to early discover the progression and to adjust second-line therapeutic protocol can prolong the survival. So it is necessary to have indicators for evaluating the efficacy of maintenance treatment and the time of scheduling second-line chemotherapy. In this review,the commonly used evaluation means are discussed,including imaging,tumor markers,molecular detection and clinical features.
引文
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[2]Shi Q,Hu S,Furnback WE,et al.The cost-effectiveness of a NSCLC patient assistance program for pemetrexed maintenance therapy in People's Republic of China[J].Clinico Economics and Outcomes Research,2017,9:99-106.
[3]Dranitsaris G,Beegle B,Ravelo A,et al.Evaluating the impact of bevacizumab maintenance therapy on overall survival in advanced non-small-cell lung cancer[J].Original Study,2013,14(2):120-127.
[4]Wasan H,Meade AM,Adams R,et al.Intermittent chemotherapy plus either intermittent or continuous cetuximab for first-line treatment of patients with KRAS wildtype advanced colorectal cancer(COIN-B):a randomised phase 2 trial[J].Lancet Oncol,2014,15(6):631-639.
[5]Ma J,Yang QL,Ling Y.Rechallenge and maintenance therapy using cetuximab and chemotherapy administered to a patient with metastatic colorectal cancer[J].BMC Cancer,2017,17(1):132.
[6]Reck M,Rodríguezabreu D,Robinson AG,et al.Pembrolizumab versus Chemotherapy for PD-L1-positive nonsmall-cell lung cancer[J].N Engl J Med,2016,375(19):1823-1833.
[7]Therasse P,Arbuck SG,Eisenhauer EA,et al.New guidelines to evaluate the response to treatment in solid tumors.European organization for research and treatment of cancer,national cancer institute of the United States,national cancer institute of Canada[J].Natl Cancer Inst,2000,92(3):205-216.
[8]Eisenhauer EA,Therasse P,Bogaerts J.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[9]Hirano S,Naka G,Takeda Y.A prospective,multicenter phaseⅡtrial of low-dose erlotinib as maintenance treatment after platinum doublet chemotherapy for advanced non-small cell lung cancer harboring EGFR mutation[J].Chin Clin Oncol,2016,5(6):77.
[10]Yeh YS,Tsai HL,Huang CW,et al.Maintenance tegafururacil versus observation following an adjuvant oxaliplatin-based regimen in patients with stageⅢcolon cancer after radical resection:study protocol for a randomized controlled trial[J].Trials,2017,18(1):191.
[11]Moreau P,Attal M,Caillot D,et al.Prospective evaluation of magnetic resonance imaging and[18F]fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial:results of the IMAJEM study[J].JClin Oncol,2017,JCO2017722975.
[12]Ke QH,Zhou SQ,Yang JY,et al.S-1 plus gemcitabine chemotherapy followed by concurrent radiotherapy and maintenance therapy with S-1 for unresectable pancreatic cancer[J].World J Gastroenterol,2014,20(38):13987-13992.
[13]Grimm MO,Grünwald V.Health-related quality of life as a prognostic measure of clinical outcomes in renal cell carcinoma:a review of the checkmate 025 trial[J].Oncol Ther,2017,5(1):75-78.
[14]Dong J.The efficacy evaluation criteria for targeted therapeutics in solid tumors:current status and prospective[J].Org Chin J Cancer Biother,2015,22(4):413-419.[董坚.实体肿瘤靶向药物疗效评价标准的现状和展望[J].中国肿瘤生物治疗杂志,2015,22(4):413-419.]
[15]Silva VSE,Chinen LTD,Abdallah EA,et al.Early detection of poor outcome in patients with metastatic colorectal cancer:tumor kinetics evaluated by circulating tumor cells[J].Oncotargets&Therapy,2016,9:7503-7513.
[16]Cheung KJ,Ewald AJ.A collective route to metastasis:seeding by tumor cell clusters[J].Science,2016,352(6282):167-169.
[17]Frank C,Leon T.Detection and characterization of circulating tumor cells by the cellsearch approach[J].Methods in Molecular,2015,1347:263-278.
[18]Guo M,Li X,Zhang S,et al.Real-time quantitative RT-PCR detection of circulating tumor cells from breast cancer patients[J].Int J Oncol,2015,46(1):281-289.
[19]Chen J,Li J,Sun Y.Microfluidic approaches for cancer cell detection,characterization,and separation[J].Lab Chip,2012,12(10):1753-1767.
[20]Karhade M,Hall C,Mishra P,et al.Circulating tumor cells in non-metastatic triple-negative breast cancer[J].Breast Cancer Res Treat,2014,147(2):325-333.
[21]Mehrotra P,Mehrotra A,Suryawanshi R.Meta-analysis shows that detection of circulating tumor cells indicates poor prognosis in patients with colorectal cancer.[J].Gastroenterology,2010,138(5):1714-1726.
[22]Meulendijks D,de Groot JW,Los M.Bevacizumab combined with docetaxel,oxaliplatin,and capecitabine,followed by maintenance with capecitabine and bevacizumab,as first-line treatment of patients with advanced HER2-negative gastric cancer:a multicenter phase 2study[J].Cancer,2016,122(9):1434-1443.
[23]Koyanagi,Kazuo,O’Day,Steven J,et al.Serial monitoring of circulating tumor cells predicts outcome of induction biochemotherapy plus maintenance biotherapy for metastatic melanoma[J].Clin Cancer Res,2010,16(8):2402-2408.