胆道系统肿瘤的药物治疗  

Medical Treatment for Biliary Tract Cancer

作　　者：管梅[1] 白春梅[1] GUAN Mei;BAI Chun-mei(Depaitment of Medical Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肿瘤内科,北京100730

出　　处：《协和医学杂志》2020年第3期325-333,共9页Medical Journal of Peking Union Medical College Hospital

基　　金：中国医学科学院医学与健康科技创新工程(2016-I2M-1-001)。

摘　　要：手术切除是目前胆道系统肿瘤唯一的根治方法,但早期手术切除后复发率高,且患者诊断时大多为中晚期,已失去手术机会,预后较差。荟萃分析认为,术后辅助治疗能改善患者预后,BILCAP研究中卡培他滨辅助化疗虽未在意向治疗患者中达到研究终点,但在协定治疗患者中显示存在生存获益。吉西他滨联合顺铂(GC方案)仍是晚期一线标准化疗方案,吉西他滨联合替吉奥(GS方案)和吉西他滨、替吉奥联合顺铂(GCS方案)亦是一线治疗可选择的方案。IDH1、FGFR2作为肝内胆管癌的两种主要驱动基因已成为靶向治疗的研究热点,免疫检查点抑制剂单药或联合治疗研究亦逐步开展。本文旨在回顾胆道系统肿瘤的药物治疗进程,展望其治疗前景。Curative resection remains the most effective and the only potentially curative therapy for biliary tract cancer(BTC).Most of the patients with BTC present with an advanced(inoperable or metastatic)disease,and the relapse rate is high in those undergoing curative resection.In Meta-analysis,compared with surgery only,there was a significant improvement in overall survival with any adjuvant therapy after surgery.Although the BILCAP study failed to meet its primary endpoint by intention to treat analysis,a survival benefit was seen in a preplanned sensitivity analysis.Gemcitabine combined with cisplatin is still the first-line chemotherapy for patients with advanced disease.Gemcitabine with TS-1,or gemcitabine with cisplatin and TS-1 become an alternative to the first-line chemotherapy.IDH1 mutations and FGFR2 fusions have been positioned as the two main driving alterations in intrahepatic cholangiocarcinoma,and are the hot spots for targeted therapies.Immunotherapy alone or combined with other therapy is still on the way in the treatment of advanced BTC.This review discussed the past,present and exciting future of the medical treatments of cholangiocarcinoma.

关 键 词：胆道系统肿瘤 药物治疗 化疗 靶向治疗 免疫治疗 

分 类 号：R735.8[医药卫生—肿瘤] R-1[医药卫生—临床医学]