恶性胸膜间皮瘤内科治疗进展  

Progress in treatment for malignant pleural mesothelioma

作　　者：王玉艳[1] 何语灵 迟雨佳 翟晓宇 安彤同[1] 李俭杰 卓明磊[1] 赵军[1] 王子平[1] Wang Yuyan;He Yuling;Chi Yujia;Zhai Xiaoyu;An Tongtong;Li Jianjie;Zhuo Minglei;Zhao Jun;Wang Ziping(Department of Thoracic Medical Oncology Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Peking University Cancer Hospital and Beijing Institute for Cancer Research,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胸部肿瘤内1科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华结核和呼吸杂志》2022年第1期111-115,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：CSCO肿瘤研究基金(Y-MSDPU2021-0120)。

摘　　要：恶性胸膜间皮瘤(MPM)是起源于胸膜组织的一类侵袭性恶性肿瘤,在人群中发生率不高,但预后极差,中位生存期仅12个月左右。培美曲塞联合铂类化疗是目前指南共同推荐的一线方案,增加贝伐珠单抗的使用将进一步延长生存时间;但发生耐药后,尚没有能够带来明确生存获益的抗肿瘤治疗方案。目前包括NCCN指南在内的国际国内指南目前无推荐的标准的MPM二线方案,临床上常应用的方案为长春瑞滨、吉西他滨等单药化疗,但中位无进展生存期(PFS)仅3个月左右。免疫检查点抑制剂(ICI)已被证实在多种恶性肿瘤中具有显著的肿瘤生长抑制作用,其疗效与PD-L1表达具有一定相关性。在不可切除的MPM中,PD-1/PD-L1抑制剂治疗在一线和二线及以上治疗中均开展了一系列临床研究,部分结果也获得了国际指南的引用和推荐,但总体疗效改善有限。本文对国内外MPM治疗领域的最新临床研究现状进行总结,尝试寻找未来改善治疗疗效的方向和前景。Malignant pleural mesothelioma(MPM)is a kind of invasive malignant tumor originated from pleural tissue.The incidence of MPM is not high in the population,but the prognosis is very poor.The median survival time is only about 12 months.Pemetrexed combined with platinum is the first-line chemotherapy regimen recommended by the current guidelines.The use of bevacizumab will further prolong the survival of chemotherapy.Once resistance happened,no anti-tumor treatment has been confirmed to achieve survival benefits.Therefore,there is no recommended standard second-line MPM regimen in international and domestic guidelines,including National Comprehensive Cancer Network(NCCN)guidelines.Vinorelbine,gemcitabine and other monotherapy regimens are commonly used in clinical practice,but the median progression free survival(PFS)is only about 3 months.Immune checkpoint inhibitors(ICIS)have been proved to have a significant inhibitory effect on tumor growth in a variety of malignant tumors,and their efficacy is related to the expression of programmed death-ligand 1(PD-L1).In unresectable MPM,programmed death 1(PD-1)/PD-L1 inhibitors have been used in a series of clinical studies in the first-line,second-line and above treatment.Some of the results have been cited and recommended by international guidelines,but the overall efficacy improvement is still limited.This review summarizes the latest clinical studies and researches in the field of MPM treatment and predicts the directions and prospect of improving the therapeutic effect in the future.

关 键 词：贝伐珠单抗 恶性胸膜间皮瘤 国际指南 培美曲塞 长春瑞滨 肿瘤生长抑制 内科治疗 单药化疗 

分 类 号：R734.3[医药卫生—肿瘤]