末期Xp11.2染色体易位性肾肿瘤贯序舒尼替尼、阿昔替尼医治病案评价 。
阿西替尼最新动态摘 要：英立达。
【微信号码：yaodaoyaofang】：鄢谢桥，盛锡楠，迟文斌，崔传亮，斯璐，唐碧霞，王轩，毛娜娜，郭军 北大中医医院暨北京恶性肿瘤预防研究室肾肿瘤黑色素瘤消化内科，癌病发病机制及转换科学研究国家教育部重点实验室，北京市100142 来源于：前情回望晚中后期Xp11.2染色体易位性肾肿瘤贯序舒尼替尼、阿昔替尼医治病例报道1例卧底经典话语Xp11.2染色体易位性肾肿瘤在成年人中患病率较低，侵蚀性强，面诊III、IV期病患者超出50%1。低危非全透明体细胞病理学类型病患者行减瘤性肾脏功能摘除也会有显著获利2，该病案IMDC得分为1分，故最先开展了减瘤性肾脏功能摘除。在一线医治的选用上，大部分临床试验都清除了非全透明体细胞肾肿瘤，阿昔替尼等药品那时候并未投入市场，免疫疗法也很有可能功效不佳3,4，根据PFS及OS上的考虑到，舒尼替尼可能是较好的挑选，以往报导的mPFS为7.1-8.2月5,6。肾肿瘤肺癌脑转移蔓延发病率为3.5-17%7，一旦发生愈后偏差，GPA得分0分者mOS不超过3月8，多课程综合性诊治是关键医治方式。大家消息的病案发觉肺癌脑转移蔓延时颅外疾病平稳，依据Ippen等的数据信息9，手术病患者mOS能长达21.9月，并非手术病患者仅5.9月，因而人们对颞叶疾病完成了摘除。额叶疾病因坐落于功能分区没法手术，由于不断SRS超出80%的部分率控制10,11，挑选了SRS医治。现阶段已经有诸多数据信息适用靶向治疗药物物对脑部疾病的安全性特点和实效性12,13，SRS协同靶向治疗药物物可进可明显提升存活（16.6 vs 7.2月）14。该病患者GPA得分1分，预估存活時间11月17，有效的贯序医治很有可能进一步使病患者获利。在舒尼替尼医治进度病患者中，阿昔替尼较索拉非尼有更多的RR和PFS15，较依维莫司很有可能更好（PFS非常，但阿昔替尼组欠佳愈后者占比大量16），且根据VVT方式很有可能得到更长的OS和PFS17，二线大家选用了阿昔替尼。Shimura S等18报导过一例晚中后期肾肿瘤病患者，舒尼替尼医治后发生高发肺癌脑转移蔓延，二线阿西替尼合理，因拉肚子断药，之后观念水准大幅度恶变比较严重，再度阿西替尼医治10天之后观念水准改进，21天之后脑膜炎获得操纵。小白鼠实验表明阿昔替尼可通过血脑屏障19，提升脑部CD3 CD8 T体细胞总数，提升MDSC分裂，主要表现出脑部防癌和抗毛细血管活力20,21。PgP/MDR表述很有可能与血脑屏障排出来阿昔替尼22及欠佳疗效有关23，或可做为肺癌脑转移蔓延医治治疗效果预测分析指标值。现阶段最常见的预估指标值仍是MSKCC得分。除此之外，VEGF靶向药物治疗后血压值升高者很有可能有更强的愈后24，推断基本原理与VEGF通道抑止、毛细血管左室因素NO降低有关。阿昔替尼做为强大的VEGF缓聚剂，相对性于索拉非尼也呈现出更多的血压高发病率（42% vs 30%）。PD-L1（ ）者疗效较弱25，一线PFS時间（<10月）也是二线阿昔替尼治疗效果的欠佳预测分析指标值（10.8 vs 23月），较低的一线PFS很有可能代表着更具有侵扰性的恶性肿瘤分子生物学个人行为，或对VEGF靶向药物治疗的原发性承受药品，这时乐伐替尼 依维莫司等协同方式 也许会是更快的挑选。大家消息的病患者MSKCC得分中危，PD-L1(-)，一线PFS>10月，医治后发生血压高，阿昔替尼医治是适宜的挑选。公安人员风彩盛锡楠专家教授副高职称，副教授职称，研究生硕导北大中医医院肾肿瘤黑素瘤消化内科办公室副主任北京市防癌研究会泌尿男科恶性肿瘤专业联合会青委会主委我国医学恶性肿瘤学好(CSCO)肾肿瘤权威专家联合会文秘我国肝癌医治具体指导‧2017版执笔人我国医学恶性肿瘤学好(CSCO)青年委员中国抗癌协会泌尿男科恶性肿瘤专业协会青年委员北京市医科大学学好罕见病分裂泌尿学组副处长卧底风彩郭军专家教授北京肿瘤医院、北大临床医学恶性肿瘤学校副院长、北京恶性肿瘤预防研究室副局长肾肿瘤黑素瘤内科主任我国医学恶性肿瘤研究会（CSCO）执委会委员会我国医学恶性肿瘤研究会黑素瘤&肾肿瘤权威专家协会主委国际性黑素瘤科学研究同盟亚洲地区(过虑词)论文参考文献1. P Argani, S Olgac, SK Tickoo, M Goldfischer, H Moch, Xp11 translocation renal cell carcinoma in adults: expanded clinical, pathologic, and genetic spectrum. Am J Clin Pathol. 2007;31(8):1149-60. 2. Heng DY, Wells JC, Rini BI, Beuselinck B, Lee JL, Knox JJ, Bjarnason GA, Pal SK, Kollmannsberger CK, Yuasa T, et al: Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 66: 704-710, 2014.3. Komai Y, Fujiwara M, Fujii Y, Mukai H, Yonese J, Kawakami S, Yamamoto S, Migita T, Ishikawa Y, Kurata M, et al: Adult Xp11 translocation renal cell carcinoma diagnosed by cytogenetics and immunohistochemistry. Clin Cancer Res 15: 1170-1176, 2009 4. Armah HB and Parwani AV: Renal cell carcinoma in a 33-year-old male with an unusual morphology and an aggressive clinical course: Possible Xp11.2 translocation. Pathology 40:306-308, 2008 5. Choueiri TK, Lim ZD, Hirsch MS, Tamboli P, Jonasch E, McDermott DF, Dal Cin P, Corn P, Vaishampayan U, Heng DY, et al: Vascular endothelial growth factor-targeted therapy for the treatment of adult metastatic Xp11.2 translocation renal cell carcinoma. Cancer 116: 5219-5225, 2010.6. Malouf GG, Camparo P, Oudard S, Schleiermacher G, Theodore C, Rustine A, Dutcher J, Billemont B, Rixe O, Bompas E, et al: Targeted agents in metastatic Xp11 translocation/TFE3 gene fusion renal cell carcinoma (RCC): A report from the Juvenile RCC Network. Ann Oncol 21: 1834-1838, 2010. 7. Maria B, Antonella V, Michela R, et al: Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy.Therapeutic Advances in Medical Oncology.2016;8:450–459. 8. Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, et al. Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases. Journal of Clinical Oncology. 2012;30(4):419-25.9. Ippen FM, Mahadevan A, Wong ET, Uhlmann EJ, Sengupta S, Kasper EM. Stereotactic Radiosurgery for Renal Cancer Brain Metastasis: Prognostic Factors and the Role of Whole-Brain Radiation and Surgical Resection. Journal of Oncology. 2015;2015:636918.10. Berndt Wowra, Michael Siebels, Alexander Muacevic, Friedrich Wilhelm Kreth, Andreas Mack, Alfons Hofstetter. Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma. Journal of Neurosurgery. 2002;97(4):785-93.11. Rades D., Huttenlocher S., Gebauer N., Hornung D., Trang N., Khoa M., et al. Impact of stereotactic radiosurgery dose on control of cerebral metastases from renal cell carcinoma. Anticancer Res 35: 3571–3574.12.Bastos D., Molina A., Hatzoglou V., Jia X., Velasco S., Patil S., et al. Safety and efficacy of targeted therapy for renal cell carcinoma with brain metastasis. Clin Genitourin Cancer 13: 59–66.13. Verma J., Jonasch E., Allen P., Weinberg J., Tannir N., Chang E., et al. The impact of tyrosine kinase inhibitors on the multimodality treatment of brain metastases from renal cell carcinoma. Am J Clin Oncol 36: 620–624.14. Cochran D., Chan M., Aklilu M., Lovato J., Alphonse N., Bourland J., et al. (
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S, Altieri V et al. Prognostic significance of multidrugresistance protein (MDR-1) in renal clear cell carcinomas: a fve year follow-up analysis. BMC Cancer. 2006; 6:293. 24. Rini BI, Schiller JH, Fruehauf JP, et al. Diastolic blood pressure as a biomarker of axitinib effi cacy in solid tumors. Clin Cancer Res 2011;17: 3841–49. 25. YuanYuan Qu, Kun Chang, Bo Dai, Yao Zhu, HaiLiang Zhang, DingWei Ye. PD-L1 expression in XP11.2 translocation renal cell carcinoma: indicator of tumor aggressiveness.The Journal of Urology.2017;197. 版权声明著作权属恶性肿瘤新闻资讯全部。热烈欢迎本人分享——【手机微信：india2080】共享，别的所有新闻媒体、网址如需转发或引入本网版权声明內容，须得到受权，且在显眼位子处标明“转自：良医汇-肿瘤医生APP”。药道全世界，助推性命，阿西替尼 英立达。印度的全世界海淘药店：英立达价钱。
