在细胞癌的辅助和新辅助疗法
1Homerton University Hospital, London, UK; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK; Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands.
Hematology/oncology clinics of North America
|June 27, 2023
概括
在晚期细胞癌 (RCC) 中,外科免疫检查点抑制剂 (ICI) 在第三阶段试验中显示出有限的无病生存益处. 只有辅助药布罗利祖马布显示出显著的改善,这证明了对新辅助药ICI策略的进一步研究.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
背景情况:
- 局部晚期细胞癌 (RCC) 治疗正在发展.
- 使用免疫检查点抑制剂 (ICI) 的外科手术策略正在调查中.
研究的目的:
- 对局部发达RCC患者的外科手术期间免疫检查点抑制剂 (ICI) 的第三期随机对照试验 (RCT) 进行审查.
- 评估辅助和新辅助ICI疗法的无病生存期 (DFS) 的疗效.
主要方法:
- 在外科手术前的环境中分析了6个第三阶段RCT.
- 对ICI单疗法和组合疗法方案的评估.
- 对辅助试验 (阿特佐利祖马布,潘布罗利祖马布,尼沃卢马布与伊皮利穆马布) 和外科手术前试验 (尼沃卢马布) 的综述.
主要成果:
- 与安慰剂相比,只有1年的辅助 pembrolizumab 显著改善了 DFS.
- 其他辅助和外科手术期间的ICI试验没有显示显著的DFS改善.
- 第1b/2期新辅助性ICI试验表明了安全性,有效性和免疫透变化.
结论:
- 目前的外科手术期ICI策略显示,在先进的RCC中,DFS的好处有限.
- 辅助剂pembrolizumab提供了潜在的益处,但需要进一步的研究.
- 新辅助性ICI试验为未来对RCC治疗的随机研究提供了理由.
相关概念视频
01:27Tumor Immunotherapy
575
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
575
01:26Kidney Transplant II: Surgical Procedure
36
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
36
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
40
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
40
02:56Treatment Resistant Cancers
3.4K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.4K
02:57Targeted Cancer Therapies
7.7K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
7.7K
01:11Renal Failure: Dose Adjustments
127
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
127