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目前针对高风险神经母细胞瘤第一次复发的治疗策略
Sveva Castelli1, Franziska Schulze1, Theresa M Thole-Kliesch1
1Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
概括
高风险的神经母细胞瘤复发是常见的. 分子特征指导向治疗和免疫治疗,优先考虑临床试验以获得最佳治疗策略.
科学领域:
- 儿科瘤学 儿科瘤学
- 癌症基因组学 癌症基因组学
- 翻译医学是一种翻译医学.
背景情况:
- 高危神经母细胞瘤 (HRNB) 尽管进行密集治疗,但复发率很高,复发后的生存率很差.
- 复发通常在两年内发生,需要改进治疗策略.
- 复发瘤的分子特征对于确定治疗点至关重要.
研究的目的:
- 审查当前的证据,并为复发性高风险神经母细胞瘤提出最佳的治疗策略.
- 强调在复发时分子分析的重要性,以实现个性化治疗.
- 强调需要进行临床试验,以建立关于复发管理的共识.
主要方法:
- 对复发HRNB的当前文献和临床试验数据的审查.
- 对分子标和新兴疗法的分析,包括免疫疗法和细胞疗法.
- 评估救援化疗方案和维护策略.
主要成果:
- 与GD2或VEGF向治疗相结合的基于坎普托西因的化疗是推的一线再诱导方法.
- 针对GD2的免疫疗法和细胞疗法是有前途的巩固策略.
- 特定的救援方案 (TVD,TCE,ICE,TopoCy) 和[131I]-mIBG疗法对耐火性疾病有希望.
结论:
- 复发时的活检和分子表征应该是HRNB患者的标准护理.
- 优先考虑在临床试验中的招生 (例如,BEACON2) 对于推进治疗至关重要.
- 结合化疗,免疫疗法和潜在的细胞疗法,然后进行耐受良好的维护的多式疗法,为改善复发性HRNB的结果提供了最好的希望.
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