结合腹膜内和全身化疗治疗腹膜转移:药物输送概念,药物动力学和临床应用:叙述性综述
Kohei Tamura1, Joji Kitayama2,3, Yasushi Saga1
1Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan.
腹腔内化学疗法 (IPC) 通过增强局部药物输送提供了一种可行的方法来治疗腹腔内转移 (PMs). 重复的以导管为基础的IPC,结合全身疗法,对卵巢,胃和胰腺癌有希望.
科学领域:
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
- 手术瘤学手术瘤学
背景情况:
- 腹膜转移 (PMs) 由于腹膜-血屏障限制了全身药物输送,因此难以治疗.
- 腹腔内化学疗法 (IPC),特别是通过可植入端口的重复注射,允许高局部药物度和长时间的保留.
- 本综述侧重于以导管为基础的IPC,特别是结合全身化疗,用于卵巢,胃和胰腺癌.
研究的目的:
- 审查以导管为基础的腹腔内化疗 (IPC) 的药理学理由和临床证据.
- 评估IPC的疗效和安全性,并将其与其他腹腔内疗法 (如HIPEC和PIPAC) 进行比较.
- 讨论未来的方向,包括优化药物输送和IPC患者选择.
主要方法:
- 关于IPC的前性临床试验和回顾性研究的叙述性审查.
- 基于反复导管的IPC与高温腹腔内化学疗法 (HIPEC) 和压力腹腔内气溶化学疗法 (PIPAC) 的比较.
- 检查疗效,安全性,实践考虑和基于的监测.
主要成果:
- 在卵巢癌中,IP加上静脉 (IV) 治疗在一些试验中改善了无进展生存 (PFS) 和整体生存 (OS),尽管注意到有毒性和导管并发症.
- 一项III期试验表明,IP卡博普拉丁和每周一次的帕克利塔塞尔显著延长了PFS,具有可控的毒性.
- 胃癌和胰腺癌的II期研究表明,在选定的患者中,症状控制和转换为手术,但III期数据有限. 设备并发症是可以管理的.
结论:
- 重复的以导管为基础的IPC是一种可行的策略,可以改善腹腔内药物输送和增强全身化疗.
- 未来的研究应该优先考虑随机试验,药理动力学优化和以生物标志物为指导的患者选择.
- 连续风评估可以帮助完善指示并改善IPC的结果.
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