{"id":35697,"date":"2020-09-29T00:54:12","date_gmt":"2020-09-28T16:54:12","guid":{"rendered":"https:\/\/case.ntu.edu.tw\/blog\/?p=35697"},"modified":"2020-09-22T11:04:15","modified_gmt":"2020-09-22T03:04:15","slug":"%e8%82%ba%e7%99%8c%e7%9a%84%e5%85%8d%e7%96%ab%e7%99%82%e6%b3%95","status":"publish","type":"post","link":"https:\/\/case.ntu.edu.tw\/blog\/?p=35697","title":{"rendered":"\u80ba\u764c\u7684\u514d\u75ab\u7642\u6cd5"},"content":{"rendered":"

\u80ba\u764c\u7684\u6cbb\u7642\u73fe\u5728\u4ecd\u662f\u4e00\u500b\u56b4\u5cfb\u7684\u6311\u6230\uff0c\u4ee5\u5f80\u514d\u75ab\u7642\u6cd5\u6210\u6548\u4e0d\u4f73\uff0c\u751a\u81f3\u52a0\u901f\u60a3\u8005\u75c5\u60c5\u60e1\u5316\u53ca\u6e1b\u5c11\u5b58\u6d3b\u671f\uff0c\u4f46\u8fd1\u5df2\u9010\u6f38\u767c\u5c55\u6210\u4e00\u7a2e\u6709\u6548\u7684\u7642\u6cd5\u3002\u514d\u75ab\u6aa2\u67e5\u9ede\u6291\u5236\u5291\u53ef\u5728\u81e8\u5e8a\u8a66\u9a57\u4e2d\u7522\u751f\u6709\u6548\u4e14\u6301\u4e45\u7684\u53cd\u61c9\uff0c\u6700\u4f73\u5019\u9078\u65b0\u6297\u539f\u53ca\u751f\u7269\u6a19\u8a8c\u7269\u7684\u9451\u5b9a\u66f4\u53ef\u63d0\u9ad8\u514d\u75ab\u6cbb\u7642\u7684\u6548\u529b\u3002\u7814\u7a76\u514d\u75ab\u8b58\u5225\u53ca\u6d88\u9664\u764c\u7d30\u80de\u7684\u6b65\u9a5f\u6709\u52a9\u65bc\u4e86\u89e3\u5148\u524d\u514d\u75ab\u7642\u6cd5\u5931\u6557\u7684\u539f\u56e0\u3002\u5728\u6b64\u80ba\u764c\u5fa9\u767c\u7387\u9ad8\u3001\u5b58\u6d3b\u7387\u4f4e\u4e14\u50b3\u7d71\u6cbb\u7642\u65b9\u5f0f\u4ecd\u6709\u5f88\u591a\u526f\u4f5c\u7528\u7684\u6642\u5019\uff0c\u6211\u5011\u5c0d\u80ba\u764c\u514d\u75ab\u6cbb\u7642\u7684\u524d\u666f\u61c9\u6301\u5be9\u614e\u6a02\u89c0\u7684\u614b\u5ea6\u3002<\/strong><\/span><\/p>\n

\"\"<\/p>\n

\u64b0\u6587<\/strong>\uff0f\u9673\u6df5\u9293<\/strong><\/p>\n

\u80ba\u764c\u7684\u50b3\u7d71\u6cbb\u7642\u65b9\u5f0f<\/span><\/strong><\/p>\n

\u80ba\u764c\u7684\u50b3\u7d71\u7642\u6cd5\u76f8\u7576\u591a\u6a23\u5316\uff0c\u4f9d\u4e0d\u540c\u7684\u985e\u578b\u3001\u5206\u671f\u3001\u75c7\u72c0\u53ca\u56b4\u91cd\u7a0b\u5ea6\uff0c\u63a1\u7528\u4e0d\u540c\u7684\u6cbb\u7642\u65b9\u5f0f\u5982\u4e0b: (1)\u624b\u8853\u6cbb\u7642\uff1a\u4ee5\u5916\u79d1\u624b\u8853\u5207\u9664\u75c5\u7076\uff0c\u4e00\u822c\u662f\u65e9\u671f\u80ba\u764c\u75c5\u60a3\u4e4b\u9996\u9078\u6cbb\u7642\u65b9\u5f0f\uff0c\u65b9\u6cd5\u53ef\u5206\u70ba\u80ba\u8449\u5207\u9664\u8853\u3001\u5168\u80ba\u5207\u9664\u8853\u53ca\u6954\u5f62(\u6216\u80ba\u5c0f\u7bc0)\u5207\u9664\u8853\u3002(2)\u5316\u5b78\u6cbb\u7642\uff1a\u4f7f\u7528\u7279\u5b9a\u85e5\u7269\u6291\u5236\u764c\u7d30\u80de\u751f\u9577\uff0c\u4f7f\u816b\u7624\u7e2e\u5c0f\uff0c\u751a\u81f3\u6bba\u6b7b\u764c\u7d30\u80de\uff0c\u4f46\u4e5f\u53ef\u80fd\u6703\u5f71\u97ff\u6b63\u5e38\u7d30\u80de\u3002\u76ee\u524d\u4f7f\u7528\u7684\u5316\u7642\u85e5\u7269\u4ee5\u50b3\u7d71\u7684\u9251\u985e\u70ba\u4e3b\uff0c\u518d\u642d\u914d\u65b0\u85e5\u9032\u884c\u6cbb\u7642\u3002\u6b64\u7642\u6cd5\u5e38\u6703\u7531\u4e00\u7dda\u8f49\u6210\u4e8c\u7dda\uff0c\u751a\u81f3\u4e09\u7dda\uff0c\u5e38\u898b\u5404\u7a2e\u85e5\u7269\u7d44\u5408\u5316\u7642\u4ea4\u66ff\u51fa\u73fe\u3002(3)\u653e\u5c04\u7dda\u6cbb\u7642\uff1a\u900f\u904e\u9ad8\u80fd\u91cf\u653e\u5c04\u7dda\u6cbb\u7642\u80ba\u764c\u75c5\u7076\uff0c\u5c0d\u65bc\u6240\u6709\u7d30\u80de\u90fd\u6709\u6bba\u50b7\u529b\uff0c\u4f46\u764c\u7d30\u80de\u8f03\u6613\u88ab\u6bba\u6b7b\uff0c\u800c\u6b63\u5e38\u7d30\u80de\u5c0d\u653e\u5c04\u7dda\u7684\u8010\u53d7\u6027\u8f03\u5f37\uff0c\u6709\u6642\u8207\u5316\u5b78\u6cbb\u7642\u7684\u642d\u914d\u9032\u884c\u6cbb\u7642\u3002(4)\u6a19\u9776\u6cbb\u7642\uff1a\u5c0d\u6297\u7279\u5b9a\u57fa\u56e0\uff0c\u5982\u8868\u76ae\u7d30\u80de\u751f\u9577\u56e0\u5b50\u53d7\u5668 \uff08epidermal growth factor receptor, EGFR) \u53ca\u9593\u8cea\u6027\u6dcb\u5df4\u7624\u6fc0\u9176\uff08anaplastic lymphoma kinase, ALK) \u57fa\u56e0\u7a81\u8b8a\u7684\u85e5\u7269\uff0c\u53ef\u4ee5\u5c08\u4e00\u6027\u6291\u5236\u764c\u7d30\u80de\u589e\u6b96\u3001\u8f49\u79fb\u53ca\u7522\u751f\u6297\u85e5\u6027\u7684\u80fd\u529b\uff0c\u5e38\u7528\u65bc\u5148\u524d\u5df2\u63a5\u53d7\u5316\u5b78\u6cbb\u7642\u5f8c\uff0c\u4f46\u4ecd\u5c40\u90e8\u60e1\u5316\u6216\u8f49\u79fb\u4e4b\u80ba\u764c\u60a3\u8005\u3002<\/p>\n

\u514d\u75ab\u6aa2\u67e5\u9ede<\/strong><\/span><\/p>\n

\u514d\u75ab\u6aa2\u67e5\u9ede\uff08immune checkpoint\uff09\u662f\u4e00\u7a2e\u751f\u7269\u9ad4\u5167\u7684\u8abf\u7bc0\u6a5f\u5236\uff0c\u6b63\u5e38\u4eba\u85c9\u7531\u8abf\u63a7\u914d\u9ad4\uff08ligand\uff09\u53ca\u53d7\u9ad4\uff08receptor\uff09\u7684\u4f5c\u7528\u800c\u4f7fT\u7d30\u80de\u7684\u514d\u75ab\u4f5c\u7528\u8655\u65bc\u5e73\u8861\u7684\u72c0\u614b\uff0c\u7576T\u7d30\u80de\u88ab\u6d3b\u5316\u6642\u6703\u8868\u73fe\u8f03\u591a\u7684\u514d\u75ab\u6aa2\u67e5\u9ede\u53d7\u9ad4\uff0c\u5982PD-1\uff08programmed cell death protein 1\uff09\u6216CTLA4\uff08cytotoxic T lymphocyte-associated antigen 4\uff09\u3002\u7576\u9019\u4e9b\u53d7\u9ad4\u8207\u6291\u5236\u6027\u7684\u914d\u9ad4\u7d50\u5408\u6642\uff0cT\u7d30\u80de\u7684\u6d3b\u6027\u6703\u53d7\u5230\u6291\u5236\uff0c\u4ee5\u907f\u514d\u7522\u751f\u904e\u5f37\u7684\u514d\u75ab\u53cd\u61c9\u800c\u50b7\u5bb3\u6b63\u5e38\u7684\u7d30\u80de\u53ca\u5065\u5eb7\u7684\u7d44\u7e54\u3002\u764c\u7d30\u80de\u56e0\u767c\u751f\u8a31\u591a\u7a2e\u7a81\u8b8a\u800c\u5177\u6709\u8a31\u591a\u65b0\u6297\u539f\uff08neoantigen\uff09\uff0c\u7406\u8ad6\u4e0a\u9019\u4e9b\u65b0\u6297\u539f\u61c9\u53ef\u88ab\u514d\u75ab\u7cfb\u7d71\u8fa8\u8a8d\u51fa\u4f86\u800c\u6fc0\u6d3bT\u7d30\u80de\u4f86\u6d88\u6ec5\u764c\u7d30\u80de\uff0c\u4f46\u662f\u764c\u7d30\u80de\u537b\u7e7c\u7e8c\u5b58\u6d3b\u4e14\u589e\u6b96\uff0c\u610f\u5473\u8457\u764c\u7d30\u80de\u53ef\u8eb2\u904e\u514d\u75ab\u7cfb\u7d71\u7684\u76e3\u8996\u3002\u6700\u8fd1\u7684\u7814\u7a76\u986f\u793a\uff0c\u764c\u7d30\u80de\u53ef\u4ee5\u5229\u7528\u514d\u75ab\u6aa2\u67e5\u9ede\u7684\u6a5f\u5236\u4f86\u6e1b\u5f31T\u7d30\u80de\u7684\u6d3b\u6027\uff0c\u4f8b\u5982\u80ba\u764c\u7d30\u80de\u53ef\u4ee5\u8868\u73fe\u8f03\u591a\u7684PD-L1\u914d\u9ad4\uff08programmed cell death protein ligand 1\uff09\uff0c\u85c9\u7531\u548cPD-1\u53d7\u9ad4\u7d50\u5408\u4ee5\u6291\u5236T\u7d30\u80de\u7684\u514d\u75ab\u4f5c\u7528\u3002<\/p>\n

\u80ba\u764c\u7684\u514d\u75ab\u6cbb\u7642<\/span><\/strong><\/p>\n

\u80ba\u764c\u514d\u75ab\u6cbb\u7642\u4f7f\u7528\u55ae\u682a\u6297\u9ad4(monoclonal antibody)\u4f5c\u70ba\u514d\u75ab\u6aa2\u67e5\u9ede\u6291\u5236\u5291\uff08checkpoint inhibitor\uff09\u7d50\u5408\u5230\u816b\u7624\u7d30\u80de\u7684\u914d\u9ad4\u6216\u514d\u75ab\u7d30\u80de\u7684\u53d7\u9ad4\uff0c\u6e1b\u5c11\u816b\u7624\u7d30\u80de\u5c0d\u514d\u75ab\u7d30\u80de\u7684\u6291\u5236\u4f5c\u7528\uff0c\u91cd\u65b0\u559a\u9192\u514d\u75ab\u7cfb\u7d71\u653b\u64ca\u80ba\u764c\u7d30\u80de\u4f86\u9054\u5230\u6cbb\u7642\u7684\u6548\u679c\uff0c\u512a\u9ede\u5305\u62ec\u767c\u751f\u56b4\u91cd\u526f\u4f5c\u7528\u6a5f\u7387(7-26.6%)\u8f03\u5176\u4ed6\u50b3\u7d71\u6cbb\u7642(50%)\u70ba\u4f4e\u3001\u5c0d\u6709\u6548\u7684\u75c5\u4eba\u7642\u6548\u8f03\u6301\u4e45\u53ca\u53ef\u548c\u5176\u4ed6\u50b3\u7d71\u6cbb\u7642\u65b9\u5f0f\u5408\u4f75\u6cbb\u7642\uff0c\u7f3a\u9ede\u4e3b\u8981\u662f\u9808\u6aa2\u6e2c\u7279\u5b9a\u751f\u7269\u6a19\u8a18\u7269\uff08biomarker\uff09\u65b9\u80fd\u9451\u5225\u75c5\u4eba\u662f\u5426\u9069\u7528\u3001\u6709\u5f15\u767c\u81ea\u9ad4\u514d\u75ab\u53cd\u61c9\uff08autoimmune response\uff09\u7684\u53ef\u80fd\u6027\u53ca\u4ecd\u9700\u8981\u66f4\u591a\u7684\u7814\u7a76\u65b9\u80fd\u78ba\u8a8d\u7642\u6548\uff08\u56e0\u514d\u75ab\u6cbb\u7642\u5c1a\u5728\u767c\u5c55\u521d\u671f\u968e\u6bb5\uff09\u3002<\/p>\n

\u57282015\u81f32018\u5e74\uff0c\u9ece\u5df4\u5ae9\u7814\u7a76\u4eba\u54e1\u8a55\u4f30\u4e86\u6291\u5236PD-1\/PD-L1\u7684\u55ae\u682a\u6297\u9ad4\uff08Nivolumab\u548cPembrolizumab\uff09\u5728\u4e8c\u7dda\u4ee5\u4e0a\u4f7f\u7528\u6642\u7684\u529f\u6548\u3002\u4ed6\u5011\u5c07\u53d7\u904e\u7b2c\u4e00\u7dda\u6a19\u6e96\u5316\u5b78\u6cbb\u7642\u5f8c\u4ecd\u767c\u5c55\u70ba\u975e\u5c0f\u7d30\u80de\u80ba\u764c\u7b2c\u56db\u671f\uff0c\u4e26\u66fe\u5728\u4e8c\u7dda\u6216\u4ee5\u4e0a\u63a5\u53d7\u904e\u6291\u5236PD-1\u85e5\u7269\u7684110\u540d\u60a3\u8005\u7d0d\u5165\u8a66\u9a57\u5c0d\u8c61\u3002\u767c\u73fe\u572844\u540d\u53d7\u904e\u514d\u75ab\u7d44\u7e54\u5316\u5b78\u6e2c\u8a66\u7684\u60a3\u8005\u4e2d\uff0cPD-L1\u8868\u73fe\u9ad8\u65bc50%\uff0c1-49% \u548c\u4f4e\u65bc1% \u7684\u5206\u5225\u662f17\u4eba(38.6%)\u300112\u4eba(27.3%) \u548c15\u4eba(34.1%)\u3002\u4f7f\u7528\u53ef\u6291\u5236PD-1\/PD-L1\u7684\u55ae\u682a\u6297\u9ad4\u4f5c\u70ba\u7b2c\u4e8c\u3001\u7b2c\u4e09\u548c\u7b2c\u56db\u7dda\u6cbb\u7642\u85e5\u7269\u60a3\u8005\u5206\u5225\u4f5474.7%\u300121.8%\u548c3.5%\uff0c\u89c0\u5bdf\u816b\u7624\u5c0d\u6cbb\u7642\u7684\u53cd\u61c9\uff0c\u767c\u73fe43.4%\u7684\u60a3\u8005\u75c5\u60c5\u6301\u7e8c\u60e1\u5316(progressive disease)\uff0c31.3%\u75c5\u60c5\u7a69\u5b9a(stable disease)\uff0c22.2%\u6709\u90e8\u5206\u53cd\u61c9(partial response)\uff0c3.1%\u6709\u5b8c\u5168\u53cd\u61c9(complete response)\u3002\u89c0\u5bdf\u60a3\u8005\u5b58\u6d3b\u671f\uff0c\u4f7f\u7528\u85e5\u7269\u65bc\u4e8c\u7dda\u6cbb\u7642\u6642\uff0c\u7121\u60e1\u5316\u5b58\u6d3b\u671f\uff08progression-free survival, PFS\uff09\u4e2d\u4f4d\u6578\uff08median\uff09\u70ba4\u500b\u6708\uff0c\u7e3d\u9ad4\u5b58\u6d3b\u671f\uff08overall survival, OS\uff09\u4e2d\u4f4d\u6578\u70ba8.1\u500b\u6708\uff1b\u4f7f\u7528\u85e5\u7269\u65bc\u4e09\u7dda\u53ca\u4ee5\u4e0a\u6642\uff0cPFS\u53caOS\u4e2d\u4f4d\u6578\u5247\u5206\u5225\u662f3.1\u53ca7.8\u500b\u6708\uff0c\u986f\u793a\u514d\u75ab\u7642\u6cd5\u6709\u6f5b\u529b\u6210\u70ba\u80ba\u764c\u816b\u7624\u5b78\u9818\u57df\u7684\u5de5\u5177\uff0c\u5728\u81e8\u5e8a\u6cbb\u7642\u4e0a\u6709\u76f8\u7576\u7a0b\u5ea6\u53cd\u61c9\u3002<\/p>\n

\u7d50\u8ad6<\/strong><\/span><\/p>\n

\u514d\u75ab\u6cbb\u7642\u7684\u767c\u5c55\u70ba\u975e\u5c0f\u7d30\u80de\u80ba\u764c\u665a\u671f\u75c5\u4eba\u7684\u6cbb\u7642\u63d0\u4f9b\u4e86\u65b0\u7684\u9078\u64c7\uff0c\u4f7f\u80ba\u764c\u7684\u6cbb\u7642\u5411\u7cbe\u6e96\u91ab\u7642\u53c8\u9081\u9032\u4e00\u6b65\u3002\u514d\u75ab\u6aa2\u67e5\u9ede\u6291\u5236\u5291\uff08\u5982\u6291\u5236PD-1\u7684\u55ae\u682a\u6297\u9ad4Nivolumab\u548cPembrolizumab\uff1b\u6291\u5236 PD-L1\u7684\u55ae\u682a\u6297\u9ad4Atezolizumab\u548cDurvalumab\uff09\u662f\u76ee\u524d\u552f\u4e00\u8b49\u5be6\u6709\u6548\u7684\u514d\u75ab\u7642\u6cd5\uff0c\u55ae\u7368\u4f7f\u7528\u5c31\u6bd4\u50b3\u7d71\u5316\u5b78\u6cbb\u7642\u5c55\u73fe\u66f4\u597d\u7684\u7642\u6548\u53ca\u8f03\u5c11\u7684\u526f\u4f5c\u7528\u3002\u7136\u800c\uff0c\u76ee\u524d\u6838\u51c6\u4e0a\u5e02\u4e14\u53d6\u5f97\u665a\u671f\u975e\u5c0f\u7d30\u80de\u80ba\u764c\u6cbb\u7642\u9069\u61c9\u75c7\u8a31\u53ef\u7684\u514d\u75ab\u6aa2\u67e5\u9ede\u6291\u5236\u5291\uff0c\u5728\u6c92\u6709\u7d93\u904e\u751f\u7269\u6a19\u8a18\u7269\u7be9\u9078\u75c5\u4eba\u9ad4\u5167\uff0c\u55ae\u7368\u6cbb\u7642\u7684\u53cd\u61c9\u7387\u5927\u7d04\u50c5\u670920%\uff0c\u5982\u4f55\u63d0\u9ad8\u75c5\u4eba\u5c0d\u514d\u75ab\u6cbb\u7642\u7684\u53cd\u61c9\u7387\uff0c\u7121\u8ad6\u662f\u767c\u5c55\u751f\u7269\u6a19\u8a18\u7269\u4f86\u7be9\u9078\u5408\u9069\u7684\u75c5\u4eba\u6216\u662f\u5408\u4f75\u5169\u7a2e\uff08\u6216\u4ee5\u4e0a\uff09\u4e0d\u540c\u65b9\u5f0f\u4f86\u6cbb\u7642\uff0c\u76ee\u524d\u90fd\u6709\u81e8\u5e8a\u5be6\u9a57\u6b63\u5728\u9032\u884c\u4e2d\u3002\u514d\u75ab\u6cbb\u7642\u5982\u540c\u6a19\u9776\u6cbb\u7642\u4e00\u6a23\uff0c\u6703\u56e0\u816b\u7624\u7279\u6027\u7684\u4e0d\u540c\u800c\u975e\u6bcf\u500b\u4eba\u90fd\u9069\u5408\uff0c\u4f46\u7d93\u904e\u6aa2\u6e2c\u53ef\u627e\u51fa\u6700\u9069\u5408\u7684\u6cbb\u7642\u65b9\u5f0f\uff0c\u9810\u671f\u514d\u75ab\u6cbb\u7642\u5c07\u6210\u70ba\u665a\u671f\u975e\u5c0f\u7d30\u80de\u80ba\u764c\u60a3\u8005\u7684\u6700\u4f73\u7642\u6cd5\u4e4b\u4e00\u3002<\/p>\n

 <\/strong><\/p>\n

\u53c3\u8003\u8cc7\u6599\uff1a<\/strong><\/p>\n

1. Martinez P, Peters S, Stammers T, Soria JC. Immunotherapy for the First-Line Treatment of Patients with Metastatic Non\u2013Small Cell Lung Cancer. Clin Cancer Res. 2019 May 1;25(9):2691-2698. doi: 10.1158\/1078-0432.CCR-18-3904. Epub 2019 Jan 14.C.
\n2. El Karak F, Gh Haddad F, Eid R, Al Ghor M, El Rassy E, Ahmadieh N, Choullamy T, Halim NA, Tfayli A, Farhat F, Kattan J, Nasr F, Ghosn M, Assi HI. Lung cancer and immunotherapy: a real-life experience from second line and beyond. Future Oncol. 2019 Sep;15(26):3025-3032. doi: 10.2217\/fon-2019-0144. Epub 2019 Aug 19.
\n3. Rolfo C, Caglevic C, Santarpia M, Araujo A, Giovannetti E, Gallardo CD, Pauwels P, Mahave M. Immunotherapy in NSCLC: A Promising and Revolutionary Weapon. Adv Exp Med Biol. 2017; 995:97-125. doi: 10.1007\/978-3-319-53156-4_5.
\n4. \u65bd\u7a4e\u9298\u3001\u6d2a\u6dd1\u6dd3\u3001\u5f35\u7d14\u742a\u3002\u975e\u5c0f\u7d30\u80de\u80ba\u764c\u7684\u514d\u75ab\u6cbb\u7642\u3002\u5167\u79d1\u5b78\u8a8c\uff0c2017\uff1a28\uff1a271-278\u3002Doi:10.6314\/JIMT.2017.28(5).02.<\/p>\n","protected":false},"excerpt":{"rendered":"

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