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癌癥治療的新時代

一名晚期結腸癌病人,在手術和化療無效的情況下,在St.Jude Crosson癌癥研究中心,經過免疫療法和靶向治療,取得了成功,病人已經存活兩年多了,而且目前狀況很好,這是醫學史上的奇跡。這給醫生和病人更大的信心,在更多癌癥治療上創造奇跡。

2013年,64歲的Don Kwart(見下圖)做腸鏡發現II期結腸癌,即刻做了結腸癌切除術,隨后進行了6個月的化療。之后影像學檢查和血液化驗證明治療有效。但是幾個月后,腫瘤復發了并且發生了遠處轉移,隨后又進行化療,開始還有點反應,腫塊有點縮小,但是很快就無效了。

一般來說,手術和化療失敗了,也就預示著有效的治療方案終結了,病人一般只能存活6到8個月。

美國St. Jude Crosson癌癥研究所David Park博士,對Don的癌癥進行基因分析,大膽地提出新的治療策略,采用Keytruda(派姆單抗)進行試驗性免疫治療。

David J. Park, MD, Hematology andOncology (Board Certified)

但是當時美國FDA只批準Keytruda用于治療惡性黑色素瘤和肺癌。但是,Park博士認為,早先的資料已經顯露出Keytruda能治療像Don這樣結腸癌的曙光,因為他們具有相同的基因標記物。

Park博士與Keytruda廠家聯系,希望廠家給予病人同情,同意立即提供Keytruda,讓病人進行觀察性治療。

Don幾乎立即對免疫療法發生反應,治療非常有效?!皩ξ襾碚f,這是一個神奇的藥物?!?Don說:“我比以往幾年感覺更好。我應該是Keytruda治療非常有效的典型代表?!?

從Keytruda治療到現在,已經兩年多了,Don的狀態非常好。你要找他,可以去棒球場找到他,他兒子是棒球隊的先發投手,他一直去看他兒子的比賽。

Don接受Keytruda治療后的一年,美國FDA才批準了Keytruda可以用于缺乏錯配修復功能的任何癌癥,這是癌癥治療史上還是頭一次。

“治療癌癥,基于腫瘤基因或分子學特征,而不是腫瘤長在哪里-----這是一種典型的模式改變?!盤ark博士解釋道。去年,免疫治療和靶向治療的數量翻了一倍,而且治療的領域比以往更廣。只要找到癌癥的致命弱點,我們就可以將成功的可能性最大化,同時避免無效的治療。

在Crosson癌癥研究中心,擁有世界一流的腫瘤分子檢測設備,對結腸癌、乳腺癌、肺癌、黑色素瘤、頭頸腫瘤、胰腺癌以及其他癌癥包括復發癌癥,進行常規的分子檢測。

“免疫治療和靶向治療,讓癌癥治療接近于治愈水平?!盤ark博士說,St. Jude已經對十幾種癌癥開展了基因免疫療法或/和靶向治療聯合等臨床試驗。St. Jude Crosson癌癥研究所,作為精準腫瘤學聯盟成員,已經參與了幾個全國性的臨床研究項目。

信息來自:

http://www.stjudemedicalcenter.org/about-us/newsroom-and-highlights/highlights/2018/a-new-era-in-cancer-treatment/,文章經過編譯整理。

A NEW ERA INC ANCER TREATMENT

Targeted Therapies Bring Dramatic New Successes

Using the body’s own immune system to destroy cancer has been the holy grail for cancer researchers for decades. At the St. Jude Crosson Cancer Institute, the promise of immunotherapies and targeted therapies—designed to help the immune system recognize and kill cancer cells—has moved from the lab to the bedside, with often remarkable outcomes.

Just ask Don Kwart.

In 2013, a colonoscopy revealed the 64-year-old had Stage II colon cancer, and surgery to remove the diseased colon tissue was followed by six months of chemotherapy. While imaging and blood work showed the treatment was successful, several months later, the aggressive cancer had returned and metastasized. More chemotherapy over the next year at first slowed the cancer’s growth—and then simply stopped working.

In the past, the failure of surgery and chemotherapy would signal the end of available treatment options. But after genetically profiling Don’s cancer, David Park, MD, Medical Director of Oncology Services and a board-certified oncologist with St. Jude Heritage Medical Group, offered a new strategy: an experimental immunotherapy, called Keytruda.

Keytruda targets activity within a cancer cell, activity which permits the cancer to protect itself from an immune system response. By “uncloaking” the cancer cells, Keytruda allows the immune system’s T-cells to complete their search-and-destroy mission. The FDA had approved it for melanoma and lung cancer at that time, but not for colon cancer. However, Dr. Park believed the early data looked promising for cancers with the same genetic markers as Don’s.

He arranged “compassionate access” with the pharmaceutical company, allowing Don to immediately begin receiving the investigational therapy. Don responded to the immunotherapy almost immediately. “For me, it’s been a miracle drug,” says the father of five and grandfather of two. “I feel better than I have in years. I should be the ‘poster child’ for Keytruda.”

Once chemotherapy stops working, life expectancy is typically six to eight months. For Don, that milestone was over two years ago. And if you want to talk to him about it, you’ll need to catch him between baseball games: Don’s son is one of the high school team’s starting pitchers and Don never misses an inning.

Over a year after Don began therapy, the FDA approved the use of Keytruda for any tumor with the genetic feature of deficient

mismatch repair (a marker in Don’s cancer)—a first in the history of cancer therapy.

“Treating tumors based on their genetic or molecular characteristics—instead of where they are located—is a paradigm change,” explains Dr. Park, who says the number of immunotherapies and targeted therapies doubled last year with many more in the pipeline. “By finding the Achilles’ heel of a tumor, we can maximize the likelihood of success while avoiding therapies that are unlikely to work.”

At the Crosson Cancer Institute, state-of-the-art molecular profiling of tumors is now routine for patients with colon, breast, lung, melanoma, head and neck, pancreas and other cancers—as well as for patients who have experienced a recurrence.

“Immunotherapies and targeted therapies are moving us much closer to a cure,” says Dr. Park, explaining that clinical trials involving immunotherapies alone, or combined with other treatments, are underway at St. Jude for nearly a dozen different cancers. As the hospital’s board-certified oncologists aggressively pursue new breakthroughs, St. Jude has participated in several national research trials.

The Crosson Cancer Institute is a member of Precision Oncology Alliance, working with other nationally-recognized cancer centers to advance tumor profiling and research to better diagnose, treat and bring personalized precision medicine to all cancer patients.

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