晚期胰腺癌内科治疗策略

Progress of medical treatment of advanced pancreatic carcinoma

大多数胰腺癌病人确诊时已处于局部进展期或发生远处转移,无法接受手术治疗,预后较差。积极的药物治疗有利于延长生存期,改善生存质量。目前,以吉西他滨(GEM)为基础的药物治疗仍是晚期胰腺癌最主要的治疗方式。对于身体状态好的病人,一线治疗可选择的方案较多,如FOLFIRINOX、GEM联合白蛋白结合型紫杉醇、GEM联合氟尿嘧啶类等;而对于身体状态相对差的病人,可选择单药GEM或氟尿嘧啶类。对于适合的病人可以在化疗基础上联合靶向治疗,如GEM联合厄洛替尼等。二线治疗基于一线治疗方案后选择,推荐纳米脂质体伊立替康、GEM、氟尿嘧啶类等。未来应基于胰腺癌转化医学研究进展,突破传统诊疗思维,提高早期诊断率,将胰腺癌病人视为一个整体,重视微环境和免疫调节治疗,注重个体化精准治疗,开展新治疗方法的应用及新治疗靶点、新药物的研发,推荐病人参加临床试验。

Most patients of pancreatic carcinoma are local advanced or distant metastasis occurred when diagnosed, and they don＇ t have the chance to operate, with a poorer diagnosis. Positive internal medical treatment could prolong the overall survival time, and promote quality of life and improve the patients＇ life status. At present, the major therapy for advanced pancreatic cancer is gemcitabine-based combination treatment. For patients with a better ECOG performance status, the first line therapy could select FOLFIRINOX, gemeitabine combined nab-paclitaxel, gemcitabine combined fluorouraeil, etc. For patients with worse ECOG performance status, single medication such as gemcitabine or fluorouracil. For patients with specific targeted genes, chemotherapy and targeted therapy could be combined,such as gemcitabine combined with erlotinib. The second line therapy is based on the first line therapy selection. Nanoliposomal irinoteean, gemcitabine, fluorouracil and irinotecan are now recommended. In the future, the treatment of pancreatic carcinoma should be based on the translational medicine, regarded the pancreatic cancer patients as a whole, focusing on microenvironment and immunological regulation. New treatments appliance and new targeted therapy should be explored, and clinical trials are strongly recommended. The final aim is to realize personal precision treatment instead of traditional diagnostic procedure.