Nature:历经三十年,免疫疗法实现膀胱癌治疗重大突破
2014/11/28
近日,发表在《自然》杂志上的一项研究中,伦敦玛丽皇后大学的科学家们实现了治疗晚期膀胱癌的重大突破。68名晚期膀胱癌患者使用了罗氏研发的癌症免疫治疗药物MPDL3280A 12周后,52%的PD-L1阳性患者的肿瘤缩小了。随后的治疗中,有2人放射成像检测发现不再有癌症迹象。


近日,发表在《自然》杂志上的一项研究中,伦敦玛丽皇后大学的科学家们实现了治疗晚期膀胱癌的重大突破。在过去的三十年里,晚期膀胱癌的治疗没有任何的重大进展。研究检测了阻断PD-L1的抗体MPDL3280A的治疗效果,PD-L1是一种帮助癌细胞躲避免疫系统检测的蛋白。

膀胱癌是英国排名第七的癌症,约10%的患者在诊断时已经是晚期了。这让治疗变得非常困难,化疗是唯一的选择。很多人最终因为化疗的毒性大、作用小而放弃了治疗;患者在确诊后的平均生存期为12-18个月。

三十年来膀胱癌治疗巨大突破

第一阶段的国际多中心临床试验中,68名晚期膀胱癌患者(其它标准治疗已经对这些患者无效了,如化疗)接受了罗氏研发的癌症免疫治疗药物MPDL3280A。这些患者还接受了蛋白PD-L1的检测,其中大约30名患者被确定为PD-L1阳性肿瘤。

治疗6周后,43%的PD-L1阳性患者的肿瘤缩小了;12周后,比例上升到52%。在随后的治疗中,这些患者中有2人(7%)放射成像检测发现不再有癌症迹象。在PD-L1阴性患者中,也有11%的患者对治疗有积极的响应。

研究还发现,这种治疗效果是长期的;安全性也是振奋人心的,副作用只包括了疲劳、食欲不振这些最常见的症状。该临床试验的初步结果为晚期膀胱癌患者带了巨大希望,也预示着MPDL3280A未来将是非常有前景的药物。

目前,MPDL3280A抗体药物已通过FDA突破疗法的认定。如果在更大的临床试验中表现出相同的结果,那么在2015年底将可能被患者广泛使用。

领导该研究的伦敦玛丽皇后大学Barts癌症研究所的Tom Powles博士说:“这个研究在晚期膀胱癌治疗领域是一项非常大的进步。几十年来,化疗是这些患者唯一的选择,费用昂贵不说,很多患者的病情根本无法承担化疗。MPDL3280A有惊人的响应率,我们可以筛选PD-L1阳性病人进行靶向治疗。”

免疫疗法开启癌症治疗全新时代

在接受BBC记者采访时,Tom Powles表示,癌症免疫疗法开启了癌症治疗全新的时代。他的研究小组正在集中研究肿瘤的微环境,帮助预测哪些病人会对治疗有响应。

今年6月在芝加哥召开的美国临床肿瘤学会会议上,一组类似的试验揭示了癌症免疫疗法能够改善晚期皮肤癌患者的生存率。411名患者在临床试验中接受了pembrolizumab的治疗,有69%的患者存活至少一年。

此外耶鲁大学领导的一项试验中,非小细胞肺癌、黑色素瘤、肾癌和其它癌症患者也对免疫疗法的药物产生了响应。

英国癌症研究中心首席临床医生Peter Johnson教授说:“利用免疫系统,这些新的突破疗法给我们带来了很多激动人心的结果。免疫疗法对晚期膀胱癌治疗的突破进一步验证了这种新疗法的力量,这可能就是我们多年来一直寻找的治疗癌症的新方法。”

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