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中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 644 -650. doi: 10.3877/cma.j.issn.2095-3232.2024.05.010

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合并远处转移胰腺癌系统性治疗的梳理和展望
魏妙艳1, 徐近1,()   
  1. 1. 200032 上海,复旦大学附属肿瘤医院胰腺外科/胰腺肿瘤综合治疗部 上海市胰腺肿瘤研究所 复旦大学胰腺肿瘤研究所
  • 收稿日期:2024-06-21 出版日期:2024-10-10
  • 通信作者: 徐近
  • 基金资助:
    国家自然科学基金面上项目(82072698); 复旦大学附属肿瘤医院临床博士后科学基金资助(ZYJH202114)

Progress and prospects of systemic treatment for pancreatic cancer with distant metastasis

Miaoyan Wei1, Jin Xu1,()   

  1. 1. Department of Pancreatic Surgery/Department of Comprehensive Treatment of Pancreatic Tumors, Shanghai Pancreatic Cancer Institute, Fudan University Pancreatic Cancer Institute, Shanghai 200032, China
  • Received:2024-06-21 Published:2024-10-10
  • Corresponding author: Jin Xu
引用本文:

魏妙艳, 徐近. 合并远处转移胰腺癌系统性治疗的梳理和展望[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 644-650.

Miaoyan Wei, Jin Xu. Progress and prospects of systemic treatment for pancreatic cancer with distant metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 644-650.

胰腺癌目前总体疗效欠佳,化学治疗、靶向治疗、免疫治疗等系统性治疗是合并远处转移性胰腺癌的主要治疗手段。自吉西他滨、氟尿嘧啶在胰腺癌中奠定基石药物地位后,白蛋白紫杉醇、脂质体伊立替康等新剂型药物的应用提升了胰腺癌的治疗疗效。AG、FOLFIRINOX方案是目前转移性胰腺癌的标准一线治疗。作为FOLFIRINOX方案的优化版,NALIRIFOX方案的高质量证据得到认可,已写入最新发布的NCCN指南的一线方案。靶向治疗方面,PARP抑制剂的确切疗效为BRCA1/2突变胰腺癌患者的维持治疗提供了更优策略,KRAS G12C抑制剂的成功问世为相应突变的晚期胰腺癌患者及KRAS其他突变位点的药物研发带来了曙光和信心。免疫治疗是当前肿瘤研究的重要突破方向,具体方式包括将免疫冷肿瘤变成免疫热肿瘤,扩大免疫检查点抑制剂的适用人群;另一方面则是寻找新兴的免疫疗法,如CAR-T疗法、TCR-T疗法、mRNA疫苗等。诸多的深入探索和创新疗法为晚期胰腺癌患者带来了生存希望,临床医师应和基础医学专家、药物研发科学家密切协作,加速新药或新疗法在胰腺癌这一难治性肿瘤中的开发与应用。

At present, the overall clinical efficacy of pancreatic cancer is poor. Systemic therapies, such as chemotherapy, targeted therapy and immunotherapy, are the main treatment methods for pancreatic cancer complicated with distant metastasis. Since gemcitabine and fluorouracil have been used as the main drugs in pancreatic cancer, the application of new dosage forms, such as albumin-bound paclitaxel and irinotecan-loaded liposome, has improved the therapeutic effect of pancreatic cancer. AG and FOLFIRINOX regimens are the standard first-line treatments for metastatic pancreatic cancer. As an optimized version of FOLFIRINOX regimen, high-quality evidence of NALIRIFOX regimen has been recognized and considered as the first-line regimen in the latest NCCN guideline. In terms of targeted therapy, the exact efficacy of PARP inhibitors provides a better strategy for maintenance treatment of patients with BRCA1/2-mutant pancreatic cancer. The introduction of KRAS G12C inhibitors brings confidence and hope to the drug research and development for patients with advanced pancreatic cancer and other mutation sites of KRAS. Currently, immunotherapy is an important breakthrough direction of tumor research mainly by converting immune cold tumors into immune hot tumors and expanding the applicable populations of immune checkpoint inhibitors. In addition, novel immunotherapies, such as CAR-T therapy, TCR-T therapy and mRNA vaccine, are being investigated. Multiple in-depth explorations and innovative therapies have brought hope for the survival of patients with advanced pancreatic cancer. Clinicians should work closely with basic medicine experts and drug research and development scientists to accelerate the development and application of new drugs or new therapies in refractory pancreatic cancer.

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