? 靶向药物、免疫药物,哪个更好?_蜘蛛365棋牌 全民街机_365棋牌游戏大厅官网下载手机版_365棋牌送新手卡 365棋牌 全民街机_365棋牌游戏大厅官网下载手机版_365棋牌送新手卡

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靶向药物、免疫药物,哪个更好?

????本文来自微信公众号:菠萝因子(ID:checkpoint_1),作者:80后菠萝博士,
,靶向药物和免疫药物是两大类新的抗癌药,目前上市的靶向药物有几十个,免疫药物也有几个,已经成为很多病种的主流治疗方案。两类药物都还有更多正在进行临床试验,会在未来逐渐上市。,
,很多人爱问:“靶向药物和免疫药物,哪个更好?”,
,这个问题没法回答,因为它就像问“小鸡和蘑菇,哪个更好吃?”,
,它们不是一类东西,无法比较,更无法简单替换。有人爱吃蘑菇,有人爱吃小鸡,更多人爱吃小鸡炖蘑菇。同样的道理,有些人更适合靶向药物,有些更适合免疫药物,有些适合两个同时用。,
,虽然很难直接比较好坏,但靶向药物和免疫药物确实有很多明显区别,今天就简单介绍一下。,
,作用细胞不同,
,靶向药物,顾名思义,针对的是癌细胞上特定的靶点,比如某个特有的基因突变。靶向药物和化疗的目的都是直接杀死尽可能多的癌细胞。比起化疗,靶向药物理论上只会抑制癌细胞,而不会对正常细胞造成显着伤害,因此副作用小很多。典型代表是针对白血病的格列卫(Bcr-Abl 基因突变)和针对肺癌的易瑞沙(EGFR 基因突变)。,
,免疫药物,与以往药物的逻辑截然不同。它的作用对象不是癌细胞,而是免疫细胞。这类药物自己不能直接杀伤癌细胞,而是激活针对癌细胞的免疫系统,然后让大量活跃的免疫细胞成为真正的抗癌武器,完成使命。目前上市的PD1 抑制剂,PD-L1抑制剂,或CTLA4 抑制剂都是如此。,
,靶向药物是打击黑势力的警察,免疫药物是给特种兵部队进行动员的政委。,
,副作用不同,
,任何药物都有副作用。由于作用机制不同,靶向药物和免疫药物副作用很不一样。,
,靶向药物针对的往往是对肿瘤生长非常重要的蛋白,可以说是癌细胞生长的重要食粮。靶向药物通过抑制这些蛋白活性,从而达到“饿死”癌细胞的目的。,
,但由于种种原因,药物也会“饿死”一些正常细胞,产生副作用,这点和化疗有点类似。比如肺癌EGFR 靶向药物易瑞沙,对表皮细胞有副作用,所以患者使用后会有明显的皮疹。,
,免疫药物功能是激活免疫细胞,来对抗癌细胞。但它也有副作用,不是毫无风险的。被激活的免疫细胞除了能攻击癌细胞,也能攻击自身的正常细胞,这会产生暂时的“自免疫疾病”,严重的话是可能致命的。,
,目前使用的PD1?抑制剂、CTLA4 抑制剂等免疫药物,有代表性的副作用是免疫系统活跃导致的皮疹、肠炎、腹泻、肝损伤等,它们的临床特征和化疗或靶向疗法的副作用截然不同,要控制这类副作用需要的药物也不同。,
,起效速度不同,
,靶向药物因为直接针对性杀死癌细胞,起效往往比较快。如果有效,通常几个星期,甚至几天,就会发现肿瘤缩小,或者肿瘤标志物降低。比如,易瑞沙平均起效时间是6 个星期,患者通常服药第一次去医院复查,就会知道是否有效了。,
,免疫药物反应要慢得多,也要复杂得多。免疫药物是通过激活免疫系统,而间接杀死癌细胞,因此变数比较大。很多患者用了好几个月的药,也不完全确定到底起作用了没有。,
,甚至有患者用PD-1抑制剂超过1 年后,肿瘤大小看起来纹丝不动,医生决定停止用药,谁知几年后复查癌症却消失了。这个现象与下面要谈到的“假进展”密切相关。,
,对“肿瘤变大”的判断不同,
,临床上“肿瘤进展”指的是肿瘤在扫描影像下体积增大,或者出现新的肿瘤。对于靶向药物(或者化疗)来说,这通常意味着药物对肿瘤无效,标准操作是停止治疗,换别的药物。,
,但免疫药物带来了一个前所未有的现象,叫“假进展”。约10%?使用免疫药物的患者,用药后CT 扫描会看到“肿瘤变大”。如果按传统经验,这是药物失败,应该换药。但实际上后来知道,药物是成功的,因为这10%?患者后来肿瘤又缩小。,
,“假进展”出现的主要原因是免疫药物起效后,会引发大量免疫细胞进入肿瘤组织,和恶势力斗争。但CT 区分不了癌细胞和免疫细胞,只是简单发现肿瘤变大了。其实,这是免疫细胞部队进入战场,是大大的好事。,
,,
,使用免疫疗法的时候,如何区分“假进展”和“真进展”非常重要,因为它涉及是继续坚持用免疫疗法,还是赶快换药这个生死决定。,
,长期、短期效果不同,
,如果用在合适患者身上,靶向药物有效率高,而且起效快,能迅速缓解肿瘤带来的症状,提高患者的生活质量,一定时期内能显着提高存活率。,
,但由于肿瘤的异质性和进化,一段时间后几乎无一例外会出现抗药性,需要换药,极少出现长期存活或治愈。,
,免疫药物目前最大问题是有效率不高,仅在10%~20%,所以对很多人来说,它是无效的。加上“假进展”现象,一开始多数人肿瘤都不会缩小。但随着时间流逝,开始有患者出现响应,肿瘤缩小,而且很多响应的患者会长期受益,这就是所谓的生存曲线“拖尾现象”(见下图):一小部分患者会长期存活,甚至被治愈。,
,,
,使用CTLA4 抑制剂的黑色素瘤患者,一旦活过3 年,80%?都能活过10?年,甚至临床治愈!这是大家热衷于免疫疗法的主要原因。,
,当然,理想情况是把两类药物优点结合在一起,提高响应比例,同时让更多人长期存活,这就是大量尝试各种组合疗法的原因。,
,目前精准程度不同,
,抗癌药很贵,因此最好只用在能受益的患者身上,何况用错药还会浪费宝贵的时间。,
,经过多年研究,很多靶向药物的使用原则越来越清楚,一般就是携带某种特定基因突变的肿瘤,比如有EGFR敏感突变的肺癌,使用EGFR靶向药物,多数会有效。有ALK突变的肺癌,用ALK靶向药,效果也很好。目前很多靶向药的使用已经比较“精准”。,
,但对于免疫药物,预测疗效还很难,加上很多患者把它当作最后的“救命稻草”,导致使用非常“不精准”。大规模人群里面盲试,成功率通常仅为10%~20%。这是目前的状况,而预测免疫疗法疗效可能是目前最热的领域之一,希望能尽早有突破,让免疫疗法也进入“精准医疗”行列。,
,总之,靶向药物和免疫药物没有绝对的好坏之分,不同的药适合不同的患者。,
,再好的药也不会对100%?患者有效,对患者而言,有药物可选当然是好事,甚至越多越好。关键,是要认清每个药的特性,了解它是否合适自己的情况,找到最“精准”,最好的组合。,
,“靶向”、“免疫”哪家好?精准用药不可少!,
,本文来自微信公众号:菠萝因子(ID:checkpoint_1),作者:80后菠萝博士

ben wen lai zi wei xin gong zhong hao: bo luo yin zi ID: checkpoint_1, zuo zhe: 80 hou bo luo bo shi,, ba xiang yao wu he mian yi yao wu shi liang da lei xin de kang ai yao, mu qian shang shi de ba xiang yao wu you ji shi ge, mian yi yao wu ye you ji ge, yi jing cheng wei hen duo bing zhong de zhu liu zhi liao fang an. liang lei yao wu dou hai you geng duo zheng zai jin xing lin chuang shi yan, hui zai wei lai zhu jian shang shi.,, hen duo ren ai wen:" ba xiang yao wu he mian yi yao wu, nei ge geng hao?",, zhe ge wen ti mei fa hui da, yin wei ta jiu xiang wen" xiao ji he mo gu, nei ge geng hao chi?",, ta men bu shi yi lei dong xi, wu fa bi jiao, geng wu fa jian dan ti huan. you ren ai chi mo gu, you ren ai chi xiao ji, geng duo ren ai chi xiao ji dun mo gu. tong yang de dao li, you xie ren geng shi he ba xiang yao wu, you xie geng shi he mian yi yao wu, you xie shi he liang ge tong shi yong.,, sui ran hen nan zhi jie bi jiao hao huai, dan ba xiang yao wu he mian yi yao wu que shi you hen duo ming xian qu bie, jin tian jiu jian dan jie shao yi xia.,, zuo yong xi bao bu tong,, ba xiang yao wu, gu ming si yi, zhen dui de shi ai xi bao shang te ding de ba dian, bi ru mou ge te you de ji yin tu bian. ba xiang yao wu he hua liao de mu di dou shi zhi jie sha si jin ke neng duo de ai xi bao. bi qi hua liao, ba xiang yao wu li lun shang zhi hui yi zhi ai xi bao, er bu hui dui zheng chang xi bao zao cheng xian zhu shang hai, yin ci fu zuo yong xiao hen duo. dian xing dai biao shi zhen dui bai xue bing de ge lie wei BcrAbl ji yin tu bian he zhen dui fei ai de yi rui sha EGFR ji yin tu bian.,, mian yi yao wu, yu yi wang yao wu de luo ji jie ran bu tong. ta de zuo yong dui xiang bu shi ai xi bao, er shi mian yi xi bao. zhe lei yao wu zi ji bu neng zhi jie sha shang ai xi bao, er shi ji huo zhen dui ai xi bao de mian yi xi tong, ran hou rang da liang huo yue de mian yi xi bao cheng wei zhen zheng de kang ai wu qi, wan cheng shi ming. mu qian shang shi de PD1 yi zhi ji, PDL1 yi zhi ji, huo CTLA4 yi zhi ji dou shi ru ci.,, ba xiang yao wu shi da ji hei shi li de jing cha, mian yi yao wu shi gei te zhong bing bu dui jin xing dong yuan de zheng wei.,, fu zuo yong bu tong,, ren he yao wu dou you fu zuo yong. you yu zuo yong ji zhi bu tong, ba xiang yao wu he mian yi yao wu fu zuo yong hen bu yi yang.,, ba xiang yao wu zhen dui de wang wang shi dui zhong liu sheng zhang fei chang zhong yao de dan bai, ke yi shuo shi ai xi bao sheng zhang de zhong yao shi liang. ba xiang yao wu tong guo yi zhi zhei xie dan bai huo xing, cong er da dao" e si" ai xi bao de mu di.,, dan you yu zhong zhong yuan yin, yao wu ye hui" e si" yi xie zheng chang xi bao, chan sheng fu zuo yong, zhe dian he hua liao you dian lei si. bi ru fei ai EGFR ba xiang yao wu yi rui sha, dui biao pi xi bao you fu zuo yong, suo yi huan zhe shi yong hou hui you ming xian de pi zhen.,, mian yi yao wu gong neng shi ji huo mian yi xi bao, lai dui kang ai xi bao. dan ta ye you fu zuo yong, bu shi hao wu feng xian de. bei ji huo de mian yi xi bao chu le neng gong ji ai xi bao, ye neng gong ji zi shen de zheng chang xi bao, zhe hui chan sheng zan shi de" zi mian yi ji bing", yan zhong de hua shi ke neng zhi ming de.,, mu qian shi yong de PD1 yi zhi ji CTLA4 yi zhi ji deng mian yi yao wu, you dai biao xing de fu zuo yong shi mian yi xi tong huo yue dao zhi de pi zhen chang yan fu xie gan sun shang deng, ta men de lin chuang te zheng he hua liao huo ba xiang liao fa de fu zuo yong jie ran bu tong, yao kong zhi zhe lei fu zuo yong xu yao de yao wu ye bu tong.,, qi xiao su du bu tong,, ba xiang yao wu yin wei zhi jie zhen dui xing sha si ai xi bao, qi xiao wang wang bi jiao kuai. ru guo you xiao, tong chang ji ge xing qi, shen zhi ji tian, jiu hui fa xian zhong liu suo xiao, huo zhe zhong liu biao zhi wu jiang di. bi ru, yi rui sha ping jun qi xiao shi jian shi 6 ge xing qi, huan zhe tong chang fu yao di yi ci qu yi yuan fu zha, jiu hui zhi dao shi fou you xiao le.,, mian yi yao wu fan ying yao man de duo, ye yao fu za de duo. mian yi yao wu shi tong guo ji huo mian yi xi tong, er jian jie sha si ai xi bao, yin ci bian shu bi jiao da. hen duo huan zhe yong le hao ji ge yue de yao, ye bu wan quan que ding dao di qi zuo yong le mei you.,, shen zhi you huan zhe yong PD1 yi zhi ji chao guo 1 nian hou, zhong liu da xiao kan qi lai wen si bu dong, yi sheng jue ding ting zhi yong yao, shei zhi ji nian hou fu zha ai zheng que xiao shi le. zhe ge xian xiang yu xia mian yao tan dao de" jia jin zhan" mi qie xiang guan.,, dui" zhong liu bian da" de pan duan bu tong,, lin chuang shang" zhong liu jin zhan" zhi de shi zhong liu zai sao miao ying xiang xia ti ji zeng da, huo zhe chu xian xin de zhong liu. dui yu ba xiang yao wu huo zhe hua liao lai shuo, zhe tong chang yi wei zhe yao wu dui zhong liu wu xiao, biao zhun cao zuo shi ting zhi zhi liao, huan bie de yao wu.,, dan mian yi yao wu dai lai le yi ge qian suo wei you de xian xiang, jiao" jia jin zhan". yue 10 shi yong mian yi yao wu de huan zhe, yong yao hou CT sao miao hui kan dao" zhong liu bian da". ru guo an chuan tong jing yan, zhe shi yao wu shi bai, ying gai huan yao. dan shi ji shang hou lai zhi dao, yao wu shi cheng gong de, yin wei zhe 10 huan zhe hou lai zhong liu you suo xiao.,," jia jin zhan" chu xian de zhu yao yuan yin shi mian yi yao wu qi xiao hou, hui yin fa da liang mian yi xi bao jin ru zhong liu zu zhi, he e shi li dou zheng. dan CT qu fen bu liao ai xi bao he mian yi xi bao, zhi shi jian dan fa xian zhong liu bian da le. qi shi, zhe shi mian yi xi bao bu dui jin ru zhan chang, shi da da de hao shi.,,,, shi yong mian yi liao fa de shi hou, ru he qu fen" jia jin zhan" he" zhen jin zhan" fei chang zhong yao, yin wei ta she ji shi ji xu jian chi yong mian yi liao fa, hai shi gan kuai huan yao zhe ge sheng si jue ding.,, chang qi duan qi xiao guo bu tong,, ru guo yong zai he shi huan zhe shen shang, ba xiang yao wu you xiao lv gao, er qie qi xiao kuai, neng xun su huan jie zhong liu dai lai de zheng zhuang, ti gao huan zhe de sheng huo zhi liang, yi ding shi qi nei neng xian zhu ti gao cun huo lv.,, dan you yu zhong liu de yi zhi xing he jin hua, yi duan shi jian hou ji hu wu yi li wai hui chu xian kang yao xing, xu yao huan yao, ji shao chu xian chang qi cun huo huo zhi yu.,, mian yi yao wu mu qian zui da wen ti shi you xiao lv bu gao, jin zai 10 20, suo yi dui hen duo ren lai shuo, ta shi wu xiao de. jia shang" jia jin zhan" xian xiang, yi kai shi duo shu ren zhong liu dou bu hui suo xiao. dan sui zhe shi jian liu shi, kai shi you huan zhe chu xian xiang ying, zhong liu suo xiao, er qie hen duo xiang ying de huan zhe hui chang qi shou yi, zhe jiu shi suo wei de sheng cun qu xian" tuo wei xian xiang" jian xia tu: yi xiao bu fen huan zhe hui chang qi cun huo, shen zhi bei zhi yu.,,,, shi yong CTLA4 yi zhi ji de hei se su liu huan zhe, yi dan huo guo 3 nian, 80 dou neng huo guo 10 nian, shen zhi lin chuang zhi yu! zhe shi da jia re zhong yu mian yi liao fa de zhu yao yuan yin.,, dang ran, li xiang qing kuang shi ba liang lei yao wu you dian jie he zai yi qi, ti gao xiang ying bi li, tong shi rang geng duo ren chang qi cun huo, zhe jiu shi da liang chang shi ge zhong zu he liao fa de yuan yin.,, mu qian jing zhun cheng du bu tong,, kang ai yao hen gui, yin ci zui hao zhi yong zai neng shou yi de huan zhe shen shang, he kuang yong cuo yao hai hui lang fei bao gui de shi jian.,, jing guo duo nian yan jiu, hen duo ba xiang yao wu de shi yong yuan ze yue lai yue qing chu, yi ban jiu shi xie dai mou zhong te ding ji yin tu bian de zhong liu, bi ru you EGFR min gan tu bian de fei ai, shi yong EGFR ba xiang yao wu, duo shu hui you xiao. you ALK tu bian de fei ai, yong ALK ba xiang yao, xiao guo ye hen hao. mu qian hen duo ba xiang yao de shi yong yi jing bi jiao" jing zhun".,, dan dui yu mian yi yao wu, yu ce liao xiao hai hen nan, jia shang hen duo huan zhe ba ta dang zuo zui hou de" jiu ming dao cao", dao zhi shi yong fei chang" bu jing zhun". da gui mo ren qun li mian mang shi, cheng gong lv tong chang jin wei 10 20. zhe shi mu qian de zhuang kuang, er yu ce mian yi liao fa liao xiao ke neng shi mu qian zui re de ling yu zhi yi, xi wang neng jin zao you tu po, rang mian yi liao fa ye jin ru" jing zhun yi liao" hang lie.,, zong zhi, ba xiang yao wu he mian yi yao wu mei you jue dui de hao huai zhi fen, bu tong de yao shi he bu tong de huan zhe.,, zai hao de yao ye bu hui dui 100 huan zhe you xiao, dui huan zhe er yan, you yao wu ke xuan dang ran shi hao shi, shen zhi yue duo yue hao. guan jian, shi yao ren qing mei ge yao de te xing, liao jie ta shi fou he shi zi ji de qing kuang, zhao dao zui" jing zhun", zui hao de zu he.,," ba xiang"" mian yi" na jia hao? jing zhun yong yao bu ke shao!,, ben wen lai zi wei xin gong zhong hao: bo luo yin zi ID: checkpoint_1, zuo zhe: 80 hou bo luo bo shi

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