Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis.
Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. In recent years many countries, especially in Western industrial countries showed an upward trend in the incidence of major health threat, to be aroused our attention, is on the clinical treatment of MPM progress summarized below.
1 incidence
2 O in the early MPM was the first report, 6 O in contact with asbestos and the relationship between the MPM was confirmed that the report of its incidence rate increased gradually, because the incubation period MPM incidence can be achieved for decades, so strictly limit the use of asbestos 30 ~ 4O years of time, the incidence rate will continue to increase. In the United Kingdom, is expected in 2010 and 2020 the incidence will reach the peak between each of the MPM led to the death toll could reach a maximum of about 2,700 people. Now the United States each year about 3,000 patients were diagnosed with MPM E. Zhang Jianguo, such as the domestic from 1980 to 1999 reported 382 cases of MPM 1 for statistical analysis: Men 908 cases, 474 cases of women, men and women ratio was 1.92:1, the age of 15 to 83-year-old, of which 45 ~ 6 O-year-old accounted for 61.2, Average 47-year-old.
2 causes
MPM 2.1 asbestos exposure and about the relationship between the 8 O MPM cases were considered in the environmental and occupational exposure on all kinds of asbestos fibers, blue: brown asbestos: chrysotile ratio of 500:100:1 E. MPM led to the current asbestos on the mechanism although there are physical stimulation theory, theory and the dissolution of molecular mechanisms, but the exact mechanism is unclear, and 2 O cases without a clear professional reasons, was considered the relevant factors and the etiology: including non-contact Industrial fibers such as wool and zeolite contact monkey virus 40 (SV40), and so on.
2.2 SV40 and the relationship between SV4O MPM is a monkey-derived within the DNA tumor virus believed to be infected by the spread of polio vaccine to humans in recent years, the human MPM specimens found SV40 in the homologous gene sequences And experimental animals can be induced by subcutaneous injection of SV40 is a MPM], there are studies that SV4O and the people of asbestos in the mesothelial cells malignant transformation may have synergies. MPM now SV4O in the etiology of great concern, and that this may have developed a new treatment methods. But there are many recent results indicate that SV40 was infected with the polio vaccine and there was no correlation between MpM relations.
2.3 MPM other factors lead to other possible factors tuberculous pleural scarring, chronic inflammation, infection, radiation, non-specific history of exposure to industrial compounds and genetic factors. On the relationship between smoking and MPM is generally believed that smoking does not increase the incidence of MPM, but will the deterioration.
3 pathological type
Because of skin on the morphology of the characteristics of two-way division, mesothelioma cells can differentiate into shape, but also can be turned into fibroblasts morphological usually based on tumor growth mode and the whole shape will pleural mesothelioma into localized and Diffuse, according to cytology morphology and biological behavior is divided into benign and malignant. Is generally believed that localized tissue from the pleura, more benign, a small number of low-grade, vicious coverage ratio varies from diffuse pleural itself, almost all high grade. Limitations of benign pleural mesothelioma often divided into fiber types, epithelial and mixed, diffuse type MPM into sarcoma (12.1), E-(60.6) and mixed.
4 diagnosis
4.1 MPM clinical diagnosis diverse and have a cough, Bieqi, chest pain and other symptoms, imaging examination showed pleural effusion, pleural thickening or pleural nodules, but less specific, the time of diagnosis to be considered, confirmed the need to rely on Histological examination. Percutaneous pleural biopsy and pleural effusion cytology easy, but the diagnosis rate is not high, were reported in the literature for 6 to 38 _8 and 0 to 22 _9], or B-CT-guided pleural more to puncture, The positive rate of increase, but the result is still not satisfactory. Thoracoscopy can peep the whole chest, directly observed lesions the size, distribution and the approach of the organs of the situation and look to take adequate biopsy specimens, literature positive rate of up to 91 ~ 100 Do3, is the diagnosis of MPM The best means
4.2 As early diagnosis of MPM high degree of malignancy, treatment, many patients already in advanced, in recent years, MPM in the early diagnosis and differential diagnosis also had a lot of exploration. Robinson, and so _ I detected 44 cases of patients with MPM of soluble inter-related protein Paper (sol-uble mesothelin-related proteins, SMR) found that 37 cases (84) in patients with elevated concentrations of SMR, and 16 O in the case of cancer or other diseases pleural Patients, only three cases (2) increased, the authors suggest that SMR concentration and the tumor size and progress on, can be used to monitor tumor growth, further study showed that SMR can also be used to infer the incidence of MPM crowd. Although chemical organizations have been widely applied, but there are still 1 O ~ 15 cases of MPM in cancer diagnosis and difficult to distinguish between _ I2]. Malle, such as "MPM found in the effusions, N cadherin increased significantly, but adenocarcinoma of the effusions do not have this expression, and about 9 o cases of adenocarcinoma of E-cadherin protein, the authors also found that healthy seepage Out of CD44 (one of the adhesion molecule) than the expression of malignant effusion increased, those found to be MPM, cancer and benign oozed from the differential to provide a new approach.
5 treatment
5.1 surgery and radiation therapy treatment MPM is the main means of treatment, pleura, lung resection and pleural removal (stripping) is the most commonly used for the surgical method of pleural pneumonectomy mainly refers to the same side of the pleural and removal Lung, pericardium transfer of a surgical approach. Mediastinal to request as much as possible with all the visceral pleural masses, including some pericardium. Resection of part of the pleura range from the thorax after lateral incision, stripping Feijian to the majority of pleural diaphragm and pericardium. More than that of the current limitations of the pleural mesothelioma (benign or malignant) suitable for surgical treatment, diffuse and widespread disease due to frequent malignant pleural effusion, generally unsuitable for surgical treatment, but treatment can significantly ease symptoms. AisnerE1 4] reported pleura, lung resection and pleural after the two-year survival rate was 10 percent to 37 and 11 to 35. Radiation therapy is generally used after surgery or not the adjuvant therapy, to reduce symptoms, especially pain relief is effective, but its application by the size of tumors and normal cells to the toxic effect of the restrictions.
5.2 single-drug chemotherapy traditional single-drug chemotherapy on MPM are less efficient, such as Adriamycin treatment efficiency of about 15 l1, others such as carboplatin, cyclophosphamide and ifosfamide, the chemotherapy drug Taxol, and so the average single - Treatment efficiency of not more than 1 O ~ 2O. In recent years the emergence of a new chemotherapy drugs such as Adriamycin liposome anthracycline, gemcitabine and Pei Mei Qu Cypriot disodium (Pemetrexed disodium, trade names: Alimta) single-drug efficacy is not satisfactory. Pemetrexed is a more targeted folic acid inhibitors, which inhibit the enzyme dependent on a variety of folic acid play a role, is the primary mechanism of inhibition of purine and pyrimidine in the course of three enzymes: thymine nucleotide synthase, Dihydrofolate reductase and Gan ammonia amide ribose nucleotides A acyltransferase, there is no other drug can also inhibit the three enzymes, but a separate application Pem-etrexed chemotherapy The total efficiency is only about 14, The median survival time is about 1 O.7 months, the addition of folic acid and vitamin B. increase after five months]. In short, the current application of a single chemotherapy drug, whether it is efficient in the median survival time or have not achieved satisfactory results.
5.3 combined with chemotherapy in a long time, combined with chemotherapy in the treatment response rate, in essence, no more than single-drug chemotherapy, in recent years as new chemotherapy drug research and development and joint exploration of different drugs, combined with chemotherapy has encouraging results , For the treatment of MPM has brought new hope. In 2002 the American Society of Clinical Oncology (A-merican Society of Clinical Oncology, AS-CO) annual meeting. Vogelzang, and other reports and in 2003 issued a formal currently the largest MPM for the random single-blind clinical stage Ⅲ l The results caused strong concern. In 456 cases of inappropriate operation of MPM patients, 226 cases with Pemetrexed + cisplatin (PC programme, Pemetrexed 500 mg / m, cisplatin 75 mgm, are every 21 days 1) .222 with cisplatin alone (75 mg / m, every 21 days 1), eight cases do not have any medicine, before the results of the two groups are intravenous injection, the results showed that the combined group compared with single-drug treatment can significantly improve the efficiency MPM (41.3 than 16.7), Median survival time (12.1 months than the 9.3 months), time to tumor progression (5.7 months than the 3.9 months), the quality of life and lung function, statistically significant difference. In the beginning of the experiment, 25 cases of serious side effects and the addition of folic acid and vitamin B. oral vaccination, the results show that in the two experimental groups in the application of folic acid and vitamin Bt z can significantly reduce the side effects of chemotherapy, and The survival time without adverse effects.
February 5, 2004, the U.S. Food and Drug Administration (FDA) approved Pemetrexed and cisplatin can not be combined with chemotherapy as the standard surgical treatment of MPM. Pemetrexed is received FDA approval of a drug treatment MPM, but with folic acid and vitamin B also be used to reduce adverse reactions. Byrne, such as 1: 21 patients had gemcitabine and cisplatin combination of observation, the treatment efficiency of 47.6, but only in the median survival time was 9.4 months. Favaretto, such as "Application of gemcitabine and carboplatin joint 5 O patients on the study, the rate was 26, the median survival time for a 6.5, 46 patients with breathing difficulties to improve, 4 O weight gain, alleviate pain 26. In the case of 7 O In the mine for the song Cypriots (raltitrexed) and oxaliplatin combined with the experiment, the average effective rate of 2 o, time to tumor progression for 18 weeks, but the median survival time of about 12 months]. At present, one pair of 240 cases of patients with cisplatin + raltitrexed combined with chemotherapy with cisplatin alone in the stage Ⅲ randomized controlled experiment in progress.
5.4 neoadjuvant chemotherapy although many researchers believe that MPM surgery on the cure rate is very low, but I and Phase Ⅱ patients should consider. Kestenholz, such as 0 for 16 cases of patients with a new adjuvant chemotherapy experiments, first with cisplatin and gemcitabine combined with chemotherapy after a pleura, lung resection, the overall median survival time for a 9.4 months, one year overall survival Rate was 72, the results suggest that advanced the exercise of tumor cells to reduce the chemotherapy to surgery may be a promising treatment methods.
5.5 Although the molecular target for the current understanding of the biological characteristics of MPM relatively small, but a lot of research, including angiogenesis, signal transduction and cell receptor, and other factors, many of the exploration, in order to find a new treatment MPM Target, which is more study of vascular endothelial growth factor (vascular endothelialgrowth factor, VEGF) signaling pathway and the epidermal growth factor receptor (epidermal growth factor
Receptor, EGFR). VEGF is a self-secreting growth factors, the most characteristic of promoting angiogenesis factor, with the endothelial cells on the receptor-binding, a cascade Larger signal so as to stimulate the formation of blood vessels in the MPM invasive growth and the transfer of play Important role, so can be considered by inhibiting the activity of VEGF treatment of MPM. Another possible treatment is to VEGF inhibitor and now the cells of the poison used in the study of the anti-VEGF drugs mainly SU5416, tha-lidomide, PTK787/ZK222584, Bevacizumab, and so on.
EGFR is another cause of concern and angiogenesis-related goals, MPM often over-expression of EGFR, 68 MPM embedded in paraffin sections of the report found its expression. Gefitinib is the EGFR tyrosine kinase inhibitors, which inhibit cell proliferation and MPM in the EGFR phosphorylation, but Govindan, such as ¨ 2 43 cases of patients with advanced research shows that, although the 97 patients with EGFR-positive for performance, but Gefitinib The treatment is not satisfactory, with only one case of patients achieved complete remission, 1 (2) in patients with partial remission, 21 patients (49) unchanged, 15 (35) progress, five cases (12) early death, the results show that MPM EG-FR expression and no recurrence survival has nothing to do.
5.6 immune therapy, including systemic or local chest to interferon or interleukin, in the clinical treatment of MPM reported mixed results. Astoul, such as' two nail on the chest of 23 patients given IL-2, of which 11 cases of partial remission, one case of complete remission, the median survival time for 18 months. Many of the interferon and a combination of chemotherapy drugs, although there have been reports that efficiency can achieve 36, but most single-drug chemotherapy and similar, but also increased the toxicity. Because SV40 may be the cause of MPM, Imperiale, such as considering whether SV40 in the vaccine can be applied to treatment of MPM, the study has been carried out.
6 prognosis
Is generally believed that, MPM tissue types, E-best prognosis, the worst-sarcoma, a mixed-type center, disease stage and the history of exposure to asbestos is an important factor affecting the prognosis. Although the use of the tumor stage to speculate the prognosis of patients with MPM has been widely accepted, but only a very small number of patients suitable for surgery, its clinical application are largely limited. There are reports a study of cancer and leukemia group B (Cancer and Leukemia Group B, CALGB) and the European Cancer Treatment and Research Organization (Eu-ropean Organization for Research andTreatment of Cancer, EORTC) advocated by the way to a better prognosis Judgement. EORTC poor prognosis that the factors include: the tumor function score (Performance Status, PS) poor, interleukin increase, organizations diagnosis is not clear, male patients or organization for the type of sarcoma. CALGB poor prognosis that the factors include: male, PS poor, aged> 75-year-old, chest pain or difficulty in breathing, platelets and elevated LDH, lower hemoglobin. Curran, etc. [2 EORTC adopted the method of analysis of 204 cases of patients, patients with poor prognosis in the median survival time was 5.5 months, no 2-year survival, and the prognosis is good for the group 1 O.8 months and 14.
7 MPM monitoring of new technologies
With the in-depth study of MPM, how to MPM before and after treatment to monitor the changes become more important. Armato, etc. [2, a new study in the semi-automatic computer-aided measurement technology, it can use the computer through the CT scan on the scope of MPM quantitative measurement, this technology can scan the 22 cases of patients with continuous, can reproduce The measurement. In short, in the diagnosis and treatment of MPM, has made great progress, combined with chemotherapy has been established for its important position. As people MPM molecular biological characteristics of the constant deepening of understanding and a new diagnosis, treatment methods will continue to emerge, I believe there will be more encouraging results, the MPM will ease or even bring new hope for recovery.
Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. In recent years many countries, especially in Western industrial countries showed an upward trend in the incidence of major health threat, to be aroused our attention, is on the clinical treatment of MPM progress summarized below.
1 incidence
2 O in the early MPM was the first report, 6 O in contact with asbestos and the relationship between the MPM was confirmed that the report of its incidence rate increased gradually, because the incubation period MPM incidence can be achieved for decades, so strictly limit the use of asbestos 30 ~ 4O years of time, the incidence rate will continue to increase. In the United Kingdom, is expected in 2010 and 2020 the incidence will reach the peak between each of the MPM led to the death toll could reach a maximum of about 2,700 people. Now the United States each year about 3,000 patients were diagnosed with MPM E. Zhang Jianguo, such as the domestic from 1980 to 1999 reported 382 cases of MPM 1 for statistical analysis: Men 908 cases, 474 cases of women, men and women ratio was 1.92:1, the age of 15 to 83-year-old, of which 45 ~ 6 O-year-old accounted for 61.2, Average 47-year-old.
2 causes
MPM 2.1 asbestos exposure and about the relationship between the 8 O MPM cases were considered in the environmental and occupational exposure on all kinds of asbestos fibers, blue: brown asbestos: chrysotile ratio of 500:100:1 E. MPM led to the current asbestos on the mechanism although there are physical stimulation theory, theory and the dissolution of molecular mechanisms, but the exact mechanism is unclear, and 2 O cases without a clear professional reasons, was considered the relevant factors and the etiology: including non-contact Industrial fibers such as wool and zeolite contact monkey virus 40 (SV40), and so on.
2.2 SV40 and the relationship between SV4O MPM is a monkey-derived within the DNA tumor virus believed to be infected by the spread of polio vaccine to humans in recent years, the human MPM specimens found SV40 in the homologous gene sequences And experimental animals can be induced by subcutaneous injection of SV40 is a MPM], there are studies that SV4O and the people of asbestos in the mesothelial cells malignant transformation may have synergies. MPM now SV4O in the etiology of great concern, and that this may have developed a new treatment methods. But there are many recent results indicate that SV40 was infected with the polio vaccine and there was no correlation between MpM relations.
2.3 MPM other factors lead to other possible factors tuberculous pleural scarring, chronic inflammation, infection, radiation, non-specific history of exposure to industrial compounds and genetic factors. On the relationship between smoking and MPM is generally believed that smoking does not increase the incidence of MPM, but will the deterioration.
3 pathological type
Because of skin on the morphology of the characteristics of two-way division, mesothelioma cells can differentiate into shape, but also can be turned into fibroblasts morphological usually based on tumor growth mode and the whole shape will pleural mesothelioma into localized and Diffuse, according to cytology morphology and biological behavior is divided into benign and malignant. Is generally believed that localized tissue from the pleura, more benign, a small number of low-grade, vicious coverage ratio varies from diffuse pleural itself, almost all high grade. Limitations of benign pleural mesothelioma often divided into fiber types, epithelial and mixed, diffuse type MPM into sarcoma (12.1), E-(60.6) and mixed.
4 diagnosis
4.1 MPM clinical diagnosis diverse and have a cough, Bieqi, chest pain and other symptoms, imaging examination showed pleural effusion, pleural thickening or pleural nodules, but less specific, the time of diagnosis to be considered, confirmed the need to rely on Histological examination. Percutaneous pleural biopsy and pleural effusion cytology easy, but the diagnosis rate is not high, were reported in the literature for 6 to 38 _8 and 0 to 22 _9], or B-CT-guided pleural more to puncture, The positive rate of increase, but the result is still not satisfactory. Thoracoscopy can peep the whole chest, directly observed lesions the size, distribution and the approach of the organs of the situation and look to take adequate biopsy specimens, literature positive rate of up to 91 ~ 100 Do3, is the diagnosis of MPM The best means
4.2 As early diagnosis of MPM high degree of malignancy, treatment, many patients already in advanced, in recent years, MPM in the early diagnosis and differential diagnosis also had a lot of exploration. Robinson, and so _ I detected 44 cases of patients with MPM of soluble inter-related protein Paper (sol-uble mesothelin-related proteins, SMR) found that 37 cases (84) in patients with elevated concentrations of SMR, and 16 O in the case of cancer or other diseases pleural Patients, only three cases (2) increased, the authors suggest that SMR concentration and the tumor size and progress on, can be used to monitor tumor growth, further study showed that SMR can also be used to infer the incidence of MPM crowd. Although chemical organizations have been widely applied, but there are still 1 O ~ 15 cases of MPM in cancer diagnosis and difficult to distinguish between _ I2]. Malle, such as "MPM found in the effusions, N cadherin increased significantly, but adenocarcinoma of the effusions do not have this expression, and about 9 o cases of adenocarcinoma of E-cadherin protein, the authors also found that healthy seepage Out of CD44 (one of the adhesion molecule) than the expression of malignant effusion increased, those found to be MPM, cancer and benign oozed from the differential to provide a new approach.
5 treatment
5.1 surgery and radiation therapy treatment MPM is the main means of treatment, pleura, lung resection and pleural removal (stripping) is the most commonly used for the surgical method of pleural pneumonectomy mainly refers to the same side of the pleural and removal Lung, pericardium transfer of a surgical approach. Mediastinal to request as much as possible with all the visceral pleural masses, including some pericardium. Resection of part of the pleura range from the thorax after lateral incision, stripping Feijian to the majority of pleural diaphragm and pericardium. More than that of the current limitations of the pleural mesothelioma (benign or malignant) suitable for surgical treatment, diffuse and widespread disease due to frequent malignant pleural effusion, generally unsuitable for surgical treatment, but treatment can significantly ease symptoms. AisnerE1 4] reported pleura, lung resection and pleural after the two-year survival rate was 10 percent to 37 and 11 to 35. Radiation therapy is generally used after surgery or not the adjuvant therapy, to reduce symptoms, especially pain relief is effective, but its application by the size of tumors and normal cells to the toxic effect of the restrictions.
5.2 single-drug chemotherapy traditional single-drug chemotherapy on MPM are less efficient, such as Adriamycin treatment efficiency of about 15 l1, others such as carboplatin, cyclophosphamide and ifosfamide, the chemotherapy drug Taxol, and so the average single - Treatment efficiency of not more than 1 O ~ 2O. In recent years the emergence of a new chemotherapy drugs such as Adriamycin liposome anthracycline, gemcitabine and Pei Mei Qu Cypriot disodium (Pemetrexed disodium, trade names: Alimta) single-drug efficacy is not satisfactory. Pemetrexed is a more targeted folic acid inhibitors, which inhibit the enzyme dependent on a variety of folic acid play a role, is the primary mechanism of inhibition of purine and pyrimidine in the course of three enzymes: thymine nucleotide synthase, Dihydrofolate reductase and Gan ammonia amide ribose nucleotides A acyltransferase, there is no other drug can also inhibit the three enzymes, but a separate application Pem-etrexed chemotherapy The total efficiency is only about 14, The median survival time is about 1 O.7 months, the addition of folic acid and vitamin B. increase after five months]. In short, the current application of a single chemotherapy drug, whether it is efficient in the median survival time or have not achieved satisfactory results.
5.3 combined with chemotherapy in a long time, combined with chemotherapy in the treatment response rate, in essence, no more than single-drug chemotherapy, in recent years as new chemotherapy drug research and development and joint exploration of different drugs, combined with chemotherapy has encouraging results , For the treatment of MPM has brought new hope. In 2002 the American Society of Clinical Oncology (A-merican Society of Clinical Oncology, AS-CO) annual meeting. Vogelzang, and other reports and in 2003 issued a formal currently the largest MPM for the random single-blind clinical stage Ⅲ l The results caused strong concern. In 456 cases of inappropriate operation of MPM patients, 226 cases with Pemetrexed + cisplatin (PC programme, Pemetrexed 500 mg / m, cisplatin 75 mgm, are every 21 days 1) .222 with cisplatin alone (75 mg / m, every 21 days 1), eight cases do not have any medicine, before the results of the two groups are intravenous injection, the results showed that the combined group compared with single-drug treatment can significantly improve the efficiency MPM (41.3 than 16.7), Median survival time (12.1 months than the 9.3 months), time to tumor progression (5.7 months than the 3.9 months), the quality of life and lung function, statistically significant difference. In the beginning of the experiment, 25 cases of serious side effects and the addition of folic acid and vitamin B. oral vaccination, the results show that in the two experimental groups in the application of folic acid and vitamin Bt z can significantly reduce the side effects of chemotherapy, and The survival time without adverse effects.
February 5, 2004, the U.S. Food and Drug Administration (FDA) approved Pemetrexed and cisplatin can not be combined with chemotherapy as the standard surgical treatment of MPM. Pemetrexed is received FDA approval of a drug treatment MPM, but with folic acid and vitamin B also be used to reduce adverse reactions. Byrne, such as 1: 21 patients had gemcitabine and cisplatin combination of observation, the treatment efficiency of 47.6, but only in the median survival time was 9.4 months. Favaretto, such as "Application of gemcitabine and carboplatin joint 5 O patients on the study, the rate was 26, the median survival time for a 6.5, 46 patients with breathing difficulties to improve, 4 O weight gain, alleviate pain 26. In the case of 7 O In the mine for the song Cypriots (raltitrexed) and oxaliplatin combined with the experiment, the average effective rate of 2 o, time to tumor progression for 18 weeks, but the median survival time of about 12 months]. At present, one pair of 240 cases of patients with cisplatin + raltitrexed combined with chemotherapy with cisplatin alone in the stage Ⅲ randomized controlled experiment in progress.
5.4 neoadjuvant chemotherapy although many researchers believe that MPM surgery on the cure rate is very low, but I and Phase Ⅱ patients should consider. Kestenholz, such as 0 for 16 cases of patients with a new adjuvant chemotherapy experiments, first with cisplatin and gemcitabine combined with chemotherapy after a pleura, lung resection, the overall median survival time for a 9.4 months, one year overall survival Rate was 72, the results suggest that advanced the exercise of tumor cells to reduce the chemotherapy to surgery may be a promising treatment methods.
5.5 Although the molecular target for the current understanding of the biological characteristics of MPM relatively small, but a lot of research, including angiogenesis, signal transduction and cell receptor, and other factors, many of the exploration, in order to find a new treatment MPM Target, which is more study of vascular endothelial growth factor (vascular endothelialgrowth factor, VEGF) signaling pathway and the epidermal growth factor receptor (epidermal growth factor
Receptor, EGFR). VEGF is a self-secreting growth factors, the most characteristic of promoting angiogenesis factor, with the endothelial cells on the receptor-binding, a cascade Larger signal so as to stimulate the formation of blood vessels in the MPM invasive growth and the transfer of play Important role, so can be considered by inhibiting the activity of VEGF treatment of MPM. Another possible treatment is to VEGF inhibitor and now the cells of the poison used in the study of the anti-VEGF drugs mainly SU5416, tha-lidomide, PTK787/ZK222584, Bevacizumab, and so on.
EGFR is another cause of concern and angiogenesis-related goals, MPM often over-expression of EGFR, 68 MPM embedded in paraffin sections of the report found its expression. Gefitinib is the EGFR tyrosine kinase inhibitors, which inhibit cell proliferation and MPM in the EGFR phosphorylation, but Govindan, such as ¨ 2 43 cases of patients with advanced research shows that, although the 97 patients with EGFR-positive for performance, but Gefitinib The treatment is not satisfactory, with only one case of patients achieved complete remission, 1 (2) in patients with partial remission, 21 patients (49) unchanged, 15 (35) progress, five cases (12) early death, the results show that MPM EG-FR expression and no recurrence survival has nothing to do.
5.6 immune therapy, including systemic or local chest to interferon or interleukin, in the clinical treatment of MPM reported mixed results. Astoul, such as' two nail on the chest of 23 patients given IL-2, of which 11 cases of partial remission, one case of complete remission, the median survival time for 18 months. Many of the interferon and a combination of chemotherapy drugs, although there have been reports that efficiency can achieve 36, but most single-drug chemotherapy and similar, but also increased the toxicity. Because SV40 may be the cause of MPM, Imperiale, such as considering whether SV40 in the vaccine can be applied to treatment of MPM, the study has been carried out.
6 prognosis
Is generally believed that, MPM tissue types, E-best prognosis, the worst-sarcoma, a mixed-type center, disease stage and the history of exposure to asbestos is an important factor affecting the prognosis. Although the use of the tumor stage to speculate the prognosis of patients with MPM has been widely accepted, but only a very small number of patients suitable for surgery, its clinical application are largely limited. There are reports a study of cancer and leukemia group B (Cancer and Leukemia Group B, CALGB) and the European Cancer Treatment and Research Organization (Eu-ropean Organization for Research andTreatment of Cancer, EORTC) advocated by the way to a better prognosis Judgement. EORTC poor prognosis that the factors include: the tumor function score (Performance Status, PS) poor, interleukin increase, organizations diagnosis is not clear, male patients or organization for the type of sarcoma. CALGB poor prognosis that the factors include: male, PS poor, aged> 75-year-old, chest pain or difficulty in breathing, platelets and elevated LDH, lower hemoglobin. Curran, etc. [2 EORTC adopted the method of analysis of 204 cases of patients, patients with poor prognosis in the median survival time was 5.5 months, no 2-year survival, and the prognosis is good for the group 1 O.8 months and 14.
7 MPM monitoring of new technologies
With the in-depth study of MPM, how to MPM before and after treatment to monitor the changes become more important. Armato, etc. [2, a new study in the semi-automatic computer-aided measurement technology, it can use the computer through the CT scan on the scope of MPM quantitative measurement, this technology can scan the 22 cases of patients with continuous, can reproduce The measurement. In short, in the diagnosis and treatment of MPM, has made great progress, combined with chemotherapy has been established for its important position. As people MPM molecular biological characteristics of the constant deepening of understanding and a new diagnosis, treatment methods will continue to emerge, I believe there will be more encouraging results, the MPM will ease or even bring new hope for recovery.
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