JCO：免疫疗法与化疗相结合或可延长脑癌患者寿命

临床肿瘤学杂志本周报道了一种新的治疗脑癌的方法,即将免疫治疗与高剂量化疗相结合而不是传统的全脑放疗与化疗结合.

这种新的疗法能明显降低因全脑放疗而给脑细胞带来的毒性,因为高剂量的全脑放疗可杀死脑细胞,从而导致患者的神经系统功能的逐渐退化.据报道,许多脑癌患者就是死于放疗辐射的毒性而不是癌症本身.

免疫治疗与放疗联合治疗前(A)后(B)的脑部扫面图

研究结果显示,连续5年使用这种新的疗法治疗脑癌的患者依然还活着,这表明,这种新的治疗方法似乎可以更有效的治疗癌症.

该研究的领导者、肿瘤学家James Rubenstein教授称:这种新的治疗方法与以前全脑放疗的治疗方法相比,它使淋巴瘤患者的存活率增加了一倍.此外,不同于以往治疗原发性中枢神经系统淋巴瘤的方法,新的方法对年轻患者和60岁以上的老年患者具有同样的疗效.这一发现是非常有意义的,因为这种类型的脑肿瘤在65岁及以上的老年人身上发现的概率较高.

研究人员还发现了一中可以预测治疗效果的生物标志物—BCL6基因,这个基因的多少取决于淋巴肿瘤细胞的多少,这项成果可以用于指导研究专门针对淋巴癌的治疗方法.

目前,针对这种新的治疗方法的疗效,加州大学旧金山分校和美国其他医疗中心正在对更多的人群做一项随机临床试验.

原发性中枢神经系统淋巴瘤是一种致命的非霍奇金式淋巴瘤,美国每年约有1600人被诊断出患有原发性中枢神经系统淋巴瘤,这种肿瘤很难被诊断,因为这种疾病常被误认为是其他形式的脑肿瘤或其他神经系统疾病,如阿尔茨海默氏症或多发性硬化症.

然而,不同于其他脑肿瘤的是原发性中枢神经系统淋巴瘤会导致严重的神经衰弱.而且,手术只能用于诊断原发性中枢神经系统淋巴瘤而不能治疗,因为这种肿瘤能够在大脑中广泛传播.

十几年前,Rubenstein来到加州大学旧金山分校,他想改变这种现状,于是与他的同事开始了化疗与免疫治疗相结合的方法来治疗这种脑瘤的研究,这种免疫疗法主要是依赖一种来自免疫系统组分的生物药.

“我们希望开发一种高效低毒的新的治疗原发性中枢神经系统淋巴瘤的方法.”鲁宾斯坦说.第2期多中心临床试验的结果表明,这种新的疗法能够使患者长期生存下去.

与脑癌相关的拓展阅读：

• Mol Cancer Ther：研究证实小分子药物CFAK-Y15可有效治疗脑癌
• 手机或增脑癌风险
• Sci Transl Med：保护脑癌患者免受化疗副作用影响
• Neuro-Oncology：发现脑癌的非手术性测试
• Cancer：频繁的牙科X射线检测和脑癌风险升高有关 更多信息请点击：有关脑癌更多资讯

Intensive Chemotherapy and Immunotherapy in Patients With Newly Diagnosed Primary CNS Lymphoma

Purpose Concerns regarding neurocognitive toxicity of whole-brain radiotherapy (WBRT) have motivated development of alternative, dose-intensive chemotherapeutic strategies as consolidation in primary CNS lymphoma (PCNSL). We performed a multicenter study of high-dose consolidation, without WBRT, in PCNSL. Objectives were to determine: one, rate of complete response (CR) after remission induction therapy with methotrexate, temozolomide, and rituximab (MT-R); two, feasibility of a two-step approach using high-dose consolidation with etoposide plus cytarabine (EA); three, progression-free survival (PFS); and four, correlation between clinical and molecular prognostic factors and outcome.

Patients and Methods Forty-four patients with newly diagnosed PCNSL were treated with induction MT-R, and patients who achieved CR received EA consolidation. We performed a prospective analysis of molecular prognostic biomarkers in PCNSL in the setting of a clinical trial.

Results The rate of CR to MT-R was 66%. The overall 2-year PFS was 0.57, with median follow-up of 4.9 years. The 2-year time to progression was 0.59, and for patients who completed consolidation, it was 0.77. Patients age > 60 years did as well as younger patients, and the most significant clinical prognostic variable was treatment delay. High BCL6 expression correlated with shorter survival.

Conclusion CALGB 50202 demonstrates for the first time to our knowledge that dose-intensive consolidation for PCNSL is feasible in the multicenter setting and yields rates of PFS and OS at least comparable to those of regimens involving WBRT. On the basis of these encouraging results, an intergroup study has been activated comparing EA consolidation with myeloablative chemotherapy in this randomized trial in PCNSL, in which neither arm involves WBRT.