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王子平教授:力争防控同时保证肿瘤患者能够有序诊疗,安罗替尼等口服抗肿瘤药物在疫情期间发挥重要作用

2020-03-11 佚名 肿瘤资讯

在当前新型冠状病毒肺炎疫情逐步得到控制的大环境下,各大医院将会面临大量肿瘤患者复查、返院治疗需求,如何在避免感染新冠肺炎的同时保障肿瘤患者的有序诊疗,成为当下一个亟需解决的问题。

在当前新型冠状病毒肺炎疫情逐步得到控制的大环境下,各大医院将会面临大量肿瘤患者复查、返院治疗需求,如何在避免感染新冠肺炎的同时保障肿瘤患者的有序诊疗,成为当下一个亟需解决的问题。

现阶段仍需在防控新冠肺炎大框架下,保证肿瘤患者有序诊疗

现阶段新冠肺炎疫情逐渐得到了控制,但仍然处于流行阶段,因此需要根据大环境制定医院诊疗工作计划。总体而言,要力争防控,在防控新冠肺炎大框架下,保证肿瘤患者有序诊疗。疫情初期,医院一直在尽量保证治疗中患者治疗的平稳过渡,包括药物使用、放射治疗等;要理清轻重缓急,对于病情紧急患者要优先安排进行治疗,对于非紧急患者,可以适当延后治疗;还要做好与患者之间的沟通。在疫情逐步得到控制后,医疗工作会逐步恢复正常。

目前,北京大学肿瘤医院门诊诊疗采取预约诊疗制度,只有在特殊情况下允许加号。如果患者一直在服用药物治疗阶段,因疫情出现治疗中断的情况允许门诊加号,对于病情发展较快的小细胞肺癌患者,也可以临时加号。并非所有肿瘤都进展迅速,相比于新冠肺炎,传染病对患者生命产生的风险更大。根据最新的研究显示,肿瘤患者在新冠肺炎所占比例较总体人群里的比例更高。肿瘤患者本来免疫力相对较低,特别是化疗期间,更容易感染新冠肺炎。对于这部分患者,患者一定要清楚风险,对于非紧急处理情况,可以通过网络门诊、微信等联系主管医生,根据患者情况制定下一步治疗计划。要知道一个最基本的道理:两害相权,取其轻者。

肿瘤患者感染风险更高,疫情期间治疗策略可以适当调整

随着疫情逐步缓解,很多肿瘤患者会面临复查、返院治疗等问题。返院前要做好与患者之间的沟通,让患者知晓与普通人相比新冠肺炎对肿瘤患者造成的死亡风险更大。2月14日《柳叶刀·肿瘤学》杂志发表的研究结果表明,在新冠病毒肺炎患者中,肿瘤患者感染新冠肺炎的风险高于中国总体人群;与非癌症感染患者相比恶性肿瘤患者感染新冠肺炎后,发生重症的风险更高。

另一方面,疫情期间部分患者的治疗又不宜中断,在这一特殊时期,部分患者的治疗可以做适当调整。例如能够口服用药,就尽可能不用肌肉注射,能肌肉注射就不用静脉输注,这样能够最大限度地降低患者就诊次数,最大限度地降低被感染的风险。此外,对于某些肿瘤患者的治疗可以适当延缓,举例而言,在没有疫情的情况下,对于肺癌术后可以按时开始辅助化疗,但疫情期间,就可以适当推迟术后辅助治疗。根据国外的研究发现,术后4个月内行辅助化疗并不影响治疗疗效。而中国研究也显示术后开始辅助化疗时间并不重要,所以没有必要在疫情期间非得要开始进行术后辅助化疗。另外对于骨转移患者,如果没有严重疼痛或明显高钙血症,也可以适当往后推迟双磷酸盐类药物的输注时间。对于存在肺内小结节需要复查的患者更可以在疫情过后再进行正规检查,避免没有必要的感染,患者可以通过网上问诊等途径与医生交流、解决存在问题。

疫情期间口服抗肿瘤药物应用注意事项

在新冠肺炎疫情特殊背景下,对于驱动基因阴性的晚期非小细胞肺癌患者,为了保障治疗的延续性,不影响病情进展,又可以减少被感染的机会可以考虑口服的抗肿瘤药物。如口服化疗药或安罗替尼等药物。能够口服就尽量不要去医院接受静脉注射治疗,作为感染的高危人群,减少就医次数,才能能够最大限度地减少感染风险。一定要拎清楚传染病和肿瘤哪个对人的生命威胁最大。

以具备自主知识产权的安罗替尼为例,目前安罗替尼已经对非小细胞肺癌和小细胞肺癌获批适应证,临床研究中证实其疗效明确,并且不良反应较轻。相比于静脉输注治疗,口服相对更加便捷,服药两周,停药一周。居家用药又能够降低感染新冠肺炎风险。目前在北京肿瘤医院门诊治疗中已经有相当的病人开始口服安罗替尼治疗,疫情期间还可以较平时多开药物,最大限度地降低被感染的风险。当然在采用安罗替尼治疗时,一定要在医生的指导下进行,注意复查血象、尿蛋白、血压等,同时与主管医生积极沟通。

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肿瘤患者需警惕静脉血栓栓塞症

静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)与肺栓塞(PE),已成为住院肿瘤患者死亡的第二大原因,仅次于肿瘤本身,堪称肿瘤患者的定时炸弹。肿瘤患者如果发生静脉血栓栓塞症,不仅增加治疗难度,降低患者的生活质量,减少生存预期,还会大幅增加住院时间与治疗费用。

肿瘤患者静脉化疗后千万别忘了这件事

肿瘤患者的静脉化疗指细胞毒性药物经静脉通道进入人体,到达各组织器官,是各种恶性肿瘤疾病患者的常用治疗方法。

临床心得:别对肿瘤患者说“想吃什么吃什么”

前段时间,我们对近200名外科肿瘤患者开展术前的营养状况和膳食摄入量评估。结果发现,近30%患者存在营养不良的问题,80%患者术前膳食摄入能量不足,91%患者蛋白质摄入不足。尤其是消化系统肿瘤患者,由于受到肿瘤部位影响,营养不良发生比例更高。本次调查中也发现,原发性肝癌患者存在营养风险的比例高达45.9%,患有轻中度营养不良的占39%,重度营养不良的占13.4%。可见,肿瘤患者的营养问题是普遍存在

ESMO-WCGI大会主席说:肿瘤患者的抗凝治疗不应忽视

在西班牙巴塞罗那召开的ESMO第21届世界胃肠道肿瘤大会(ESMO-WCGI)上,ESMO-WCGI大会主席、卢森堡肿瘤中心医院的Mario Dicato教授发表重要演讲:新型口服抗凝药和胃肠道肿瘤患者。

肿瘤患者放化疗后口腔粘膜炎的处理

肿瘤化疗和放疗过程中都可能对快速增长的黏膜上皮细胞造成损伤,引发口腔黏膜炎和胃肠道黏膜炎。放化疗后口腔黏膜炎是指由于放射线电离辐射损伤或者化疗药物的应用引起免疫力下降,口腔内菌群失调,导致口腔软组织发生炎症病变,是肿瘤患者接受化疗过程中较常见,最痛苦的毒副作用之一。粘膜炎一般具有自愈性,一旦组织不受损伤,就开始愈合。黏膜损伤会在几天内自然地消失,一般在化疗后10~14天内完全愈合。

又一名人因癌去世!肿瘤患者该不该化疗,北京医生说了大实话!

媒体报道,台湾文化名人曾仕强于11日在台湾辞世,享年84岁。此前他曾在央视百家讲坛中讲解《易经的奥秘》等作品。2016年,他被检查出癌症,他说:“经不起化疗的折腾,那怎么办呢?那只好快快乐乐的面对它!既不怨天尤人,也不在那里叫苦连天”。

拓展阅读

STTT | 安罗替尼联合化疗作为不可切除肝转移胃肠道癌症患者的一线治疗方案:一项多队列、多中心、探索性试验

该研究旨在评估一线安罗替尼联合化疗治疗晚期胃肠道癌症伴不可切除肝转移患者的疗效和安全性,一线安罗替尼联合化疗随后接受安罗替尼联合小剂量卡培他滨维持治疗显示出良好的抗肿瘤活性,并且耐受性良好。

STTT | 突破治疗瓶颈:贝莫苏拜单抗联合安罗替尼和化疗为晚期食管癌患者带来显著生存获益

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STTT | 新突破:术前信迪利单抗、安罗替尼和化疗,术后辅助信迪利单抗治疗可切除非小细胞肺癌:疗效显著,安全性良好

研究旨在评估术前新辅助信迪利单抗联合安罗替尼和化疗,术后辅助信迪利单抗治疗可切除NSCLC的疗效和安全性,研究结果表明该方案在治疗可切除NSCLC患者中具有良好的疗效和安全性。

读书报告 | 派安普利单抗和安罗替尼联合白蛋白结合型紫杉醇/吉西他滨一线治疗晚期胰腺癌的II期临床研究

胰腺癌(PC)是一种常见的消化系统恶性肿瘤,在世界范围内的发病率和死亡率逐渐增加。

STTT | 新方案:贝莫苏拜单抗联合安罗替尼显著延长EGFR阳性晚期NSCLC患者的PFS

该研究旨在评估贝莫苏拜单抗联合安罗替尼在EGFR突变阳性晚期NSCLC患者中的疗效和安全性,研究结果显示,这一无化疗方案在EGFR突变阳性晚期NSCLC患者中显示出良好的抗肿瘤活性,且安全可控。

读书报告 | ETER701研究:贝莫苏拜单抗和安罗替尼联合化疗治疗广泛期非小细胞肺癌的III期临床研究

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