Chemotherapy and targeted therapies for unresectable malignant mesothelioma.
Chemotherapy and targeted therapies for unresectable malignant mesothelioma.
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DOI：
10.1016/j.lungcan.2011.04.014
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发表时间：
2011-09
期刊：
影响因子：
5.3
通讯作者：
Hassan, Raffit
中科院分区：
文献类型：
--
作者：
Kelly, Ronan Joseph;Sharon, Elad;Hassan, Raffit
间皮瘤的全球负担预计将在未来几十年增加。因此，开发更有效的疗法，强调基于经验证的预后和预测性生物标志物的个性化治疗是一项基本要求。在过去十年中，随着新一代抗叶酸药物的开发，培美曲塞和顺铂在不可切除疾病患者中的当前标准治疗取得了进展。然而，接受这种联合治疗的患者的中位总生存期仅为12个月。尽管吉西他滨联合铂类化合物或长春瑞滨单药治疗是一种合理的选择，但对基于培美曲塞的治疗进展或无应答的患者的二线治疗尚无共识。迄今为止，间皮瘤中有效的靶向药物的开发令人失望。在一线治疗中，贝伐珠单抗联合培美曲塞和顺铂，组蛋白脱乙酰酶抑制剂伏立诺他作为二线治疗，以及评估间皮瘤维持治疗效用的研究都在进行中，似乎很有前景。此外，临床试验研究免疫治疗和基因治疗与化疗相结合可能会改善间皮瘤患者的预后。
The global burden of mesothelioma is expected to increase in the coming decades. As a result the development of more effective therapies with an emphasis on personalized treatments based on validated prognostic and predictive biomarkers is an essential requirement. Progress has been made in the last decade with the development of newer generation anti-folates leading to the current standard of care of pemetrexed and cisplatin in patients with unresectable disease. However, the median overall survival of patients with this combination treatment is only 12 months. There is no consensus regarding second line therapy for patients who have progressed or not responded to pemetrexed based therapies although gemcitabine in combination with a platinum compound or single agent vinorelbine is a reasonable option. The development of effective targeted agents that are active in mesothelioma has to date been disappointing. Strategies involving the addition of bevacizumab to pemetrexed and cisplatin in the frontline setting, the histone deacetylase inhibitor vorinostat as second line therapy and studies evaluating the utility of maintenance therapy in mesothelioma.are all ongoing and appear promising. In addition clinical trials investigating immunotherapy and gene therapy in combination with chemotherapy could potentially improve the prognosis of patients with mesothelioma.
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