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\u4e0a\u671f\u5185\u5bb9\uff1a\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c32\u7ae0\uff1a1\u671f\u8bd5\u9a8c\u4e2d\u7684\u514d\u75ab\u7597\u6cd5\uff08\u4e0a\uff09<\/span><\/a><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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32.2.6 \u53cd\u5e94\u53ca\u7597\u6548\u8bc4\u4ef7<\/p>\n<\/section>\n

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\u514d\u75ab\u7597\u6cd5\u7684\u4f5c\u7528\u673a\u5236\u72ec\u7279\uff0c\u5176\u6cbb\u7597\u53cd\u5e94\u53ef\u80fd\u8868\u73b0\u51fa\u4e00\u4e9b\u975e\u5178\u578b\u7279\u5f81\uff0c\u5982\u89e3\u79bb\u6027\u53cd\u5e94\u3001\u5ef6\u8fdf\u53cd\u5e94\u3001\u8d85\u8fdb\u5c55\u548c\u5047\u8fdb\u5c55\uff08\u6700\u521d\u89c2\u5bdf\u5230\u80bf\u7624\u4f53\u79ef\u589e\u5927\uff0c\u968f\u540e\u51fa\u73b0\u7f29\u5c0f\uff09\u3002\u8fd9\u4e9b\u73b0\u8c61\u4e3b\u8981\u662f\u56e0\u4e3a\u514d\u75ab\u6fc0\u6d3b\u9700\u8981\u65f6\u95f4\uff0c\u514d\u75ab\u6548\u5e94\u7684\u4e34\u5e8a\u8868\u73b0\u53ef\u80fd\u6709\u6240\u5ef6\u8fdf\uff0c\u4e14\u7531\u4e8e\u514d\u75ab\u7ec6\u80de\u88ab\u62db\u52df\u81f3\u80bf\u7624\u5e8a\u53ef\u80fd\u6682\u65f6\u589e\u52a0\u80bf\u7624\u4f53\u79ef\uff0c\u4f7f\u5f97\u80bf\u7624\u5728\u6709\u6548\u7f29\u5c0f\u4e4b\u524d\u5148\u8868\u73b0\u4e3a\u4f53\u79ef\u589e\u5927\u3002<\/p>\n

\u56e0\u6b64\uff0c\u4f20\u7edf\u7684\u4e16\u754c\u536b\u751f\u7ec4\u7ec7\uff08WHO\uff09\u8bc4\u4ef7\u6807\u51c6\u548c\u5b9e\u4f53\u7624\u53cd\u5e94\u8bc4\u4ef7\u6807\u51c61.1\u7248\uff08RECIST v1.1\uff09\u5e76\u4e0d\u5b8c\u5168\u9002\u7528\u4e8e\u8bc4\u4ef7\u514d\u75ab\u6cbb\u7597\u7684\u53cd\u5e94\u3002\u4e3a\u4e86\u66f4\u51c6\u786e\u5730\u8bc4\u4f30\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u6ede\u5242\u7684\u4e34\u5e8a\u6548\u679c\uff0c\u6700\u8fd1\u5728\u591a\u6570\u4e00\u671f\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c\u5df2\u7ecf\u5f00\u53d1\u5e76\u5f15\u5165\u4e86\u4e00\u79cd\u540d\u4e3a\u514d\u75ab\u76f8\u5173\u53cd\u5e94\u6807\u51c6\uff08irRC\uff09\u7684\u65b0\u8bc4\u4ef7\u4f53\u7cfb\uff0c\u8be5\u4f53\u7cfb\u88ab\u6dfb\u52a0\u5230\u4f20\u7edf\u7684RECIST\u6807\u51c6\u4e2d\uff0c\u4ee5\u66f4\u597d\u5730\u53cd\u6620\u514d\u7597\u7597\u6cd5\u7684\u7597\u6548\u548c\u53cd\u5e94\u7279\u70b9\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8fd9\u4e9b\u6807\u51c6\u66f4\u597d\u5730\u8003\u8651\u4e86\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u6ede\u5242\u6240\u89e6\u53d1\u7684\u975e\u5178\u578b\u53cd\u5e94\u6a21\u5f0f\uff0c\u5305\u62ec\u53ef\u80fd\u51fa\u73b0\u7684\u65b0\u975e\u9776\u5411\u75c5\u53d8\u3001\u5728\u80bf\u7624\u7f29\u5c0f\u524d\u73b0\u6709\u75c5\u53d8\u7684\u589e\u957f\uff0c\u4ee5\u53ca\u957f\u671f\u75be\u75c5\u7a33\u5b9a\uff0c\u6709\u65f6\u751a\u81f3\u5728\u505c\u6b62\u6cbb\u7597\u540e\u8fd8\u4f1a\u89c2\u5bdf\u5230\u5ef6\u8fdf\u53cd\u5e94\u3002\u4f8b\u5982\uff0c\u5728Keynote-001\u7814\u7a76\u4e2d\uff0c\u4f7f\u7528\u6297PD-L1\u836f\u7269\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u4e2d\uff0c7.3%\uff0824\/327\uff09\u8868\u73b0\u51fa\u975e\u5178\u578b\u53cd\u5e94\uff0c\u5176\u4e2d4.6%\uff0815\/327\uff09\u4e3a\u65e9\u671f\u5047\u8fdb\u5c55\uff0c2.8%\uff089\/327\uff09\u4e3a\u5ef6\u8fdf\u5047\u8fdb\u5c55\u3002\u6b64\u5916\uff0c\u6839\u636eRECIST v1.1\uff0c14%\uff0884\/592\uff09\u7684\u60a3\u8005\u88ab\u8bca\u65ad\u4e3a\u75c5\u60c5\u8fdb\u5c55\uff0c\u800c\u5728\u514d\u75ab\u76f8\u5173\u53cd\u5e94\u6807\u51c6\uff08irRC\uff09\u4e2d\uff0c\u8fd9\u4e9b\u60a3\u8005\u88ab\u8bc4\u4f30\u4e3a\u975e\u8fdb\u5c55\u6027\u75be\u75c5\u3002\u57fa\u4e8e\u8fd9\u4e24\u79cd\u6807\u51c6\uff0c\u975e\u8fdb\u5c55\u6027\u7597\u6548\u60a3\u8005\u7684\u4e24\u5e74\u603b\u751f\u5b58\u7387\u4e3a78%\uff0c\u800c\u6839\u636eRECIST v1.1\u8bc4\u4f30\u7684\u8fdb\u5c55\u6027\u75be\u75c5\u60a3\u8005\u7684\u4e24\u5e74\u603b\u751f\u5b58\u7387\u4e3a37%\uff0c\u663e\u793aRECIST v1.1\u53ef\u80fd\u5bfc\u81f4\u6cbb\u7597\u8fc7\u65e9\u4e2d\u65ad\uff0c\u4ece\u800c\u4f4e\u4f30\u4e86\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u6ede\u5242\u7684\u6f5c\u5728\u76ca\u5904\u3002<\/p>\n

\u5c3d\u7ba1\u5728\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u4e2d\u975e\u5178\u578b\u53cd\u5e94\u6a21\u5f0f\u4f3c\u4e4e\u66f4\u5e38\u89c1\uff0c\u4f7f\u7528irRC\u6807\u51c6\u5728\u8be5\u4eba\u7fa4\u4e4b\u5916\u7684\u76ca\u5904\u5c1a\u672a\u5f97\u5230\u5145\u5206\u9a8c\u8bc1\uff0c\u4f46\u5f53\u524d\u5927\u591a\u6570\u8bc4\u4f30\u514d\u75ab\u7597\u6cd5\u7684\u4e00\u671f\u8bd5\u9a8c\u90fd\u5efa\u8bae\u4f7f\u7528RECIST v1.1\u6807\u51c6\u6765\u8fdb\u884c\u521d\u6b65\u7684\u53cd\u5e94\u8bc4\u4f30\uff0c\u540c\u65f6\u5728\u6cbb\u7597\u505c\u6b62\u65f6\u91c7\u7528irRC\u6807\u51c6\u3002\u8fd9\u610f\u5473\u7740\u5728\u521d\u6b65\u8bca\u65ad\u4e3a\u75c5\u60c5\u8fdb\u5c55\u540e4\u5468\u5185\uff0c\u9700\u8981\u8fdb\u884c\u7b2c\u4e8c\u6b21\u5f71\u50cf\u5b66\u8bc4\u4f30\u4ee5\u786e\u8ba4\u75c5\u60c5\u8fdb\u5c55\uff0c\u8fd9\u662f\u5728\u60a3\u8005\u9000\u51fa\u7814\u7a76\u524d\u7684\u5fc5\u8981\u6b65\u9aa4\u3002\u5373\u5c06\u53d1\u5e03\u7684iRECIST\u6807\u51c6\u65e8\u5728\u6574\u5408irRC\u548cRECIST v1.1\u6807\u51c6\uff0c\u63d0\u4f9b\u4e00\u4e2a\u66f4\u5e7f\u6cdb\u9002\u7528\u7684\u6846\u67b6\uff0c\u66f4\u597d\u5730\u53cd\u6620\u8fd9\u4e9b\u975e\u5178\u578b\u7684\u54cd\u5e94\u60c5\u51b5\u3002\u6700\u540e\uff0c\u5efa\u8bae\u5728\u4e34\u5e8a\u83b7\u76ca\u7684\u60c5\u51b5\u4e0b\uff0c\u5141\u8bb8\u5728\u786e\u8ba4\u75c5\u60c5\u8fdb\u5c55\u540e\u7ee7\u7eed\u6cbb\u7597\uff0c\u8fd9\u9700\u8981\u7814\u7a76\u53d1\u8d77\u4eba\u3001\u60a3\u8005\u7684\u4e66\u9762\u6279\u51c6\uff0c\u5e76\u57fa\u4e8e\u6240\u6709\u5408\u4f5c\u7814\u7a76\u8005\u7684\u5171\u8bc6\u3002\u57fa\u4e8e\u8fd9\u4e9b\u8003\u8651\uff0c\u975e\u8fdb\u5c55\u7387\u6216\u4e34\u5e8a\u83b7\u76ca\u7387\u53ef\u80fd\u662f\u8bc4\u4f30\u4e00\u671f\u514d\u75ab\u6cbb\u7597\u7597\u6548\u7684\u6f5c\u5728\u76f8\u5173\u66ff\u4ee3\u65b9\u6848(Fig 32.4<\/span>)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig .<\/span>32.4 <\/span>\u5c55\u793a\u4e86\u81ea\u7ec6\u80de\u6bd2\u6027\u5316\u7597\u65f6\u4ee3\u4ee5\u6765\uff0c\u4e00\u671f\u4e34\u5e8a\u8bd5\u9a8c\u5728\u8fdb\u5165\u514d\u75ab\u80bf\u7624\u5b66\u65f6\u4ee3\u540e\u7684\u6f14\u53d8\uff08\u6539\u7f16\u81eaPostel-Vinay\u7b49\u4eba\uff0c\u7ecf\u300a\u80bf\u7624\u5b66\u5e74\u9274\u300b\u7f16\u8f91\u90e8\u8bb8\u53ef\uff09\u3002\u81ea\u7ec6\u80de\u6bd2\u6027\u5316\u7597\u65f6\u4ee3\u4ee5\u6765\uff0c\u4e00\u671f\u4e34\u5e8a\u8bd5\u9a8c\u5df2\u7ecf\u53d1\u751f\u4e86\u663e\u8457\u7684\u53d8\u5316\u3002\u8fd9\u4e9b\u8bd5\u9a8c\u5df2\u7ecf\u4ece\u5c0f\u89c4\u6a21\u7814\u7a76\u8f6c\u53d8\u4e3a\u5927\u89c4\u6a21\u7814\u7a76\uff0c\u80fd\u591f\u5728\u5e73\u884c\u6269\u5c55\u961f\u5217\u4e2d\u7eb3\u5165\u6570\u767e\u540d\u6839\u636e\u5206\u5b50\u7279\u5f81\u6216\u8868\u578b\u7cbe\u9009\u7684\u60a3\u8005\u3002\u968f\u7740\u6700\u5927\u8010\u53d7\u5242\u91cf\uff08MTD\uff09\u4e0d\u7ecf\u5e38\u8fbe\u5230\uff0c\u65b0\u7684\u7ed9\u836f\u9014\u5f84\u548c\u5242\u91cf\u63a8\u8350\u65b9\u6cd5\u5df2\u7ecf\u88ab\u5f00\u53d1\u3002\u836f\u6548\u5b66\u548c\u836f\u4ee3\u52a8\u529b\u5b66\u53c2\u6570\u5728\u786e\u5b9a\u540e\u671f\u8bd5\u9a8c\u7684\u63a8\u8350\u5242\u91cf\u65b9\u9762\u53d1\u6325\u7740\u8d8a\u6765\u8d8a\u91cd\u8981\u7684\u4f5c\u7528\u3002\u57fa\u4e8e\u514d\u75ab\u76d1\u6d4b\u7684\u836f\u4ee3\u52a8\u529b\u5b66\uff08PK\uff09\u548c\u836f\u6548\u5b66\uff08PD\uff09\u6570\u636e\u63a8\u5bfc\u51fa\u7684\u514d\u75ab\u6700\u4f73\u5242\u91cf\uff0c\u5176\u6982\u5ff5\u662f\u5426\u53ef\u4ee5\u7c7b\u4f3c\u4e8e\u9776\u5411\u5236\u5242\u7684\u6700\u4f73\u751f\u7269\u5242\u91cf\u7528\u4e8e\u514d\u75ab\u523a\u6fc0\u5242\uff0c\u8fd9\u4e00\u70b9\u503c\u5f97\u8fdb\u4e00\u6b65\u63a2\u7d22\u3002<\/span>\u540c\u65f6\uff0c\u65e9\u671f\u8bd5\u9a8c\u7684\u8bbe\u8ba1\u4e5f\u5728\u5e73\u884c\u53d1\u5c55\uff0c\u65e8\u5728\u4fdd\u6301\u5feb\u901f\u7684\u5242\u91cf\u9012\u589e\u9636\u6bb5\uff0c\u5e76\u8bc4\u4f30\u5927\u578b\u9009\u62e9\u6027\u961f\u5217\u7684\u7597\u6548\u3002\u56e0\u6b64\uff0c\u4f20\u7edf\u76841-2-3\u671f\u836f\u7269\u5f00\u53d1\u7b56\u7565\u6b63\u5728\u88ab\u6574\u5408\u76841\/3\u671f\u8bd5\u9a8c\u6240\u53d6\u4ee3\uff0c\u8fd9\u4e9b\u8bd5\u9a8c\u7ed5\u8fc7\u4e86\u4f20\u7edf\u7684\u4e8c\u671f\u7814\u7a76\u3002\u6240\u6709\u8fd9\u4e9b\u8fdb\u5316\u663e\u8457\u7f29\u77ed\u4e86\u836f\u7269\u5f00\u53d1\u7684\u65f6\u95f4\uff0c\u5e76\u4e14\u5bf9\u60a3\u8005\u66f4\u4e3a\u6709\u5229\u3002<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u603b\u7684\u6765\u8bf4\uff0c\u73b0\u884c\u7684\u8bc4\u4f30\u6807\u51c6\u2014\u2014\u65e0\u8bba\u662fRECIST\u3001irRC\u8fd8\u662fiRECIST\u2014\u2014\u90fd\u53ef\u80fd\u4e0d\u5b8c\u5168\u8db3\u4ee5\u6355\u6349\u514d\u75ab\u7597\u6cd5\u4e2d\u89c2\u5bdf\u5230\u7684\u6240\u6709\u7279\u6b8a\u53cd\u5e94\u6a21\u5f0f\u3002\u56e0\u6b64\uff0c\u4e00\u671f\u8bd5\u9a8c\u4e2d\u5e94\u7cfb\u7edf\u5730\u8003\u8651\u548c\u5b9e\u65bd\u66ff\u4ee3\u7b56\u7565\u3002\u8fd9\u4e9b\u7b56\u7565\u5305\u62ec\u52a8\u6001\u8bc4\u4f30\uff08\u5982\u80bf\u7624\u751f\u957f\u901f\u5ea6\uff09\u3001\u4ee3\u8c22\u6210\u50cf\u6280\u672f\u4ee5\u53ca\u5916\u5468\u514d\u75ab\u76d1\u6d4b\u2014\u2014\u540e\u8005\u4e5f\u53ef\u80fd\u6210\u4e3a\u4e00\u79cd\u53cd\u5e94\u6307\u6807\u3002\u6700\u7ec8\uff0c\u5728\u514d\u75ab\u6cbb\u7597\u7684\u4e00\u671f\u8bd5\u9a8c\u4e2d\u662f\u5426\u5e94\u8be5\u7cfb\u7edf\u5730\u8bb0\u5f55\u603b\u751f\u5b58\u671f\u662f\u4e00\u4e2a\u5f53\u524d\u7684\u95ee\u9898\u3002<\/p>\n

\u8fd9\u4e00\u7ec8\u70b9\u5728\u4f20\u7edf\u4e0a\u5e76\u672a\u5728\u65e9\u671f\u8bd5\u9a8c\u4e2d\u6ce8\u518c\uff0c\u56e0\u4e3a\u8fd9\u4e9b\u8bd5\u9a8c\u7684\u4e3b\u8981\u76ee\u7684\u662f\u8bc4\u4f30\u5b89\u5168\u6027\u3002\u521d\u6b65\u7597\u6548\u6570\u636e\u901a\u5e38\u4f5c\u4e3a\u6b21\u8981\u7ec8\u70b9\uff0c\u4e3b\u8981\u901a\u8fc7\u7f13\u89e3\u7387\u6216\u65e0\u8fdb\u5c55\u751f\u5b58\u671f\uff08PFS\uff09\u8fdb\u884c\u8bc4\u4f30\u3002\u7136\u800c\uff0c\u8003\u8651\u5230\u514d\u75ab\u7597\u6cd5\u53ef\u80fd\u663e\u8457\u5f71\u54cd\u751f\u5b58\u66f2\u7ebf\u7684\u5c3e\u90e8\uff0c\u603b\u751f\u5b58\u671f\u6210\u4e3a\u4e00\u4e2a\u76f8\u5173\u7684\u7ec8\u70b9\u6765\u8bc4\u4f30\u5176\u957f\u671f\u7597\u6548\u3002<\/p>\n

\u5c3d\u7ba1\u5982\u6b64\uff0c\u4e00\u671f\u8bd5\u9a8c\u2014\u2014\u5373\u4f7f\u5728\u5f53\u524d\u8f6c\u53d8\u4e3a\u201c\u4e00\u671f\u6ce8\u518c\u8bd5\u9a8c\u201d\u7684\u60c5\u51b5\u4e0b\u2014\u2014\u4ecd\u4e0d\u662f\u8bc4\u4f30\u603b\u4f53\u751f\u5b58\u7684\u7406\u60f3\u573a\u6240\uff0c\u539f\u56e0\u5305\u62ec\uff1a(1) \u4e00\u671f\u8bd5\u9a8c\u4e0d\u5305\u542b\u4efb\u4f55\u5bf9\u7167\u7ec4\uff1b(2) \u60a3\u8005\u5728\u8bd5\u9a8c\u4e4b\u540e\u53ef\u80fd\u63a5\u53d7\u591a\u79cd\u6cbb\u7597\u65b9\u6848\uff0c\u8fd9\u4e9b\u65b9\u6848\u4f1a\u5f15\u5165\u591a\u79cd\u6df7\u6dc6\u56e0\u7d20\uff1b(3) \u8fd9\u4f1a\u65e0\u8c13\u5730\u589e\u52a0\u4e0e\u4e00\u671f\u8bd5\u9a8c\u76f8\u5173\u7684\u5de5\u4f5c\u91cf\uff0c\u5c24\u5176\u662f\u4e00\u671f\u60a3\u8005\u7ecf\u5e38\u4ece\u5916\u90e8\u4e2d\u5fc3\u8f6c\u8bca\uff0c\u5e76\u5728\u8bd5\u9a8c\u7ed3\u675f\u540e\u8fd4\u56de\u539f\u533b\u9662\uff1b\u4ee5\u53ca(4) \u968f\u7740\u4e00\u671f\u7814\u7a76\u8d8a\u6765\u8d8a\u65e9\u5730\u8fdb\u5165\u60a3\u8005\u7684\u6cbb\u7597\u7ebf\uff0c\u8fd9\u4e9b\u6570\u636e\u5f88\u53ef\u80fd\u53ea\u6709\u5728\u8bd5\u9a8c\u7ed3\u679c\u5df2\u7ecf\u62a5\u544a\u548c\u53d1\u8868\u540e\u624d\u53ef\u7528\uff0c\u56e0\u6b64\u51e0\u4e4e\u6c38\u8fdc\u4e0d\u4f1a\u88ab\u53ca\u65f6\u66f4\u65b0\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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32.2.7 \u8bd5\u9a8c\u8bbe\u8ba1:\u201c\u7b2c\u4e00\u9636\u6bb5\u6ce8\u518c\u201d\u8bd5\u9a8c<\/p>\n<\/section>\n

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\u8fc7\u53bb\u4e94\u5e74\u4e2d\uff0c\u4e00\u671f\u4e34\u5e8a\u8bd5\u9a8c\u7684\u8bbe\u8ba1\u53d1\u751f\u4e86\u663e\u8457\u53d8\u5316(Fig 32.2\u548c<\/span>Fig 32.4<\/span>)\u3002\u4f20\u7edf\u4e0a\uff0c\u65e9\u671f\u8bd5\u9a8c\u4f1a\u62db\u52df\u5927\u7ea630\u81f360\u540d\u60a3\u8005\uff0c\u5982ipilimumab\u7684\u4e00\u671f\u7814\u7a76\u3002\u7136\u800c\uff0c\u6700\u8fd1\u7684\u514d\u75ab\u7597\u6cd5\u4e00\u671f\u7814\u7a76\u7531\u4e8e\u5176\u6a21\u5757\u5316\u8bbe\u8ba1\u548c\u8fde\u7eed\u4fee\u8ba2\uff0c\u5df2\u5728\u591a\u4e2a\u6269\u5c55\u961f\u5217\u4e2d\u7eb3\u5165\u4e86\u8d85\u8fc71000\u540d\u60a3\u8005\u3002\u4ee5\u6297PD-1\u836f\u7269\u6d3e\u59c6\u5355\u6297\u7684\u5f00\u53d1\u4e3a\u4f8b\uff0c\u591a\u4e2aKeynote\u7814\u7a76\u4e2d\u8fd9\u79cd\u8303\u5f0f\u7684\u8f6c\u53d8\u5f97\u4ee5\u4f53\u73b0\u3002<\/p>\n

\u8003\u8651\u5230\u6700\u521d\u5728\u9ed1\u8272\u7d20\u7624\u548c\u975e\u5c0f\u7ec6\u80de\u80ba\u764c\uff08NSCLC\uff09\u60a3\u8005\u4e2d\u8fdb\u884c\u7684\u9996\u6b21\u4eba\u4f53\u4e00\u671f\u7814\u7a76\u4e2d\u89c2\u5bdf\u5230\u7684\u9ad8\u6548\u6d3b\u6027\uff0c\u7279\u522b\u4e3a\u8fd9\u4e9b\u80bf\u7624\u7c7b\u578b\u589e\u8bbe\u4e86\u4e13\u95e8\u961f\u5217\u3002\u8fd9\u4e9b\u961f\u5217\u4e0d\u4ec5\u65e8\u5728\u786e\u8ba4\u7814\u7a76\u836f\u7269\u7684\u5b89\u5168\u6027\u548c\u836f\u4ee3\u52a8\u529b\u5b66\uff08PK\uff09\u7279\u5f81\uff0c\u8fd8\u8981\u8bc4\u4f30\u5176\u7597\u6548\u2014\u2014\u8fd9\u662f\u4f20\u7edf\u4e8c\u671f\u8bd5\u9a8c\u7684\u7ec8\u70b9\u3002\u5728\u5bf9\u8fd9\u4e9b\u961f\u5217\u4e2d\u6570\u767e\u540d\u60a3\u8005\u8fdb\u884c\u6cbb\u7597\u540e\uff0c\u4e34\u5e8a\u7597\u6548\u7684\u786e\u8ba4\u4fc3\u6210\u4e86\u6d3e\u59c6\u5355\u6297\u57282013\u5e749\u6708\u9488\u5bf9\u4e0d\u53ef\u5207\u9664\u6216\u8f6c\u79fb\u6027\u9ed1\u8272\u7d20\u7624\u83b7\u5f97\u52a0\u901f\u6279\u51c6\uff0c\u4ee5\u53ca\u57282015\u5e7410\u6708\u9488\u5bf9\u8f6c\u79fb\u6027PD-L1\u9633\u6027NSCLC\u83b7\u5f97\u6279\u51c6\uff0c\u5206\u522b\u662f\u5728\u7b2c\u4e00\u4f4d\u60a3\u8005\u4f7f\u7528\u8be5\u836f\u7269\u6cbb\u75973\u5e74\u53ca5\u5e74\u540e\u7684\u7ed3\u679c\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u514d\u75ab\u7ec4\u7ec7\u5316\u5b66\u8f85\u52a9\u8bca\u65ad\u768422C3 PharmDx\u8bd5\u9a8c\u4e5f\u540c\u65f6\u83b7\u5f97\u6279\u51c6\uff0c\u8fd9\u8fdb\u4e00\u6b65\u9a8c\u8bc1\u4e86\u8be5\u836f\u7269\u5f00\u53d1\u6a21\u578b\u7684\u6210\u529f\u3002\u8fd9\u79cd\u201c\u7b2c\u4e00\u9636\u6bb5\u6ce8\u518c\u201d\u8bd5\u9a8c\u6a21\u5f0f\u4e0d\u4ec5\u52a0\u5feb\u4e86\u836f\u7269\u7684\u4e0a\u5e02\u8fdb\u7a0b\uff0c\u4e5f\u4e3a\u514d\u75ab\u7597\u6cd5\u63d0\u4f9b\u4e86\u4e00\u6761\u9ad8\u6548\u5feb\u6377\u7684\u4e34\u5e8a\u9a8c\u8bc1\u8def\u5f84\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8fd9\u79cd\u9002\u5e94\u6027\u8bbe\u8ba1\u76ee\u524d\u5728\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u6ede\u5242\u7684\u4e00\u671f\u8bd5\u9a8c\u4e2d\u5f97\u5230\u4e86\u5e7f\u6cdb\u5e94\u7528\uff0c\u4e0d\u4ec5\u53ef\u4ee5\u6269\u5c55\u5230\u9009\u5b9a\u7684\u80bf\u7624\u7c7b\u578b\uff0c\u8fd8\u53ef\u4ee5\u6d4b\u8bd5\u4e0e\u5171\u540c\u514d\u75ab\u6cbb\u7597\u4e3b\u5e72\u5e76\u884c\u7684\u591a\u79cd\u7ec4\u5408(Fig 32.2<\/span>)\u3002\u8fd9\u79cd\u65b9\u6cd5\u975e\u5e38\u503c\u5f97\u80af\u5b9a\uff0c\u56e0\u4e3a\u5b83\u5141\u8bb8\u5feb\u901f\u4e14\u9ad8\u6548\u7684\u836f\u7269\u5f00\u53d1\u3002\u4f8b\u5982\uff0c\u5f53\u524d\u7684MASTERKEY-265\u4e00\/\u4e09\u671f\u8bd5\u9a8c\u5c31\u662f\u8bc4\u4f30\u6eb6\u7624\u75c5\u6bd2(T-VEC)\u4e0e\u5e15\u535a\u5229\u73e0\u5355\u6297\u6ce8\u5c04\u6db2\u7ec4\u5408\u7684\u76f8\u5173\u6027\uff0c\u5c55\u793a\u4e86\u201c\u4e00\u671f\u6ce8\u518c\u8bd5\u9a8c\u201d\u6a21\u578b\u7684\u8fdb\u4e00\u6b65\u6f14\u5316\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7136\u800c\uff0c\u6211\u4eec\u5fc5\u987b\u8bb0\u4f4f\uff0c\u4e00\u671f\u8bd5\u9a8c\u7684\u4e3b\u8981\u76ee\u7684\u662f\u786e\u5b9a\u5728\u540e\u671f\u8bd5\u9a8c\u4e2d\u53ef\u4ee5\u5b89\u5168\u4f7f\u7528\u7684\u6700\u4f73\u5242\u91cf\u3002\u4e00\u65e6\u8fd9\u4e2a\u5242\u91cf\u88ab\u786e\u5b9a\uff0c\u5b83\u5f88\u5c11\u88ab\u91cd\u65b0\u8bc4\u4f30\u3002\u56e0\u6b64\uff0c\u5728\u5f00\u5c55\u65e8\u5728\u63a2\u7d22\u7597\u6548\u7684\u961f\u5217\u65f6\uff0c\u8fd9\u4e00\u76ee\u6807\u4e0d\u5e94\u88ab\u8fc7\u5feb\u5ffd\u7565\uff0c\u56e0\u4e3a\u8fd9\u53ef\u80fd\u4e0d\u7b26\u5408\u4f26\u7406\uff0c\u8ba9\u5927\u91cf\u60a3\u8005\u66b4\u9732\u4e8e\u6b21\u4f18\u5242\u91cf\u7684\u5b9e\u9a8c\u836f\u7269\u3002\u6b64\u5916\uff0c\u4e00\u65e6\u7eb3\u5165\u7684\u60a3\u8005\u6570\u91cf\u8d85\u8fc7\u4e86\u83b7\u53d6\u4ee4\u4eba\u6ee1\u610f\u7684\u5b89\u5168\u6027\u3001\u836f\u4ee3\u52a8\u529b\u5b66\uff08PK\uff09\u548c\u836f\u6548\u5b66\uff08PD\uff09\u6570\u636e\u6240\u9700\u7684\u4eba\u6570\uff0c\u8fd9\u79cd\u6269\u5927\u7684\u961f\u5217\u5e94\u6709\u660e\u786e\u7684\u9884\u5148\u89c4\u5b9a\u7684\u65e0\u7597\u6548\u505c\u6b62\u89c4\u5219\u3002\u6700\u540e\uff0c\u5e94\u5145\u5206\u5229\u7528\u8fd9\u4e9b\u961f\u5217\u7684\u7ed3\u679c\uff0c\u4ee5\u6700\u4f73\u65b9\u5f0f\u4e3a\u836f\u7269\u7684\u6ce8\u518c\u548c\u540e\u7eed\u7684\u5927\u578b\u968f\u673a\u8bd5\u9a8c\u505a\u597d\u51c6\u5907\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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<\/p>\n<\/section>\n<\/section>\n

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32.3 \u5176\u4ed6\u514d\u75ab\u7597\u6cd5\u53ca\u5176\u7279\u5f02\u6027:\u7cbe\u9009\u4f8b\u5b50<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u514d\u75ab\u7597\u6cd5\u7684\u7c7b\u578b\u6781\u5176\u4e30\u5bcc\uff0c\u5f53\u524d\u6fc0\u6d3b\u7684\u4e00\u671f\u8bd5\u9a8c\u6570\u91cf\u8d85\u8fc71500\u9879\uff0c\u8fd9\u4f7f\u5f97\u5168\u9762\u63cf\u7ed8\u6bcf\u4e00\u79cd\u7597\u6cd5\u7684\u72ec\u7279\u6027\u53d8\u5f97\u6781\u4e3a\u590d\u6742(Fig 32.5<\/span>)\u3002\u56e0\u6b64\uff0c\u5728\u6b64\uff0c\u6211\u4eec\u4e13\u6ce8\u4e8e\u4ecb\u7ecd\u4e09\u79cd\u514d\u75ab\u7597\u6cd5\u7684\u4f8b\u5b50\uff0c\u8fd9\u4e9b\u4f8b\u5b50\u4e0d\u4ec5\u5c55\u793a\u4e86\u4e0e\u5e38\u89c4\u9488\u5bf9\u514d\u75ab\u68c0\u67e5\u70b9\u7684\u6297\u4f53\u6cbb\u7597\u4e0d\u540c\u7684\u72ec\u7279\u53d1\u5c55\u8def\u5f84\uff0c\u5176\u4e2d\u4e24\u79cd\u7597\u6cd5\u6700\u8fd1\u5df2\u83b7\u6279\u51c6\u4f7f\u7528\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 32.5 \u514d\u75ab\u80bf\u7624\u5b66\uff08I-O\uff09\u7597\u6cd5\u7684\u4e00\u671f\u4e34\u5e8a\u8bd5\u9a8c\uff08\u6765\u6e90\uff1aClinicalTrials.gov\uff0c\u8bbf\u95ee\u65e5\u671f\uff1a2017\u5e741\u670810\u65e5\uff09\u3002\u6b64\u56fe\u4ec5\u5c55\u793a\u4e86\u4f7f\u7528\u5173\u952e\u8bcd\u201c\u6297\u764c\u7c7b\u201d\u548c\u201c\u764c\u75c7\u201d\u8fdb\u884c\u641c\u7d22\u7684\u4e00\u671f\u8bd5\u9a8c\u7ed3\u679c\uff0c\u5176\u4e2d\u201c\u6297\u764c\u7c7b\u201d\u6db5\u76d6\u4e86\u56fe\u4e2d\u8be6\u7ec6\u8bf4\u660e\u7684\u6bcf\u4e2a\u7597\u6cd5\u7c7b\u522b\u3002\u8fd9\u6837\u7684\u5206\u7c7b\u6709\u52a9\u4e8e\u66f4\u597d\u5730\u7406\u89e3\u5f53\u524d\u514d\u75ab\u7597\u6cd5\u8bd5\u9a8c\u7684\u5206\u5e03\u548c\u91cd\u70b9\u7814\u7a76\u9886\u57df\u3002<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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32.3.1 \u535a\u7eb3\u5410\u5355\u6297<\/p>\n<\/section>\n

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Blinatumomab\uff08Blincyto\u00ae\uff0c\u7531Amgen\u751f\u4ea7\uff09\u662f\u4e00\u79cd\u53cc\u7279\u5f02\u6027\u6297\u4f53\uff0c\u4e8e2014\u5e7412\u6708\u83b7\u5f97\u7f8e\u56fd\u98df\u54c1\u548c\u836f\u7269\u7ba1\u7406\u5c40\uff08FDA\uff09\u7684\u52a0\u901f\u6279\u51c6\uff0c\u7528\u4e8e\u6cbb\u7597\u8d39\u57ce\u67d3\u8272\u4f53\u9634\u6027\u7684\u590d\u53d1\u6216\u96be\u6cbb\u6027B\u7ec6\u80de\u524d\u4f53\u6025\u6027\u6dcb\u5df4\u7ec6\u80de\u767d\u8840\u75c5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Blinatumomab\u4f5c\u4e3a\u4e00\u79cd\u53cc\u7279\u5f02\u6027CD19\u9776\u5411CD3 T\u7ec6\u80de\u63a5\u5408\u5242\uff0c\u80fd\u591f\u6fc0\u6d3b\u8868\u8fbeCD19\u7684\u9776\u7ec6\u80de\u4e0a\u7684\u5185\u6e90\u6027T\u7ec6\u80de\u3002\u8fd9\u79cd\u836f\u7269\u7684\u7597\u6548\u548c\u5b89\u5168\u6027\u4e0e\u514d\u75ab\u68c0\u67e5\u70b9\u6297\u4f53\u6709\u663e\u8457\u5dee\u5f02\uff0c\u7279\u522b\u662f\u5728\u514d\u75ab\u7cfb\u7edf\u6fc0\u6d3b\u65b9\u9762\u3002\u9996\u5148\uff0c\u4e0e\u6cbb\u7597\u76f8\u5173\u7684\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff08irAEs\uff09\u9891\u53d1\u4e14\u4e25\u91cd\uff0c\u5176\u4e2d11%\u7684\u60a3\u8005\u51fa\u73b0\u4e86\u53ef\u80fd\u5371\u53ca\u751f\u547d\u7684\u7ec6\u80de\u56e0\u5b50\u91ca\u653e\u7efc\u5408\u5f81\u3002\u6b64\u5916\uff0c\u7ea6\u6709\u4e00\u534a\u7684\u60a3\u8005\u8868\u73b0\u51fa\u7279\u5b9a\u7684\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u6bd2\u6027\u53cd\u5e94\uff0c\u5305\u62ec\u5b9a\u5411\u969c\u788d\u3001\u62bd\u6410\u3001\u9707\u98a4\u548c\u8bed\u8a00\u969c\u788d\uff0c\u8fd9\u4e9b\u75c7\u72b6\u5728\u505c\u6b62\u6cbb\u7597\u540e\u901a\u5e38\u53ef\u9006\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u56e0\u6b64\uff0c\u8be5\u836f\u7269\u7684\u4ea7\u54c1\u6807\u7b7e\u4e2d\u5305\u542b\u4e86\u5173\u4e8e\u7ec6\u80de\u56e0\u5b50\u91ca\u653e\u7efc\u5408\u5f81\u548c\u795e\u7ecf\u6bd2\u6027\u7684\u8b66\u544a\uff0c\u5e76\u901a\u8fc7\u4e86\u98ce\u9669\u8bc4\u4f30\u4e0e\u7f13\u89e3\u7b56\u7565\uff08REMS\uff09\u8ba1\u5212\uff0c\u4ee5\u5411\u533b\u7597\u4fdd\u5065\u63d0\u4f9b\u8005\u901a\u62a5\u8fd9\u4e9b\u4e25\u91cd\u98ce\u9669\u53ca\u6f5c\u5728\u7684\u5236\u5907\u548c\u7ed9\u836f\u9519\u8bef\u3002\u5728\u6cbb\u7597\u7684\u521d\u671f\uff0c\u8f7b\u5ea6\u4f46\u9891\u7e41\u7684irAEs\uff08\u5982\u53d1\u70ed\u3001\u767d\u7ec6\u80de\u51cf\u5c11\u3001\u5bd2\u6218\u548cC\u53cd\u5e94\u86cb\u767d\u589e\u9ad8\uff09\u5e38\u89c1\uff0c\u4f46\u901a\u5e38\u968f\u7740\u6cbb\u7597\u7684\u6df1\u5165\u4f1a\u9010\u6e10\u51cf\u8f7b\u3002\u6b64\u5916\uff0c\u7814\u7a76\u89c2\u5bdf\u5230\u5242\u91cf\u6c34\u5e73\u4e0e\u6297\u80bf\u7624\u6d3b\u6027\u4e4b\u95f4\u5b58\u5728\u660e\u663e\u7684\u76f8\u5173\u6027\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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32.3.2 \u6eb6\u7624\u75c5\u6bd2 (T-VEC)<\/p>\n<\/section>\n

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\u8f6c\u57fa\u56e0\u6eb6\u7624\u75c5\u6bd2\u7597\u6cd5T-VEC\uff08Imlygic\u00ae\uff0cAmgen\uff09\u4e8e2015\u5e7410\u6708\u83b7\u5f97FDA\u6279\u51c6\uff0c\u7528\u4e8e\u6cbb\u7597\u590d\u53d1\u6027\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u4e0d\u53ef\u5207\u9664\u7684\u76ae\u80a4\u3001\u76ae\u4e0b\u548c\u6dcb\u5df4\u7ed3\u75c5\u53d8\u3002\u5728\u6700\u521d\u7684\u4e00\u671f\u7814\u7a76\u4e2d\uff0c\u4f7f\u7528\u7684OncoVEXGM-CSF\u7684\u6ce8\u5c04\u5242\u91cf\u9010\u6b65\u589e\u52a0\uff0c\u5bf9\u4e8e\u5355\u5242\u91cf\u6cbb\u7597\u540e\u4ecd\u4e3a\u8840\u6e05\u9634\u6027\u7684\u60a3\u8005\uff0c\u5242\u91cf\u9650\u5236\u5728107<\/sup> PFU\/mL\u3002\u7136\u800c\uff0c\u5bf9\u4e8e\u63a5\u53d7\u591a\u6b21\u5242\u91cf\u6cbb\u7597\u5e76\u8840\u6e05\u8f6c\u5316\u4e3a\u9633\u6027\u7684\u60a3\u8005\uff0c\u8fd9\u4e00\u5242\u91cf\u6700\u7ec8\u53ef\u4ee5\u589e\u52a0\u5230108<\/sup> PFU\/mL\u3002\u5728\u591a\u5242\u91cf\u7ec4\u4e2d\uff0c\u65e0\u6cd5\u786e\u5b9a\u6700\u5927\u8010\u53d7\u5242\u91cf\uff08MTD\uff09\u3002<\/p>\n

\u9664\u4e86\u6ce8\u5c04\u90e8\u4f4d\u53cd\u5e94\u5916\uff0cT-VEC\u89c2\u5bdf\u5230\u7684\u6700\u5e38\u89c1\u4e0d\u826f\u4e8b\u4ef6\u5305\u62ec\u75b2\u52b3\u3001\u53d1\u70ed\u3001\u53d1\u51b7\u548c\u6d41\u611f\u6837\u75c7\u72b6\uff0c\u8fd9\u4e9b\u901a\u5e38\u53d1\u751f\u5728\u6cbb\u7597\u7684\u524d\u4e09\u4e2a\u6708\uff0c\u4e00\u822c\u4e3a\u8f7b\u5ea6\u6216\u4e2d\u5ea6\uff0c\u5e76\u57283\u81f34\u5929\u5185\u6d88\u9000\u3002\u8fd9\u4e2a\u6848\u4f8b\u7279\u522b\u5f3a\u8c03\u4e86\u5728\u8bbe\u8ba1\u539f\u4f4d\u7ed9\u836f\u7684\u514d\u75ab\u7597\u6cd5\u65f6\uff0c\u9700\u8981\u8003\u8651\u4e25\u91cd\u5c40\u90e8\u6bd2\u6027\u3002\u5728\u6ca1\u6709\u5168\u8eab\u6bd2\u6027\u7684\u60c5\u51b5\u4e0b\uff0c\u8fd9\u4e9b\u6bd2\u6027\u4e5f\u53ef\u80fd\u6210\u4e3a\u5242\u91cf\u9650\u5236\u56e0\u7d20\uff0c\u5e76\u5e94\u88ab\u7eb3\u5165\u5242\u91cf\u9650\u5236\u6bd2\u6027\uff08DLT\uff09\u7684\u5b9a\u4e49\u4e2d\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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32.3.3 CAR-T\u7ec6\u80de\u7597\u6cd5<\/p>\n<\/section>\n

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\u5d4c\u5408\u6297\u539f\u53d7\u4f53T (CAR-T) \u7ec6\u80de\u7597\u6cd5\u662f\u4e00\u79cd\u9886\u5148\u7684\u764c\u75c7\u514d\u75ab\u7597\u6cd5\uff0c\u4f46\u5b83\u4f34\u968f\u7740\u4e00\u4e9b\u7279\u6709\u7684\u5b89\u5168\u6311\u6218\u3002\u8fd9\u79cd\u7597\u6cd5\u53ef\u80fd\u5bfc\u81f4\u6f5c\u5728\u81f4\u547d\u7684\u7ec6\u80de\u56e0\u5b50\u91ca\u653e\u7efc\u5408\u5f81\uff08CRS\uff09\uff0c\u4ee5\u53ca\u4e0e\u5176\u4ed6\u7279\u5b9a\u6bd2\u6027\u76f8\u5173\u7684\u75c5\u75c7\uff0c\u5982\u5de8\u566c\u7ec6\u80de\u6fc0\u6d3b\u7efc\u5408\u5f81\u548c\u566c\u8840\u7ec6\u80de\u6dcb\u5df4\u7ec4\u7ec7\u7ec6\u80de\u589e\u591a\u75c7\u3002\u8fd9\u4e9b\u95ee\u9898\u4fc3\u4f7f\u514d\u75ab\u5b66\u4e13\u5bb6\u5efa\u8bae\u4f7f\u7528\u975e\u7279\u5f02\u6027\u514d\u75ab\u6291\u5236\u5242\uff08\u5982\u76ae\u8d28\u7c7b\u56fa\u9187\uff09\u4ee5\u53ca\u9488\u5bf9IL-6\u53d7\u4f53\u7684\u6297\u4f53tocilizumab\uff08Actemra\u00ae\uff0cGenentech\uff09\u3002\u6b64\u5916\uff0c2014\u5e743\u6708\uff0c\u5728\u7ebd\u7ea6\u7eaa\u5ff5\u65af\u9686-\u51ef\u7279\u7433\u764c\u75c7\u4e2d\u5fc3\uff08MSKCC\uff09\u8fdb\u884c\u7684\u4e00\u4e9bCAR-T\u4e34\u5e8a\u8bd5\u9a8c\u5728\u53d1\u751f\u4e86\u51e0\u8d77\u4e0e\u8f93\u6db2\u76f8\u5173\u7684\u60a3\u8005\u6b7b\u4ea1\u4e8b\u4ef6\u540e\u88ab\u6682\u65f6\u4e2d\u6b62\u3002<\/p>\n

\u5c3d\u7ba1\u6709\u4e13\u5bb6\u5047\u8bbe\u8fd9\u4e9b\u6bd2\u6027\u4e8b\u4ef6\u662f\u836f\u7269\u53d1\u6325\u6700\u5927\u7597\u6548\u7684\u5fc5\u8981\u6761\u4ef6\uff0c\u4f46\u8fd9\u4e9b\u53cd\u5e94\u4f3c\u4e4e\u4e0e\u60a3\u8005\u7279\u5b9a\u7684\u53c2\u6570\uff08\u5982\u80bf\u7624\u8d1f\u8377\uff09\u66f4\u4e3a\u76f8\u5173\uff0c\u800c\u975e\u836f\u7269\u672c\u8eab\u3002\u56e0\u6b64\uff0c\u8bd5\u9a8c\u65b9\u6848\u8fdb\u884c\u4e86\u8c03\u6574\uff0c\u51cf\u5c11\u4e86\u80bf\u7624\u8d1f\u62c5\u8f83\u5927\u7684\u60a3\u8005\u7684\u5242\u91cf\uff0c\u5e76\u6392\u9664\u4e86\u90a3\u4e9b\u5728\u4e25\u91cdCRS\u60c5\u51b5\u4e0b\u65e0\u6cd5\u63a5\u53d7\u79ef\u6781\u652f\u6301\u6027\u62a4\u7406\u7684\u60a3\u8005\u3002<\/p>\n

CAR-T\u7ec6\u80de\u7597\u6cd5\u8fd8\u9762\u4e34\u5176\u4ed6\u6311\u6218\uff0c\u6bd4\u5982\u4e0e\u5065\u5eb7\u7ec4\u7ec7\u4e0a\u7684\u6b63\u5e38\u6297\u539f\u53d1\u751f\u4ea4\u53c9\u53cd\u5e94\u7684\u8131\u9776\u6548\u5e94\uff0c\u8fd9\u5728\u4e00\u4e9b\u60c5\u51b5\u4e0b\u5bfc\u81f4\u4e86\u81f4\u547d\u540e\u679c\u3002\u4f8b\u5982\uff0c\u9488\u5bf9\u9ed1\u8272\u7d20\u7624\u76f8\u5173\u6297\u539f3\uff08MAGE-3\uff09\u7684\u4eb2\u548c\u529b\u589e\u5f3a\u7684T\u7ec6\u80de\u53d7\u4f53\u4e0e\u6a2a\u7eb9\u808c\u4e0a\u7684\u4e00\u79cd\u975e\u76f8\u5173\u80bd\u2014\u2014\u808c\u80bd\u53d1\u751f\u4ea4\u53c9\u53cd\u5e94\uff0c\u5bfc\u81f4\u9996\u4e24\u540d\u63a5\u53d7\u6cbb\u7597\u7684\u60a3\u8005\u51fa\u73b0\u81f4\u547d\u7684\u5fc3\u6e90\u6027\u4f11\u514b\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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<\/p>\n<\/section>\n<\/section>\n

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32.4 \u8054\u5408\u6cbb\u7597<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8054\u5408\u6cbb\u7597\u7684\u76ee\u6807\u662f\u514b\u670d\u5bf9\u514d\u75ab\u7597\u6cd5\u7684\u539f\u53d1\u6027\u6216\u83b7\u5f97\u6027\u8010\u836f\uff0c\u6216\u5ef6\u957f\u6cbb\u7597\u7684\u53cd\u5e94\u65f6\u95f4\u3002\u9274\u4e8e\u8fd9\u4e00\u76ee\u6807\uff0c\u672c\u8282\u5c06\u91cd\u70b9\u8ba8\u8bba\u4f18\u5316\u514d\u75ab\u80bf\u7624\u5b66\uff08I-O\uff09\u7ec4\u5408\u5f00\u53d1\u7684\u5173\u952e\u6982\u5ff5\u3002\u514d\u75ab\u7cfb\u7edf\u662f\u4e00\u4e2a\u53d7\u5230\u4e25\u683c\u8c03\u63a7\u7684\u5e73\u8861\u7cfb\u7edf\uff0c\u9700\u8981\u7cbe\u786e\u7684\u8c03\u6574\u6765\u6709\u6548\u6fc0\u6d3b\uff0c\u540c\u65f6\u907f\u514d\u8fc7\u5ea6\u523a\u6fc0\uff0c\u8fd9\u53ef\u80fd\u5bfc\u81f4\u6162\u6027\u81ea\u8eab\u514d\u75ab\u6027\u75be\u75c5\u6216\u81f4\u547d\u7684\u6025\u6027\u5e76\u53d1\u75c7\u3002<\/p>\n

\u5728\u5f00\u53d1\u8054\u5408\u7597\u6cd5\u65f6\uff0c\u5fc5\u987b\u8003\u8651\u5230\u6240\u4f7f\u7528\u836f\u7269\u7684\u6027\u8d28\u3002\u5c06\u514d\u75ab\u836f\u7269\u4e0e\u975e\u514d\u75ab\u836f\u7269\uff08\u5305\u62ec\u7ec6\u80de\u6bd2\u6027\u836f\u7269\u3001\u9776\u5411\u7597\u6cd5\u6216\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\uff09\u7ed3\u5408\u4f7f\u7528\u5728\u8bb8\u591a\u60c5\u51b5\u4e0b\u662f\u53ef\u884c\u7684\uff0c\u5c24\u5176\u662f\u5728\u4e24\u79cd\u836f\u7269\u7684\u5168\u5242\u91cf\u4e0b\uff0c\u56e0\u4e3a\u5b83\u4eec\u9884\u671f\u5177\u6709\u6709\u9650\u7684\u91cd\u53e0\u6bd2\u6027\u6216\u836f\u7269\u4ee3\u8c22\u52a8\u529b\u5b66\uff08PK\uff09\u76f8\u4e92\u4f5c\u7528\u3002\u7136\u800c\uff0c\u5fc5\u987b\u683c\u5916\u8c28\u614e\u3002\u4f8b\u5982\uff0c\u5c3d\u7ba1\u67d0\u4e9b\u7ec4\u5408\u5728\u5168\u5242\u91cf\u4e0b\u7684\u7ec6\u80de\u6bd2\u7d20\u3001\u5c0f\u5206\u5b50\u6216\u9776\u5411\u8840\u7ba1\u751f\u6210\u7684\u6297\u4f53\u662f\u53ef\u884c\u7684\uff0c\u5176\u4ed6\u7ec4\u5408\u5219\u88ab\u8bc1\u660e\u662f\u4e0d\u53ef\u5bb9\u5fcd\u7684\uff0c\u5982\u8bc4\u4f30vemurafenib\u4e0eipilimumab\u8054\u5408\u6cbb\u7597\u9ed1\u8272\u7d20\u7624\u7684\u4e00\u671f\u8bd5\u9a8c\u56e0\u809d\u6bd2\u6027\u800c\u63d0\u524d\u7ec8\u6b62\u3002<\/p>\n

\u76f8\u6bd4\u4e4b\u4e0b\uff0c\u5728BRAF\u7a81\u53d8\u578b\u548c\u91ce\u751f\u578b\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u4e2d\uff0cdurvalumab\u53ef\u4e0e\u66f2\u7f8e\u66ff\u5c3c\u548c\/\u6216\u8fbe\u62c9\u6cd5\u975e\u5c3c\u5168\u5242\u91cf\u8054\u5408\u4f7f\u7528\u3002
<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5728\u4e24\u79cd\u514d\u75ab\u7597\u6cd5\u8054\u5408\u4f7f\u7528\u65f6\uff0c\u5982ipilimumab\u4e0enivolumab\u7684\u8054\u5408\uff0c\u5e38\u89c1\u7684\u9ad8\u53d1\u4e25\u91cd\u6bd2\u6027\u4e5f\u662f\u4e00\u5927\u6311\u6218\u3002\u7136\u800c\uff0c\u901a\u8fc7\u7279\u5b9a\u7684\u7ed9\u836f\u9014\u5f84\uff0c\u5c24\u5176\u662f\u539f\u4f4d\u514d\u75ab\u7b56\u7565\uff0c\u53ef\u4ee5\u5728\u964d\u4f4e\u6bd2\u6027\u7684\u540c\u65f6\u63d0\u9ad8\u7597\u6548\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u603b\u4f53\u800c\u8a00\uff0c\u5c06\u514d\u75ab\u7597\u6cd5\u4e0e\u5176\u4ed6\u514d\u75ab\u80bf\u7624\u836f\u7269\u7ed3\u5408\u7684\u53ef\u80fd\u6027\u662f\u5de8\u5927\u7684\uff0c\u76ee\u524d\u6709\u6570\u767e\u79cd\u7ec4\u5408\u6b63\u5728\u65e9\u671f\u8bd5\u9a8c\u9636\u6bb5\u8fdb\u884c\u63a2\u7d22(Fig 32.6<\/span>)\u3002\u8fd9\u79cd\u7ec4\u5408\u7684\u591a\u6837\u6027\u4e0d\u4ec5\u4f53\u73b0\u5728\u53ef\u8c03\u8282\u7684\u9776\u6807\u6570\u91cf\u4e0a\uff0c\u8fd8\u4f53\u73b0\u5728\u5242\u91cf\u7684\u591a\u6837\u6027\u3001\u7ed9\u836f\u9014\u5f84\u548c\u7ec4\u5408\u65f6\u95f4\u8868\u4e0a\u3002\u4f8b\u5982\uff0c\u8868\u89c2\u9057\u4f20\u836f\u7269\u53ef\u4ee5\u5728\u65e0\u6bd2\u5242\u91cf\u4e0b\u4f5c\u4e3a\u514d\u75ab\u8c03\u8282\u5242\u4f7f\u7528\uff0c\u4ece\u800c\u4e3a\u6cbb\u7597\u63d0\u4f9b\u65b0\u7684\u673a\u4f1a\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 32.6 <\/span>\u5c55\u793a\u4e86\u5f53\u524d\u6b63\u5728\u8fdb\u884c\u7684\u4e00\u671f\u8bd5\u9a8c\uff0c\u8fd9\u4e9b\u8bd5\u9a8c\u8bc4\u4f30\u8054\u5408\u6297PD-1\u6216\u6297PD-L1\u6cbb\u7597\u7684\u5b9e\u4f8b\u3002\u56fe\u4e2d\u663e\u793a\u4e86\u4e0e\u67d0\u4e9b\u6297PD-1\u6216\u6297PD-L1\u836f\u7269\u76f8\u5173\u7684\u4e3b\u8981\u9776\u70b9\u7c7b\u522b\uff0c\u5176\u4e2d\u7eff\u8272\u4ee3\u8868\u9776\u5411\u6cbb\u7597\uff0c\u6a59\u8272\u4ee3\u8868\u8868\u89c2\u9057\u4f20\u4fee\u9970\u5242\uff0c\u7d2b\u8272\u4ee3\u8868\u5e38\u89c4\u7ec6\u80de\u6bd2\u6027\u5316\u7597\uff0c\u84dd\u8272\u4ee3\u8868DNA\u4fee\u590d\u6291\u5236\u5242\uff0c\u6d45\u84dd\u8272\u4ee3\u8868\u514d\u75ab\u6cbb\u7597\uff0c\u7ea2\u8272\u4ee3\u8868\u6297\u539f\u6027\u836f\u7269\u3002\u865a\u7ebf\u8868\u793a\u4e09\u79cd\u4e0d\u540c\u6cbb\u7597\u7c7b\u522b\u4e0e\u6297PD-1\u6216\u6297PD-L1\u6cbb\u7597\u4e3b\u5e72\u7684\u5173\u8054\u3002<\/span>\u672c\u56fe\u53ea\u63cf\u8ff0\u4e86\u4e00\u90e8\u5206\u6b63\u5728\u8fdb\u884c\u7684\u8bd5\u9a8c\uff0c\u5b9e\u9645\u4e0a\u53ef\u80fd\u8fd8\u6709\u66f4\u591a\u76f8\u5173\u7684\u8bd5\u9a8c\u3002\u8fd9\u4e9b\u4fe1\u606f\u6765\u6e90\u4e8e2017\u5e741\u670814\u65e5\u8bbf\u95ee\u7684ClinicalTrials.gov\uff0c\u5176\u4e2d\u4ec5\u5305\u62ec\u6b63\u5728\u62db\u52df\u53c2\u4e0e\u8005\u7684\u4e00\u671f\u8bd5\u9a8c\u3002\u8fd9\u5f20\u56fe\u8868\u63d0\u4f9b\u4e86\u4e00\u4e2a\u5173\u4e8e\u8054\u5408\u514d\u75ab\u6cbb\u7597\u7b56\u7565\u7684\u5168\u9762\u6982\u89c8\uff0c\u5c55\u793a\u4e86\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u5982\u4f55\u4e0e\u591a\u79cd\u4e0d\u540c\u7c7b\u578b\u7684\u6cbb\u7597\u65b9\u6cd5\u7ed3\u5408\uff0c\u65e8\u5728\u63d0\u9ad8\u7597\u6548\u548c\u63a2\u7d22\u65b0\u7684\u6cbb\u7597\u6f5c\u529b\u3002<\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u514d\u75ab\u80bf\u7624\u5b66\uff08I-O\uff09\u7597\u6cd5\u7684\u51fa\u73b0\u5f15\u53d1\u4e86\u836f\u7269\u5f00\u53d1\u8303\u5f0f\u7684\u8f6c\u53d8\u3002\u663e\u800c\u6613\u89c1\uff0c\u4f20\u7edf\u7684\u4e00\u671f\u8bd5\u9a8c\u6a21\u5f0f\u5e76\u4e0d\u5b8c\u5168\u9002\u5408\u8fd9\u7c7b\u65b0\u5174\u7597\u6cd5\u3002\u56e0\u6b64\uff0c\u65e9\u671f\u8bd5\u9a8c\u8bbe\u8ba1\u5fc5\u987b\u9002\u5e94\u5e76\u4e0d\u65ad\u5237\u65b0\u601d\u8def\uff0c\u4ee5\u4fbf\u66f4\u6709\u6548\u5730\u5e94\u5bf9\u8fd9\u4e9b\u7597\u6cd5\u6240\u5e26\u6765\u7684\u5177\u4f53\u6311\u6218\u3002\u8fd9\u4e9b\u6311\u6218\u4e0d\u4ec5\u5305\u62ec\u4f20\u7edf\u7684\u4e00\u671f\u7ec8\u70b9\u2014\u2014\u5982\u5b89\u5168\u6027\u3001\u6bd2\u6027\u8bc4\u4f30\u4e0e\u7ba1\u7406\u3001\u5242\u91cf\u5efa\u8bae\u3001\u836f\u4ee3\u52a8\u529b\u5b66\/\u836f\u6548\u5b66\uff08PK\/PD\uff09\u7279\u6027\u53ca\u521d\u6b65\u6d3b\u6027\u2014\u2014\u8fd8\u6d89\u53ca\u5230\u4f34\u968f\u751f\u7269\u6807\u5fd7\u7269\u7684\u5f00\u53d1\u3001\u7597\u6548\u8bc4\u4f30\u548c\u6f5c\u5728\u7684\u836f\u7269\u6ce8\u518c\u3002<\/p>\n

\u65e9\u671f\u4e34\u5e8a\u8bd5\u9a8c\u5fc5\u987b\u8fc5\u901f\u9002\u5e94\u4e34\u5e8a\u548c\u79d1\u5b66\u7684\u53d8\u5316\uff0c\u5e76\u51c6\u5907\u597d\u9762\u5bf9\u8fd9\u4e9b\u5b9e\u9645\u6311\u6218\u3002\u9274\u4e8e\u53c2\u4e0e\u4e2d\u5fc3\u6570\u91cf\u7684\u589e\u52a0\uff0c\u786e\u4fdd\u53c2\u4e0e\u836f\u7269\u5f00\u53d1\u7684\u6240\u6709\u7814\u7a76\u8005\u3001\u533b\u7597\u76d1\u7ba1\u8005\u548c\u79d1\u5b66\u5bb6\u4e4b\u95f4\u8fdb\u884c\u6700\u4f73\u6c9f\u901a\u81f3\u5173\u91cd\u8981\uff0c\u4ee5\u4fbf\u53ca\u65f6\u4e14\u5e7f\u6cdb\u5730\u5171\u4eab\u76f8\u5173\u7684\u5b89\u5168\u4fe1\u606f\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u6b64\u5916\uff0c\u9274\u4e8eI-O\u7279\u6709\u7684\u5b89\u5168\u6027\u95ee\u9898\uff0c\u4e00\u671f\u8bd5\u9a8c\u534f\u8bae\u4e2d\u5e94\u660e\u786e\u5b9e\u65bd\u6709\u5173\u6bd2\u6027\u7ba1\u7406\u7684\u7b97\u6cd5\uff0c\u5e76\u5c3d\u53ef\u80fd\u63d0\u9ad8\u62a5\u544a\u7684\u8d28\u91cf\u3002\u8fd9\u4e00\u70b9\u5c24\u5176\u91cd\u8981\uff0c\u56e0\u4e3a\u4e00\u4e9b\u7814\u7a76\u4eba\u5458\u53ef\u80fd\u5bf9\u8fd9\u4e9b\u6bd2\u6027\u4e0d\u592a\u719f\u6089\uff0c\u8003\u8651\u5230I-O\u7597\u6cd5\u5728\u4e34\u5e8a\u4e0a\u7684\u5e7f\u6cdb\u5e94\u7528\u662f\u8fd1\u671f\u624d\u5f00\u59cb\u7684\uff0c\u5e76\u4e14\u5176\u5e94\u7528\u901f\u5ea6\u524d\u6240\u672a\u6709\u3002\u6700\u540e\uff0c\u4efb\u4f55\u65b9\u6848\u7684\u4fee\u6539\u90fd\u5e94\u57fa\u4e8e\u53ef\u9760\u7684\u4e34\u5e8a\u6570\u636e\u6216\u79d1\u5b66\u5047\u8bbe\u3002<\/p>\n

\u5728\u514d\u75ab\u80bf\u7624\u5b66\u7684\u65e9\u671f\u836f\u7269\u5f00\u53d1\u4e2d\uff0c\u6211\u4eec\u6b63\u5904\u5728\u4e00\u4e2a\u6fc0\u52a8\u4eba\u5fc3\u7684\u65f6\u4ee3\u3002\u9ad8\u6c34\u5e73\u7684\u4e34\u5e8a\u3001\u79d1\u5b66\u548c\u4f26\u7406\u4e25\u683c\u6027\u5c06\u6709\u52a9\u4e8e\u6210\u529f\u5730\u4f18\u5316\u548c\u52a0\u901f\u836f\u7269\u7684\u5f00\u53d1\u8fc7\u7a0b\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u672c\u6587\u7531Oncolab\u5fae\u4fe1\u516c\u4f17\u53f7\u7ffb\u8bd1\u6574\u7406\u81eaOncoimmunology: A Practical Guide for Cancer Immunotherapy\uff0c\u4ec5\u7528\u4e8e\u5b66\u4e60\u4ea4\u6d41\u4f7f\u7528\uff0c\u5982\u9700\u8d2d\u4e70\u539f\u7248\u4e66\u7c4d\u53ef\u70b9\u51fb\u9605\u8bfb\u539f\u6587\u8d2d\u4e70\u3002<\/span>
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\u2014 THE  END \u2014<\/span><\/p>\n


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\u6765\u6e90 | Oncoimmunology: A Practical Guide <\/span><\/p>\n

for Cancer Immunotherapy<\/span><\/p>\n

\u521d\u7a3f\u7ffb\u8bd1 | \u51bc\u91d1\u6b22<\/span><\/p>\n

\u56fe\u6587\u6392\u7248 | \u6f58\u541b\u541b<\/span><\/span><\/p>\n

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\uff08\u8f6c\u8f7d\u8bf7\u4fdd\u7559\u6b64\u90e8\u5206\u5185\u5bb9\uff09<\/span><\/strong><\/p>\n

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\u80bf\u7624\u514d\u75ab\u5b66\u7cfb\u5217<\/span><\/a><\/p>\n

ACIR\u6587\u732e\u901f\u9012<\/span><\/a><\/p>\n

SCI\u8bba\u6587\u4f5c\u56fe<\/span><\/a><\/p>\n

SCI\u8bba\u6587\u5199\u4f5c\u53ca\u6295\u7a3f<\/span><\/a><\/p>\n

\u751f\u4fe1\u5165\u95e8\u5b66\u4e60\u7b14\u8bb0<\/span><\/a><\/p>\n

R\u8bed\u8a00\u57fa\u7840\u4e0e\u5355\u7ec6\u80de\u5206\u6790\u5b9e\u6218\u89c6\u9891\u8bfe\u7a0b<\/span><\/a><\/p>\n

\u751f\u7269\u5b66\u5b9e\u9a8c\u6280\u672f\u53ca\u5e38\u7528\u8f6f\u4ef6<\/span><\/a><\/p>\n

RCIM\u4eea\u5668\u7b80\u4ecb\u53ca\u64cd\u4f5c\u89c6\u9891<\/a><\/span><\/p>\n

\u5e38\u7528\u7535\u8111\u8f6f\u4ef6\u4f7f\u7528\u6559\u7a0b<\/a><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u70b9\u4eae\u8d5e\u4e0e\u5728\u770b <\/span><\/p>\n

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\u672c\u7bc7\u6587\u7ae0\u6765\u6e90\u4e8e\u5fae\u4fe1\u516c\u4f17\u53f7: OncoLab <\/p>\n<\/blockquote>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

\u4e0a\u671f\u5185\u5bb9\uff1a\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c32\u7ae0\uff1a1\u671f\u8bd5\u9a8c\u4e2d\u7684\u514d\u75ab\u7597\u6cd5\uff08\u4e0a\uff09 32.2.6 \u53cd\u5e94\u53ca\u7597\u6548\u8bc4\u4ef7 \u514d\u75ab\u7597\u6cd5\u7684\u4f5c\u7528\u673a\u5236\u72ec…<\/p>\n","protected":false},"author":1,"featured_media":3617,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[65],"tags":[],"_links":{"self":[{"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts\/3621"}],"collection":[{"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/comments?post=3621"}],"version-history":[{"count":0,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts\/3621\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/media\/3617"}],"wp:attachment":[{"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/media?parent=3621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/categories?post=3621"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/oncolab.cn\/index.php\/wp-json\/wp\/v2\/tags?post=3621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}