{"id":3629,"date":"2024-08-06T07:00:08","date_gmt":"2024-08-05T23:00:08","guid":{"rendered":"http:\/\/oncolab.cn\/index.php\/2024\/08\/06\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac33%e7%ab%a0-%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%89%82%e6%b2%bb%e7%96%97%e7%99%8c%e7%97%87%e7%9a%84%e5%89%af-2\/"},"modified":"2024-08-06T07:00:08","modified_gmt":"2024-08-05T23:00:08","slug":"%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac33%e7%ab%a0-%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%89%82%e6%b2%bb%e7%96%97%e7%99%8c%e7%97%87%e7%9a%84%e5%89%af-2","status":"publish","type":"post","link":"http:\/\/oncolab.cn\/index.php\/2024\/08\/06\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac33%e7%ab%a0-%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%89%82%e6%b2%bb%e7%96%97%e7%99%8c%e7%97%87%e7%9a%84%e5%89%af-2\/","title":{"rendered":"\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c33\u7ae0 \u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u764c\u75c7\u7684\u526f\u4f5c\u7528\uff08\u4e0b\uff09"},"content":{"rendered":"
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\u4e0a\u671f\u5185\u5bb9\uff1a\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c33\u7ae0 \u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u764c\u75c7\u7684\u526f\u4f5c\u7528\uff08\u4e0a\uff09<\/span><\/a><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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

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33.5 \u5668\u5b98\u7279\u5f02\u6027\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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33.5.3 \u5185\u5206\u6ccc\u6bd2\u6027<\/p>\n<\/section>\n

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\u5728\u63a5\u53d7\u6297CTLA-4\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u5927\u7ea610%\u4f1a\u51fa\u73b0\u663e\u8457\u7684\u5185\u5206\u6ccc\u7cfb\u7edf\u7d0a\u4e71\u3002\u5c3c\u4f0f\u5355\u6297\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c14%\u51fa\u73b0\u5185\u5206\u6ccc\u969c\u788d\uff0c\u5176\u4e2d2%\u7684\u60a3\u8005\u7ecf\u5386\u4e863-4\u7ea7\u7684\u4e25\u91cd\u4e8b\u4ef6\u3002\u5728\u8054\u5408\u514d\u75ab\u7597\u6cd5\u4e2d\uff0c\u4e0d\u52305%\u7684\u60a3\u8005\u51fa\u73b0\u4e863-4\u7ea7\u7684\u5185\u5206\u6ccc\u6bd2\u6027\u53cd\u5e94\u3002\u8fd9\u4e9b\u5185\u5206\u6ccc\u6bd2\u6027\u901a\u5e38\u6d89\u53ca\u7532\u72b6\u817a\u3001\u5782\u4f53\u6216\u80be\u4e0a\u817a\u7684\u708e\u75c7\uff0c\u5e38\u56e0\u5176\u8868\u73b0\u4e3a\u75b2\u52b3\u3001\u6076\u5fc3\u3001\u5934\u75db\u548c\u89c6\u89c9\u53d8\u5316\u7b49\u975e\u7279\u5f02\u6027\u75c7\u72b6\u800c\u96be\u4ee5\u53ca\u65f6\u8bc6\u522b\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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33.5.3.1 \u7532\u72b6\u817a\u6bd2\u6027<\/p>\n<\/section>\n

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\u7532\u72b6\u817a\u6bd2\u6027\u53ef\u80fd\u8868\u73b0\u4e3a\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\u6216\u4ea2\u8fdb\u3002\u5728\u63a5\u53d7\u6297PD-1\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u7532\u72b6\u817a\u529f\u80fd\u4ea2\u8fdb\u8f83\u4e3a\u5e38\u89c1\uff0c\u901a\u5e38\u4e0e\u6291\u5236\u7684\u4fc3\u7532\u72b6\u817a\u6fc0\u7d20\uff08TSH\uff09\u76f8\u5173\uff0c\u8868\u73b0\u4e3a\u6e38\u79bb\u7532\u72b6\u817a\u6fc0\u7d20\u6c34\u5e73\u5347\u9ad8\uff0c\u75c7\u72b6\u8f7b\u5fae\uff0c\u9700\u901a\u8fc7\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u6765\u8bca\u65ad\u3002\u7532\u72b6\u817a\u529f\u80fd\u4ea2\u8fdb\u6709\u65f6\u4f1a\u8f6c\u53d8\u4e3a\u6865\u672c\u6c0f\u7532\u72b6\u817a\u708e\uff0c\u4f34\u968f\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\u3002\u5728\u6297CTLA-4\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u65e0\u65e2\u5f80\u7532\u4ea2\u75c5\u53f2\u7684\u6865\u672c\u6c0f\u7532\u72b6\u817a\u708e\u66f4\u4e3a\u5e38\u89c1\uff0c\u75c5\u60c5\u901a\u5e38\u7f13\u6162\u8fdb\u5c55\uff0c\u75c7\u72b6\u9010\u6e10\u663e\u73b0\u3002\u4e0d\u8fc7\uff0c\u4e5f\u6709\u62a5\u9053\u6307\u51fa\uff0c\u6025\u6027\u8d77\u75c5\u7684\u9ecf\u6db2\u6c34\u80bf\u7684\u4e25\u91cd\u75c5\u4f8b\u3002\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u901a\u5e38\u4f1a\u53d1\u73b0TSH\u3001\u6e38\u79bb\u7532\u72b6\u817a\u6fc0\u7d20\u964d\u4f4e\uff0c\u4ee5\u53ca\u7532\u72b6\u817a\u81ea\u8eab\u514d\u75ab\u6807\u5fd7\u7269\uff08\u5982\u6297\u7532\u72b6\u817a\u7403\u86cb\u767d\u548c\u6297\u7532\u72b6\u817a\u8fc7\u6c27\u5316\u7269\u9176\u6297\u4f53\uff09\u7684\u5347\u9ad8\u3002\u6cbb\u7597\u4e3b\u8981\u662f\u4f7f\u7528\u5de6\u7532\u72b6\u817a\u7d20\uff08L-thyroxine\uff09\u4f5c\u4e3a\u7532\u72b6\u817a\u6fc0\u7d20\u7684\u66ff\u4ee3\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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33.5.3.2 \u4e0b\u5782\u4f53\u708e<\/p>\n<\/section>\n

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\u5782\u4f53\u708e\u7684\u53d1\u751f\u9891\u7387\u5dee\u5f02\u8f83\u5927\uff0c\u62a5\u544a\u8303\u56f4\u4ece0%\u81f325%\uff0c\u5e73\u5747\u53d1\u751f\u7387\u7ea6\u4e3a4%\uff0c\u4e14\u6b64\u72b6\u51b5\u5728\u7537\u6027\u4e2d\u66f4\u4e3a\u5e38\u89c1\u3002\u5782\u4f53\u708e\u4e3b\u8981\u51fa\u73b0\u5728\u63a5\u53d7\u6297CTLA-4\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u800c\u6297PD-1\u6cbb\u7597\u7684\u60a3\u8005\u5219\u6781\u5c11\u89c1\u3002\u8fd9\u79cd\u5dee\u5f02\u53ef\u80fd\u6e90\u4e8eCTLA-4\u4e0ePD-1\u5728\u7ec4\u7ec7\u4e2d\u7684\u4e0d\u540c\u8868\u8fbe\u6a21\u5f0f\u3002\u6709\u5047\u8bbe\u6307\u51fa\uff0c\u6297CTLA-4\u6297\u4f53\u53ef\u80fd\u4e0e\u5782\u4f53\u5185\u5206\u6ccc\u7ec6\u80de\u8868\u9762\u5f02\u4f4d\u8868\u8fbe\u7684CTLA-4\u7ed3\u5408\uff0c\u4ece\u800c\u5f15\u8d77\u5782\u4f53\u6bd2\u6027\u3002\u8fd9\u7c7b\u4e8b\u4ef6\u901a\u5e38\u5728\u6cbb\u7597\u540e6\u81f38\u5468\u51fa\u73b0\u3002<\/p>\n

\u5782\u4f53\u708e\u7684\u521d\u671f\u75c7\u72b6\u5305\u62ec\u75b2\u52b3\u548c\u4f4e\u8840\u538b\u3002\u5728\u66f4\u4e25\u91cd\u7684\u60c5\u51b5\u4e0b\uff0c\u53ef\u80fd\u51fa\u73b0\u4e0e\u5782\u4f53\u8f74\u8870\u7aed\u76f8\u5173\u7684\u75c7\u72b6\uff0c\u5982\u5934\u75db\u3001\u89c6\u529b\u4e0b\u964d\u548c\u590d\u89c6\u7b49\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u78c1\u5171\u632f\u6210\u50cf\uff08MRI\uff09\u68c0\u67e5\u901a\u5e38\u53ef\u89c1\u8111\u4e0b\u5782\u4f53\u4f53\u79ef\u589e\u5927\uff0c\u4f34\u6709\u660e\u663e\u4e14\u5747\u5300\u7684\u5bf9\u6bd4\u589e\u5f3a\u3002<\/p>\n

\u4e00\u79cd\u4e25\u91cd\u7684\u5e76\u53d1\u75c7\u662f\u80be\u4e0a\u817a\u5371\u8c61\uff0c\u5982\u672a\u53ca\u65f6\u8bca\u6cbb\uff0c\u53ef\u80fd\u5bfc\u81f4\u4e25\u91cd\u751a\u81f3\u81f4\u547d\u540e\u679c\u3002\u76f8\u5173\u75c7\u72b6\u5305\u62ec\u75b2\u52b3\u3001\u865a\u5f31\u3001\u538c\u98df\u3001\u4f53\u91cd\u51cf\u8f7b\u3001\u6076\u5fc3\u3001\u5455\u5410\u548c\u4f4e\u8840\u538b\u3002\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u901a\u5e38\u663e\u793a\u5faa\u73af\u4e2d\u7684\u76ae\u8d28\u9187\u548c\u4fc3\u80be\u4e0a\u817a\u76ae\u8d28\u6fc0\u7d20\uff08ACTH\uff09\u6c34\u5e73\u964d\u4f4e\uff0c\u4ee5\u53ca\u964d\u4f4e\u7684\u5c3f\u76ae\u8d28\u9187\u6392\u6cc4\u91cf\uff0c\u5e38\u4f34\u6709\u5375\u6ce1\u523a\u6fc0\u7d20\uff08FSH\uff09\u3001\u4fc3\u9ec4\u4f53\u751f\u6210\u7d20\uff08LH\uff09\u548cTSH\u7684\u51cf\u5c11\uff0c\u8868\u660e\u4e2d\u67a2\u6027\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5bf9\u4e8e\u8868\u73b0\u51fa\u4e25\u91cd\u7fa4\u4f53\u6548\u5e94\u7684\u60a3\u8005\uff0c\u5982\u6709\u4e25\u91cd\u5934\u75db\u548c\u89c6\u89c9\u969c\u788d\uff0c\u53ef\u4ee5\u8003\u8651\u4f7f\u7528\u5927\u5242\u91cf\u7cd6\u76ae\u8d28\u6fc0\u7d20\u3002\u5bf9\u4e8eACTH\u7f3a\u4e4f\u7684\u60a3\u8005\uff0c\u5e94\u4f7f\u7528\u751f\u7406\u66ff\u4ee3\u5242\u91cf\u7684\u6fc0\u7d20\u6cbb\u7597\uff0c\u56e0\u4e3a\u4f7f\u7528\u836f\u7269\u6027\u7cd6\u76ae\u8d28\u6fc0\u7d20\u5e76\u672a\u660e\u663e\u6539\u5584\u8fd9\u4e9b\u60a3\u8005\u7684\u9884\u540e\u3002\u5982\u679c\u51fa\u73b03-4\u7ea7\u6bd2\u6027\uff0c\u5e94\u6682\u505c\u6216\u6c38\u4e45\u505c\u6b62\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u6297PD-1\u548c\u6297CTLA-4\u6cbb\u7597\u90fd\u662fI\u578b\u7cd6\u5c3f\u75c5\u98ce\u9669\u589e\u52a0\u7684\u91cd\u8981\u56e0\u7d20\u3002\u5728\u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u7cd6\u5c3f\u75c5\u7684\u53d1\u75c5\u7387\u7ea6\u4e3a8%\u3002\u5bf9\u4e8e3\u7ea7\u9ad8\u8840\u7cd6\u7684\u60a3\u8005\uff0c\u5e94\u6682\u505c\u4f7f\u7528\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\uff0c\u800c4\u7ea7\u6bd2\u6027\u60a3\u8005\u5219\u9700\u6c38\u4e45\u505c\u7528\u6cbb\u7597\u3002\u8fd9\u79cd\u60c5\u51b5\u4e0b\u4e0d\u63a8\u8350\u4f7f\u7528\u76ae\u8d28\u7c7b\u56fa\u9187\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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33.5.4 \u809d\u6bd2\u6027<\/p>\n<\/section>\n

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\u809d\u6bd2\u6027\u5728\u63a5\u53d7\u514d\u75ab\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u76f8\u5bf9\u8f83\u5c11\u89c1\uff0c\u901a\u5e38\u53d1\u751f\u7387\u4e0d\u8d85\u8fc710%\u3002\u4f8b\u5982\uff0c\u5728\u63a5\u53d7\u4f0a\u5339\u5355\u62973mg\/kg\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c2%\u4f1a\u51fa\u73b0\u4e25\u91cd\u6216\u751f\u547d\u5a01\u80c1\u6027\u7684\u809d\u6bd2\u6027\uff1b\u63a5\u53d7\u5c3c\u4f0f\u5355\u6297\u5355\u836f\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u6240\u6709\u7ea7\u522b\u809d\u708e\u7684\u53d1\u751f\u7387\u4e3a2.3%\u3002\u7136\u800c\uff0c\u5728\u63a5\u53d7\u4f0a\u5339\u5355\u6297\u4e0e\u5c3c\u4f0f\u5355\u6297\u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u8fd9\u4e00\u6bd4\u4f8b\u663e\u8457\u5347\u9ad8\u81f313%\u3002\u809d\u6bd2\u6027\u7684\u5178\u578b\u65e0\u75c7\u72b6\u8868\u73b0\u662f\u8f6c\u6c28\u9176\u6c34\u5e73\u5347\u9ad8\uff0c\u800c\u603b\u80c6\u7ea2\u7d20\u901a\u5e38\u8f83\u665a\u51fa\u73b0\u5f02\u5e38\uff0c\u4e14\u6076\u5316\u60c5\u51b5\u4e0d\u5e38\u89c1\u3002\u809d\u6bd2\u6027\u4e00\u822c\u5728\u6cbb\u7597\u5f00\u59cb\u540e8\u81f312\u5468\u5185\u51fa\u73b0\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5c3d\u7ba1\u4e34\u5e8a\u8bd5\u9a8c\u901a\u5e38\u6392\u9664\u6709\u4e59\u809d\u548c\u4e19\u809d\u75c5\u53f2\u7684\u60a3\u8005\uff0c\u8fd9\u4e9b\u60a3\u8005\u5728\u5b9e\u9645\u4e34\u5e8a\u4e2d\u4ecd\u4f1a\u63a5\u53d7\u6cbb\u7597\u3002\u73b0\u6709\u7684\u6570\u636e\u8868\u660e\uff0c\u65e2\u5f80\u75c5\u6bd2\u6027\u809d\u708e\u4f3c\u4e4e\u4e0d\u4f1a\u589e\u52a0\u60a3\u8005\u53d1\u5c55\u809d\u6bd2\u6027\u7684\u98ce\u9669\u3002\u56e0\u6b64\uff0c\u5728\u5f00\u59cb\u4f7f\u7528\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u524d\uff0c\u5fc5\u987b\u8bc4\u4f30\u60a3\u8005\u7684\u809d\u529f\u80fd\u548c\u4e59\u578b\u6216\u4e19\u578b\u809d\u708e\u75c5\u6bd2\u6807\u5fd7\u7269\u3002\u5bf9\u4e8e\u6240\u6709HBsAg\u9633\u6027\u7684\u60a3\u8005\uff0c\u5982\u6709\u9ad8\u75c5\u6bd2\u8f7d\u91cf\uff08HBV DNA\uff09\uff0c\u53ef\u80fd\u9700\u8981\u65e9\u671f\u542f\u52a8\u6297\u75c5\u6bd2\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5bf9\u4e8e\u51fa\u73b01\u7ea7\u809d\u6bd2\u6027\uff08\u5373\u65e0\u75c7\u72b6\u7684\u8f6c\u6c28\u9176\u6216\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7\u5347\u9ad8\uff09\u7684\u60a3\u8005\uff0c\u53ef\u7ee7\u7eed\u6cbb\u7597\u5e76\u76d1\u6d4b\u809d\u529f\u80fd\uff0c\u76f4\u81f3\u75c7\u72b6\u7f13\u89e3\u30022\u7ea7\u6bd2\u6027\u4e8b\u4ef6\u5219\u9700\u8981\u6682\u505c\u514d\u75ab\u6cbb\u7597\uff0c\u76f4\u5230\u95ee\u9898\u5f97\u5230\u89e3\u51b3\uff0c\u5e76\u53ef\u4f7f\u7528\u53e3\u670d\u6cfc\u5c3c\u677e1mg\/kg\/\u5929\u8fdb\u884c\u6cbb\u7597\u3002\u5bf9\u4e8e\u53d1\u751f3-4\u7ea7\u809d\u6bd2\u6027\u4e8b\u4ef6\u7684\u60a3\u8005\uff0c\u5e94\u6c38\u4e45\u505c\u6b62\u76f8\u5173\u514d\u75ab\u6cbb\u7597\uff0c\u5e76\u5efa\u8bae\u4f7f\u7528\u5927\u5242\u91cf\u9759\u8109\u6ce8\u5c04\u7cd6\u76ae\u8d28\u6fc0\u7d20\uff08\u4f8b\u5982\u7532\u6cfc\u5c3c\u9f992mg\/kg\/\u5929\uff09\u3002\u5982\u679c\u572848\u5c0f\u65f6\u540e\u809d\u9176\u6c34\u5e73\u4ecd\u672a\u964d\u4f4e\uff0c\u5efa\u8bae\u6bcf12\u5c0f\u65f6\u53e3\u670d\u9709\u915a\u9178500mg\u3002\u5982\u679c\u5728\u63a5\u4e0b\u6765\u76845\u81f37\u5929\u5185\u4ecd\u65e0\u6539\u5584\uff0c\u53ef\u8003\u8651\u4f7f\u7528\u4ed6\u514b\u83ab\u53f8\uff0c\u5242\u91cf\u4e3a0.10-0.15 mg\/kg\/day\u3002\u7531\u4e8e\u82f1\u592b\u5229\u6614\u5355\u6297\u5177\u6709\u6f5c\u5728\u7684\u809d\u6bd2\u6027\uff0c\u901a\u5e38\u4e0d\u63a8\u8350\u4f7f\u7528\u6b64\u836f\u7269\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.5 \u80ba\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u5728\u63a5\u53d7nivolumab\u6216pembrolizumab\u6cbb\u7597\u7684\u975e\u5c0f\u7ec6\u80de\u80ba\u764c\uff08NSCLC\uff09\u60a3\u8005\u4e2d\uff0c\u5927\u7ea65-7%\u7684\u60a3\u8005\u51fa\u73b0\u4e863\u7ea7\u6216\u66f4\u9ad8\u7ea7\u522b\u7684\u80ba\u708e\u3002\u76f8\u6bd4\u4e4b\u4e0b\uff0c\u63a5\u53d7ipilimumab\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u6709\u75c7\u72b6\u7684\u80ba\u708e\u53d1\u751f\u7387\u4ec5\u4e3a1%\u3002\u5728\u5c3c\u9c81\u5355\u6297\u548c\u4f0a\u5339\u5355\u6297\u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u7ea67%\u60a3\u6709\u80ba\u708e\uff0c\u4e14\u5176\u4e2d\u53ea\u67091%\u7684\u60a3\u8005\u75c7\u72b6\u8fbe\u52303-4\u7ea7\u4e25\u91cd\u7a0b\u5ea6\u3002\u6839\u636e\u6700\u8fd1\u7684\u4e00\u9879\u7cfb\u7edf\u7efc\u8ff0\u548c\u835f\u8403\u5206\u6790\uff0cPD-1\u6291\u5236\u5242\u5355\u836f\u6cbb\u7597\u671f\u95f4\uff0c\u6240\u6709\u7ea7\u522b\u7684\u80ba\u708e\u603b\u53d1\u75c5\u7387\u4e3a2.7%\uff0895%\u7f6e\u4fe1\u533a\u95f4\uff1a1.9-3.6%\uff09\uff0c\u800c3\u7ea7\u6216\u66f4\u9ad8\u7ea7\u522b\u7684\u80ba\u708e\u603b\u53d1\u75c5\u7387\u4e3a0.8%\uff0895%\u7f6e\u4fe1\u533a\u95f4\uff1a0.4-1.2%\uff09\u3002\u4e0e\u9ed1\u7d20\u7624\u60a3\u8005\u76f8\u6bd4\uff0cNSCLC\u60a3\u8005\u5728\u6240\u6709\u7ea7\u522b\u7684\u80ba\u708e\u53d1\u75c5\u7387\u66f4\u9ad8\uff084.1% vs 1.6%\uff1bp=0.002\uff09\u548c3\u7ea7\u6216\u4ee5\u4e0a\uff081.8% vs 0.2%\uff1bp<0.001\uff09\u3002\u5728\u6240\u6709\u7ea7\u522b\u4e2d\uff0c\u8054\u5408\u6cbb\u7597\u671f\u95f4\u80ba\u708e\u7684\u53d1\u751f\u7387\u663e\u8457\u9ad8\u4e8e\u5355\u836f\u6cbb\u7597\uff086.6% vs 1.6%\uff1bp<0.001\uff09\u4ee5\u53ca3\u7ea7\u6216\u4ee5\u4e0a\uff081.5% vs 0.2%\uff1bp=0.001\uff09\u3002\u80bf\u7624\u8d1f\u62c5\u3001\u5438\u70df\u53f2\u3001\u6162\u6027\u963b\u585e\u6027\u80ba\u75be\u75c5\u3001\u80ba\u7ea4\u7ef4\u5316\u4ee5\u53caPD-L1\u5728\u6b63\u5e38\u80ba\u7ec4\u7ec7\u4e2d\u7684\u8868\u8fbe\u53d8\u5f02\u7b49\u56e0\u7d20\u53ef\u80fd\u4e0e\u8fd9\u79cd\u5dee\u5f02\u76f8\u5173\uff0c\u4f46\u5177\u4f53\u539f\u56e0\u5c1a\u5f85\u660e\u786e\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5f53\u60a3\u8005\u51fa\u73b0\u547c\u5438\u9053\u611f\u67d3\u3001\u65b0\u53d1\u54b3\u55fd\u6216\u5598\u606f\u7b49\u75c7\u72b6\u65f6\uff0c\u5e94\u9ad8\u5ea6\u6000\u7591\u80ba\u6bd2\u6027\u3002\u5bf9\u4e8e\u6709\u75c7\u72b6\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u8fdb\u884c\u80f8\u90e8CT\u626b\u63cf\u548c\u80ba\u90e8\u4f1a\u8bca\uff0c\u5e76\u5f00\u59cb\u53e3\u670d\u6216\u9759\u8109\u6ce8\u5c04\u7cd6\u76ae\u8d28\u6fc0\u7d20\u6cbb\u7597\u3002\u4e2d\u5230\u91cd\u5ea6\u75c7\u72b6\u7684\u60a3\u8005\u5e94\u8fdb\u884c\u8bca\u65ad\u6027\u652f\u6c14\u7ba1\u955c\u68c0\u67e5\uff0c\u4ee5\u8bc4\u4f30\u662f\u5426\u6709\u5e7f\u6cdb\u7684\u6dcb\u5df4\u7ec6\u80de\u6d78\u6da6\u3002\u82e5\u6bd2\u6027\u4e3a1\u7ea7\uff0c\u8868\u73b0\u4e3a\u65e0\u75c7\u72b6\u7684\u653e\u5c04\u5b66\u5f81\u8c61\uff0c\u53ef\u8003\u8651\u6682\u505c\u6cbb\u75972-4\u5468\uff0c\u76f4\u81f3\u75c7\u72b6\u7f13\u89e3\u30022\u7ea7\u6bd2\u6027\u60a3\u8005\u5e94\u6682\u505c\u6cbb\u7597\u5e76\u5f00\u59cb\u53e3\u670d\u7cd6\u76ae\u8d28\u6fc0\u7d20\u6cbb\u7597\u3002\u5bf9\u4e8e\u4e25\u91cd\u6216\u590d\u53d1\u7684\u60c5\u51b5\uff0c\u4f7f\u7528\u9759\u8109\u6ce8\u5c04\u7532\u6cfc\u5c3c\u9f992mg\/kg\u6216\u76f8\u5e94\u5242\u91cf\u901a\u5e38\u662f\u5fc5\u8981\u7684\uff0c\u6b64\u65f6\u5e94\u6c38\u4e45\u505c\u6b62\u514d\u75ab\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5c3d\u7ba1\u4e0d\u5e38\u89c1\uff0c\u4f46\u6709\u6587\u732e\u62a5\u9053\uff0c\u5728\u63a5\u53d7\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u51fa\u73b0\u4e86\u80ba\u7ed3\u8282\u75c5\u7684\u60c5\u51b5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.6 \u80be\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u636e\u62a5\u9053\uff0c\u63a5\u53d7\u4f0a\u5339\u5355\u6297\u3001\u6297PD-1\u6291\u5236\u5242\u4ee5\u53ca\u8054\u5408\u7597\u6cd5\u7684\u60a3\u8005\u53ef\u80fd\u4f1a\u51fa\u73b0\u80be\u8870\u7aed\u3002\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u53ef\u80fd\u5f15\u53d1\u6025\u6027\u80be\u635f\u4f24\uff0c\u5176\u8868\u73b0\u7c7b\u4f3c\u4e8e\u7531\u5176\u4ed6\u836f\u7269\u5f15\u8d77\u7684\u5c0f\u7ba1\u95f4\u8d28\u6027\u80be\u708e\u3002Cortazar\u7b49\u4eba\u5bf9\u5305\u62ec3695\u540d\u60a3\u8005\u7684II\u671f\u548cIII\u671f\u4e34\u5e8a\u8bd5\u9a8c\u6570\u636e\u8fdb\u884c\u5206\u6790\uff0c\u53d1\u73b0\u6025\u6027\u80be\u8870\u7aed\u7684\u603b\u53d1\u751f\u7387\u4e3a2.2%\uff0c\u5176\u4e2d0.6%\u5c5e\u4e8e3-4\u7ea7\u4e25\u91cd\u4e8b\u4ef6\u3002\u80be\u635f\u4f24\u7684\u4e2d\u4f4d\u53d1\u751f\u65f6\u95f4\u4e3a\u6cbb\u7597\u5f00\u59cb\u540e\u7ea613\u5468\u3002<\/p>\n

\u4e0e\u5355\u72ec\u4f7f\u7528\u6297PD-1\u6cbb\u7597\u7684\u60a3\u8005\u76f8\u6bd4\uff0c\u63a5\u53d7nivolumab\u548cipilimumab\u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u6025\u6027\u80be\u8870\u7aed\u7684\u53d1\u751f\u7387\u66f4\u9ad8\uff084.9%\uff09\u3002\u6025\u6027\u80be\u8870\u7aed\u7684\u6700\u5e38\u89c1\u6307\u6807\u662f\u8840\u6e05\u808c\u9150\u6c34\u5e73\u5347\u9ad8\uff0c\u8fd9\u4e00\u73b0\u8c61\u5728\u6240\u6709\u53d7\u5f71\u54cd\u7684\u60a3\u8005\u4e2d\u5747\u6709\u89c2\u5bdf\u5230\u3002\u8113\u5c3f\uff08\u51fa\u73b0\u572868%\u7684\u80be\u635f\u4f24\u60a3\u8005\u4e2d\uff09\u548c\u8840\u5c3f\uff0816%\uff09\u4e5f\u662f\u5e38\u89c1\u75c7\u72b6\u3002<\/p>\n

\u5bf9\u4e8e\u7591\u4f3c\u56e0\u514d\u75ab\u6cbb\u7597\u5f15\u53d1\u7684\u80be\u529f\u80fd\u8870\u7aed\u7684\u60a3\u8005\uff0c\u5e94\u5c3d\u65e9\u8fdb\u884c\u80be\u810f\u4f1a\u8bca\uff0c\u5e76\u5728\u9002\u5f53\u7684\u60c5\u51b5\u4e0b\u8fdb\u884c\u80be\u810f\u6d3b\u68c0\u3002\u5bf9\u4e8e2\u81f33\u7ea7\u80be\u6bd2\u6027\u7684\u60a3\u8005\uff0c\u5efa\u8bae\u6682\u505c\u514d\u75ab\u6cbb\u7597\u5e76\u4f7f\u7528\u7c7b\u56fa\u9187\u6cbb\u7597\u3002\u5982\u679c\u75c7\u72b6\u6539\u5584\u81f31\u7ea7\u4e25\u91cd\u7a0b\u5ea6\uff0c\u53ef\u4ee5\u8003\u8651\u6062\u590d\u6cbb\u7597\u3002\u800c\u5bf9\u4e8e4\u7ea7\u80be\u6bd2\u6027\u7684\u60c5\u51b5\uff0c\u5efa\u8bae\u4f7f\u7528\u5927\u5242\u91cf\u76ae\u8d28\u7c7b\u56fa\u9187\u5e76\u6c38\u4e45\u505c\u6b62\u76f8\u5173\u7684\u514d\u75ab\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.7 \u795e\u7ecf\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u6839\u636e\u524d\u77bb\u6027\u7814\u7a76\u7684\u6570\u636e\uff0c\u63a5\u53d7\u6297CTLA-4\u6297\u4f53\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u4efb\u4f55\u7ea7\u522b\u795e\u7ecf\u6bd2\u6027\u7684\u603b\u53d1\u751f\u7387\u4e3a3.8%\uff1b\u6297PD-1\u6297\u4f53\u6cbb\u7597\u7684\u60a3\u8005\u4e3a6.1%\uff0c\u800c\u8054\u5408\u6cbb\u7597\u7684\u60a3\u8005\u5219\u9ad8\u8fbe12.0%\u3002\u8fd9\u4e9b\u795e\u7ecf\u7cfb\u7edf\u4e0d\u826f\u53cd\u5e94\u5927\u591a\u6570\u662f\u8f7b\u5230\u4e2d\u7b49\u7a0b\u5ea6\uff081-2\u7ea7\uff09\uff0c\u5e38\u89c1\u75c7\u72b6\u5305\u62ec\u5934\u75db\uff0855%\uff09\u3001\u611f\u89c9\u969c\u788d\uff0813%\uff09\u548c\u5934\u6655\uff0810%\uff09\u3002\u6240\u6709\u6cbb\u7597\u4e2d3-4\u7ea7\u4e25\u91cd\u4e8b\u4ef6\u7684\u53d1\u751f\u7387\u7ea6\u4e3a1%\u3002<\/p>\n

\u795e\u7ecf\u6bd2\u6027\u4e8b\u4ef6\u7684\u7c7b\u578b\u591a\u6837\uff0c\u6839\u636e\u5f71\u54cd\u7684\u795e\u7ecf\u7cfb\u7edf\u90e8\u4f4d\u4e0d\u540c\uff0c\u53ef\u4ee5\u5206\u7c7b\u4e3a\u8111\u75c5\u3001\u810a\u9ad3\u75c5\u3001\u5355\u7eaf\u8111\u819c\u708e\u3001\u8111\u819c\u708e\u3001\u683c\u6797-\u5df4\u5229\u7efc\u5408\u5f81\u3001\u5468\u56f4\u795e\u7ecf\u75c5\u53d8\u6216\u808c\u65e0\u529b\u7efc\u5408\u5f81\u3002\u8fd9\u4e9b\u75c7\u72b6\u7684\u8868\u73b0\u5f62\u5f0f\u975e\u5e38\u591a\u6837\uff0c\u5305\u62ec\u5934\u75db\u3001\u53d1\u70e7\u3001\u75b2\u52b3\u6216\u865a\u5f31\u3001\u610f\u8bc6\u6a21\u7cca\u3001\u8bb0\u5fc6\u95ee\u9898\u3001\u55dc\u7761\u3001\u5e7b\u89c9\u3001\u766b\u75eb\u53d1\u4f5c\u4ee5\u53ca\u8116\u5b50\u50f5\u786c\u7b49\u3002<\/p>\n

\u5728\u6587\u732e\u4e2d\uff0c\u4e5f\u62a5\u9053\u4e86\u4e00\u4e9b\u4e25\u91cd\u7684\u795e\u7ecf\u6bd2\u6027\u75c5\u4f8b\uff0c\u4f8b\u5982\u53ef\u9006\u6027\u540e\u8111\u708e\u7efc\u5408\u5f81\u3001\u683c\u6797-\u5df4\u5229\u7efc\u5408\u5f81\u3001\u91cd\u75c7\u808c\u65e0\u529b\u3001\u6a2a\u65ad\u6027\u810a\u9ad3\u708e\u548c\u8131\u9ad3\u9798\u6027\u591a\u53d1\u6027\u795e\u7ecf\u75c5\u7b49\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5bf9\u4e8e\u6240\u6709\u4e25\u91cd\u7684\u795e\u7ecf\u7cfb\u7edf\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff08irAEs\uff09\uff0c\u5efa\u8bae\u4f7f\u7528\u5927\u5242\u91cf\u76ae\u8d28\u7c7b\u56fa\u9187\u8fdb\u884c\u6cbb\u7597\uff0c\u5e76\u53ca\u65f6\u54a8\u8be2\u795e\u7ecf\u79d1\u533b\u751f\u8fdb\u884c\u8bca\u65ad\u548c\u5236\u5b9a\u8fdb\u4e00\u6b65\u7684\u6cbb\u7597\u65b9\u6848\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.8 \u98ce\u6e7f\u6bd2\u6027<\/p>\n<\/section>\n

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\n
\n

\u5173\u8282\u75db\u548c\u5173\u8282\u708e\u662f\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u76f8\u5173\u7684\u6700\u5e38\u89c1\u98ce\u6e7f\u6027\u548c\u808c\u8089\u9aa8\u9abc\u75be\u75c5\u3002\u5728III\u671f\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c\u63a5\u53d7nivolumab\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u5173\u8282\u75db\u7684\u53d1\u751f\u7387\u57285%\u81f316%\u4e4b\u95f4\uff0c\u800c\u63a5\u53d7ipilimumab\u5355\u836f\u6cbb\u7597\u7684\u60a3\u8005\u4e5f\u663e\u793a\u51fa\u7c7b\u4f3c\u7684\u53d1\u751f\u7387\u3002\u5f53\u8fdb\u884c\u8054\u5408\u6cbb\u7597\u65f6\uff0c\u5173\u8282\u75db\u7684\u53d1\u751f\u7387\u7ea6\u4e3a10%\u3002\u5c3d\u7ba1\u5173\u8282\u708e\u662f\u81ea\u8eab\u514d\u75ab\u6027\u75be\u75c5\u4e2d\u975e\u5e38\u5e38\u89c1\u7684\u4e00\u79cd\u8868\u73b0\uff0c\u4f46\u5728\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\u5b83\u5e76\u6ca1\u6709\u50cf\u9884\u671f\u4e2d\u90a3\u6837\u9891\u7e41\u5730\u88ab\u62a5\u544a\u4e3a\u4e00\u79cd\u4e0d\u826f\u4e8b\u4ef6\u3002\u8fd9\u53ef\u80fd\u662f\u56e0\u4e3a\u5f53\u524d\u7684\u7f16\u7801\u7cfb\u7edf\u4e2d\u5b58\u5728\u51e0\u79cd\u4e92\u4e0d\u76f8\u5bb9\u7684\u65b9\u6cd5\u6765\u8bb0\u5f55\u808c\u8089\u9aa8\u9abc\u76f8\u5173\u7684\u4e0d\u826f\u4e8b\u4ef6\uff0c\u4f8b\u5982\u5173\u8282\u75db\u3001\u5173\u8282\u708e\u3001\u5173\u8282\u79ef\u6db2\u548c\u808c\u8089\u9aa8\u9abc\u75db\u7b49\u90fd\u53ef\u80fd\u88ab\u7f16\u7801\u4e3a\u540c\u4e00\u4e8b\u4ef6\u3002\u6b64\u5916\uff0c\u7531\u4e8e\u5927\u591a\u6570\u4e34\u5e8a\u8bd5\u9a8c\u4e3b\u8981\u62a5\u544a3-4\u7ea7\u7684\u6bd2\u6027\u4e8b\u4ef6\uff0c\u5173\u8282\u708e\u7684\u62a5\u544a\u53ef\u80fd\u4e0d\u5982\u5176\u4ed6\u4e0d\u826f\u4e8b\u4ef6\u90a3\u6837\u8be6\u5c3d\uff0c\u56e0\u6b64\u5176\u771f\u5b9e\u53d1\u751f\u7387\u53ef\u80fd\u88ab\u4f4e\u4f30\u3002<\/p>\n

\u76ee\u524d\u8fd8\u6ca1\u6709\u89c2\u5bdf\u6027\u7814\u7a76\u76d1\u6d4b\u5230\u708e\u75c7\u6027\u5173\u8282\u708e\u7684\u53d1\u751f\u5e76\u7ecf\u7531\u98ce\u6e7f\u75c5\u5b66\u5bb6\u8bc1\u5b9e\u3002\u7136\u800c\uff0c\u5728\u4e00\u4e2a\u5305\u542b9\u4f8b\u53d1\u5c55\u4e3a\u708e\u75c7\u6027\u5173\u8282\u708e\u7684\u60a3\u8005\u7684\u75c5\u4f8b\u7cfb\u5217\u4e2d\uff0c\u75c5\u60c5\u8868\u73b0\u5404\u5f02\uff0c\u6d89\u53ca\u5230\u5927\u5c0f\u4e0d\u540c\u7684\u5173\u8282\uff0c\u5e76\u53ef\u80fd\u4f34\u6709\u6216\u4e0d\u4f34\u6709\u5168\u8eab\u6027\u75c5\u53d8\uff08\u5982\u7ed3\u80a0\u708e\u3001\u5c3f\u9053\u708e\uff09\uff0c\u4ee5\u53ca\u81ea\u8eab\u6297\u4f53\u7684\u68c0\u6d4b\u3002\u8fd9\u4e9b\u60a3\u8005\u63a5\u53d7\u4e86\u76ae\u8d28\u7c7b\u56fa\u9187\u6cbb\u7597\uff0c\u4e00\u90e8\u5206\u60a3\u8005\u8fd8\u9700\u4f7f\u7528\u7532\u6c28\u8776\u5464\u548c\/\u6216\u6297TNF\u6cbb\u7597\u3002<\/p>\n

\u6b64\u5916\uff0c\u8fd8\u62a5\u9053\u4e864\u4f8b\u5728\u63a5\u53d7\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u671f\u95f4\u53d1\u751fsicca\u7efc\u5408\u5f81\u7684\u60a3\u8005\u3002\u6240\u67094\u4f8b\u60a3\u8005\u4e2d\uff0c\u53e3\u5e72\u75c7\u72b6\u6bd4\u773c\u5e72\u66f4\u4e3a\u4e25\u91cd\u3002\u5176\u4e2d3\u4eba\u7684\u6297\u6838\u6297\u4f53\u6d4b\u8bd5\u5448\u9633\u6027\uff0c1\u4f8b\u60a3\u8005\u7684La\/SS-B\u6297\u4f53\u5448\u9633\u6027\u3002\u8fd9\u540d\u60a3\u8005\u5728\u63a5\u53d7\u4e866\u5468\u7684\u5f3a\u7684\u677e\u6cbb\u7597\u540e\uff0c\u75c7\u72b6\u5f97\u5230\u4e86\u5b8c\u5168\u7f13\u89e3\u3002\u6240\u6709\u60a3\u8005\u7684Ro\u6297\u4f53\u6d4b\u8bd5\u5747\u4e3a\u9634\u6027\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

V\u578b\u8840\u7ba1\u708e\u662f\u4e00\u79cd\u7f55\u89c1\u7684\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff08irAE\uff09\u3002\u5df2\u6709\u62a5\u9053\u63cf\u8ff0\u4e86\u4e24\u4f8b\u63a5\u53d7\u4f0a\u5339\u5355\u6297\u6cbb\u7597\u540e\u901a\u8fc7\u989e\u52a8\u8109\u6d3b\u68c0\u8bc1\u5b9e\u7684\u5de8\u7ec6\u80de\u52a8\u8109\u708e\uff0c\u8fd9\u4e9b\u60a3\u8005\u901a\u8fc7\u53e3\u670d\u76ae\u8d28\u7c7b\u56fa\u9187\u8fdb\u884c\u6cbb\u7597\u3002\u6b64\u5916\uff0c\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u5f15\u8d77\u7684\u5176\u4ed6\u5355\u5668\u5b98\u8840\u7ba1\u708e\u5305\u62ecpembrolizumab\u5f15\u53d1\u7684\u89c6\u7f51\u819c\u8840\u7ba1\u708e\u548cipilimumab\u5f15\u53d1\u7684\u5b50\u5bab\u8840\u7ba1\u708e\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5728\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c\u808c\u75db\u548c\u808c\u8089\u65e0\u529b\u4e5f\u88ab\u62a5\u9053\u4e3a\u5e38\u89c1\u7684\u4e0d\u826f\u4e8b\u4ef6\u3002\u5728\u63a5\u53d7nivolumab\u548cipilimumab\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c2-18%\u7684\u60a3\u8005\u51fa\u73b0\u808c\u75db\uff0c\u800c1-12%\u7684\u60a3\u8005\u62a5\u544a\u808c\u8089\u65e0\u529b\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5173\u4e8e\u708e\u6027\u808c\u708e\u7684\u75c5\u4f8b\uff0c\u5df2\u6709\u62a5\u9053\u5728\u63a5\u53d7\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u89c2\u5bdf\u5230\u3002\u4f8b\u5982\uff0c\u4e00\u540d\u60a3\u8005\u7684\u75c7\u72b6\u66f4\u7b26\u5408\u76ae\u808c\u708e\uff0c\u5305\u62ec\u8fd1\u7aef\u808c\u8089\u65e0\u529b\u3001\u5929\u9752\u8272\u76ae\u75b9\u548cV\u578b\u9888\u5f81\uff0c\u5176\u808c\u9178\u6fc0\u9176\uff08CK\uff09\u6c34\u5e73\u5347\u9ad8\u81f31854 U\/L\u3002\u53e6\u4e00\u4f8b\u6d89\u53ca\u63a5\u53d7nivolumab\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u4e3b\u8981\u5f71\u54cd\u547c\u5438\u808c\u548c\u8fd1\u7aef\u808c\u8089\uff0c\u5176CK\u6c34\u5e73\u5347\u9ad8\u81f32812 U\/L\u3002\u8fd9\u4e24\u540d\u60a3\u8005\u5747\u63a5\u53d7\u4e86\u76ae\u8d28\u7c7b\u56fa\u9187\u6cbb\u7597\uff0c\u5e76\u4e14\u4e0d\u826f\u4e8b\u4ef6\u5f97\u5230\u4e86\u5b8c\u5168\u89e3\u51b3\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u6b64\u5916\uff0c\u8fd8\u6709\u62a5\u9053\u6307\u51fa\uff0c\u5728\u63a5\u53d7ipilimumab\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u89c2\u5bdf\u5230\u5355\u4f8b\u7ea2\u6591\u72fc\u75ae\u80be\u708e\u7684\u60c5\u51b5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.9 \u5fc3\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u5728\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7684\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c\u5fc3\u810f\u6bd2\u6027\u4f5c\u4e3a\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff08irAE\uff09\u662f\u76f8\u5bf9\u7f55\u89c1\u7684\u3002\u7136\u800c\uff0c\u5df2\u6709\u75c5\u4f8b\u62a5\u9053\u4e86\u8fd9\u7c7b\u6cbb\u7597\u76f8\u5173\u7684\u4e0d\u540c\u5fc3\u810f\u95ee\u9898\uff0c\u5305\u62ec\u5fc3\u810f\u7ea4\u7ef4\u5316\u3001\u81ea\u8eab\u514d\u75ab\u6027\u5fc3\u808c\u708e\u3001\u5fc3\u808c\u75c5\u3001\u5fc3\u529b\u8870\u7aed\u53ca\u5fc3\u810f\u9aa4\u505c\u3002\u4e00\u9879\u6700\u8fd1\u53d1\u8868\u7684\u75c5\u4f8b\u7cfb\u5217\u6d89\u53ca12\u540d\u63a5\u53d7\u6297CTLA-4\u548c\u6297PD-1\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u8bb0\u5f55\u4e86\u8fd9\u4e9b\u4e25\u91cd\u5fc3\u810f\u4e8b\u4ef6\u7684\u53d1\u751f\u3002\u5728\u8fd9\u4e9b\u75c5\u4f8b\u4e2d\uff0c\u4f7f\u7528\u76ae\u8d28\u7c7b\u56fa\u9187\u6cbb\u7597\u663e\u8457\u6539\u5584\u4e86\u6240\u6709\u60a3\u8005\u7684\u75c7\u72b6\uff0c\u5c24\u5176\u662f\u90a3\u4e9b\u6709\u5fc3\u810f\u75c5\u53f2\u7684\u60a3\u8005\u3002<\/p>\n

\u867d\u7136\u8fd9\u7c7b\u5fc3\u810f\u6bd2\u6027\u4e0d\u5e38\u89c1\uff0c\u4f46\u5bf9\u4e8e\u5fc3\u810f\u75c5\u60a3\u8005\uff0c\u5728\u6cbb\u7597\u671f\u95f4\u8fdb\u884c\u5fc3\u810f\u529f\u80fd\u7684\u5bc6\u5207\u76d1\u6d4b\u4f3c\u4e4e\u662f\u4e00\u9879\u5408\u7406\u7684\u9884\u9632\u63aa\u65bd\uff0c\u5373\u4f7f\u60a3\u8005\u6ca1\u6709\u8868\u73b0\u51fa\u76f8\u5173\u75c7\u72b6\u3002\u5982\u679c\u6000\u7591\u60a3\u8005\u51fa\u73b0\u4e86\u514d\u75ab\u8c03\u8282\u76f8\u5173\u7684\u5fc3\u810f\u6bd2\u6027\uff0c\u5e94\u7acb\u5373\u4f7f\u7528\u76ae\u8d28\u7c7b\u56fa\u9187\u8fdb\u884c\u6cbb\u7597\u3002\u8fd9\u79cd\u505a\u6cd5\u6709\u52a9\u4e8e\u53ca\u65f6\u63a7\u5236\u6f5c\u5728\u7684\u5fc3\u810f\u5e76\u53d1\u75c7\uff0c\u964d\u4f4e\u4e25\u91cd\u5065\u5eb7\u98ce\u9669\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.10 \u80f0\u817a\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u5728\u6297CTLA-4\u548c\u6297PD-1\u7684\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c\u5e38\u62a5\u544a\u8840\u6e05\u6dc0\u7c89\u9176\u548c\u8102\u80aa\u9176\u7684\u65e0\u75c7\u72b6\u5347\u9ad8\u3002\u7136\u800c\uff0c\u9664\u975e\u60a3\u8005\u51fa\u73b0\u80f0\u817a\u708e\u7684\u75c7\u72b6\u6216\u4f53\u5f81\uff0c\u4e00\u822c\u4e0d\u9700\u8981\u7279\u522b\u6cbb\u7597\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.11 \u773c\u90e8\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u773c\u6bd2\u6027\uff0c\u5305\u62ec\u7ed3\u819c\u708e\u3001\u5de9\u819c\u708e\u548c\u8461\u8404\u819c\u708e\uff0c\u5728\u63a5\u53d7\u8fd9\u4e9b\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u8f83\u4e3a\u7f55\u89c1\uff08\u53d1\u751f\u7387\u4f4e\u4e8e1%\uff09\uff0c\u901a\u5e38\u8fd9\u4e9b\u60c5\u51b5\u5bf9\u5c40\u90e8\u7c7b\u56fa\u9187\u6cbb\u7597\u53cd\u5e94\u826f\u597d\uff0c\u5f88\u5c11\u6709\u957f\u671f\u7684\u540e\u9057\u75c7\u3002\u5728\u4e25\u91cd\u7684\u60c5\u51b5\u4e0b\uff0c\u53ef\u80fd\u9700\u8981\u4f7f\u7528\u53e3\u670d\u76ae\u8d28\u7c7b\u56fa\u9187\u3002\u5efa\u8bae\u6240\u6709\u51fa\u73b0\u773c\u90e8\u514d\u75ab\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\uff08irAEs\uff09\u7684\u60a3\u8005\u54a8\u8be2\u773c\u79d1\u533b\u751f\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n

33.5.12 \u8840\u6db2\u6bd2\u6027<\/p>\n<\/section>\n

\n
\n
\n

\u5173\u4e8e\u4f0a\u5339\u5355\u6297\u7684\u62a5\u9053\u5305\u62ec\u4e86\u518d\u751f\u969c\u788d\u6027\u8d2b\u8840\u3001\u55dc\u4e2d\u6027\u7c92\u7ec6\u80de\u51cf\u5c11\u75c7\u3001\u8840\u5c0f\u677f\u51cf\u5c11\u75c7\u548c\u83b7\u5f97\u6027\u8840\u53cb\u75c5\u7b49\u75c7\u72b6\u3002\u76ae\u8d28\u7c7b\u56fa\u9187\u662f\u8fd9\u4e9b\u60c5\u51b5\u7684\u6807\u51c6\u6cbb\u7597\u9009\u62e9\u3002\u5982\u679c\u60a3\u8005\u75c7\u72b6\u672a\u80fd\u901a\u8fc7\u76ae\u8d28\u7c7b\u56fa\u9187\u5f97\u5230\u6539\u5584\uff0c\u53ef\u80fd\u9700\u8981\u8003\u8651\u4f7f\u7528\u5176\u4ed6\u514d\u75ab\u6291\u5236\u5242\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n


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

\n
\n

33.6 \u5bf9\u65e2\u5b58\u7684\u81ea\u8eab\u514d\u75ab\u75be\u75c5\u7684\u5f71\u54cd<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
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\u5728\u53e6\u4e00\u9879\u7814\u7a76\u4e2d\uff0c8\u540d\u65e2\u5f80\u6709\u7c7b\u98ce\u6e7f\u6027\u5173\u8282\u708e\u7684\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u63a5\u53d7\u4f0a\u5339\u5355\u6297\u6cbb\u7597\uff0c\u4ec52\u540d\u60a3\u8005\u9700\u8981\u4f7f\u7528\u76ae\u8d28\u7c7b\u56fa\u9187\u3002\u5f53\u51fa\u73b0\u7ed3\u80a0\u708e\u7b49\u4e25\u91cd\u7684irAEs\u65f6\uff0c\u9700\u8981\u6682\u505c\u6cbb\u7597\u3002\u8fd8\u6709\u4e00\u4efd\u8bc4\u4f30\u62a5\u544a\u6307\u51fa\uff0c\u5728119\u4f8b\u6709\u81ea\u8eab\u514d\u75ab\u75be\u75c5\u7684\u665a\u671f\u9ed1\u8272\u7d20\u7624\u60a3\u8005\u4e2d\uff0c\u4f7f\u7528pembrolizumab\u548cnivolumab\u8fdb\u884c\u5b89\u5168\u6027\u8bc4\u4f30\u663e\u793a\uff0c38%\u7684\u60a3\u8005\u81ea\u8eab\u514d\u75ab\u75c5\u52a0\u91cd\uff0c29%\u62a5\u544a\u5176\u4ed6irAEs\uff0c30%\u7684\u60a3\u8005\u672a\u62a5\u544a\u75c5\u60c5\u6076\u5316\u6216\u6025\u6027\u80be\u635f\u4f24\uff0c\u4e14\u65e0\u6cbb\u7597\u76f8\u5173\u6b7b\u4ea1\u3002<\/p>\n

\u9274\u4e8e\u6570\u636e\u6709\u9650\uff0c\u5bf9\u4e8e\u60a3\u6709\u764c\u75c7\u548c\u81ea\u8eab\u514d\u75ab\u75be\u75c5\u7684\u60a3\u8005\uff0c\u5728\u542f\u52a8\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u524d\u5e94\u4ed4\u7ec6\u6743\u8861\u6cbb\u7597\u7684\u5229\u5f0a\u3002\u5373\u5c06\u53d1\u5e03\u7684CheckMate 172\u7814\u7a76\u5c06\u63d0\u4f9b\u6709\u5173\u65e2\u5f80\u67093-4\u7ea7irAEs\u7684\u60a3\u8005\u5728\u63a5\u53d7\u6297CTLA-4\u6cbb\u7597\u540e\u65b0\u7684\u514d\u75ab\u4ecb\u5bfc\u6bd2\u6027\u98ce\u9669\u7684\u66f4\u591a\u4fe1\u606f\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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33.7 \u514d\u75ab\u5b66\u751f\u7269\u6807\u5fd7\u7269<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8fd9\u8868\u660e\uff0c\u901a\u8fc7\u521d\u6b65\u8bc4\u4f30\u60a3\u8005\u7684\u5fae\u751f\u7269\u7fa4\u7ec4\u6210\uff0c\u53ef\u80fd\u53ef\u4ee5\u9884\u6d4b\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u7684\u6f5c\u5728\u6bd2\u6027\u3002\u56e0\u6b64\uff0c\u9700\u8981\u66f4\u591a\u7684\u7814\u7a76\u6765\u63a2\u7d22\u8fd9\u4e00\u5047\u8bbe\uff0c\u5e76\u9a8c\u8bc1\u5176\u5728\u4e34\u5e8a\u5e94\u7528\u4e2d\u7684\u6709\u6548\u6027\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7ed3\u8bba<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u968f\u7740\u8d8a\u6765\u8d8a\u591a\u7684\u80bf\u7624\u7c7b\u578b\u4f7f\u7528\u5404\u79cd\u514d\u75ab\u8c03\u8282\u6297\u4f53\uff0c\u5bf9\u4e34\u5e8a\u533b\u751f\u800c\u8a00\uff0c\u610f\u8bc6\u5230\u53ca\u65f6\u8bca\u65adirAEs\u7684\u5fc5\u8981\u6027\u5e76\u719f\u6089\u8fd9\u4e9b\u6bd2\u6027\u7684\u7ba1\u7406\u6307\u5357\u81f3\u5173\u91cd\u8981\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


<\/p>\n

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

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

\u521d\u7a3f\u7ffb\u8bd1 | \u7f57\u8377<\/span><\/p>\n

\u56fe\u6587\u6392\u7248 | \u5e94\u6b63 \u8d75\u6829<\/span><\/span><\/p>\n

\u5ba1\u6838\u4fee\u6539 | \u738b\u5764<\/span><\/p>\n

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

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\u2589  \u5f80\u671f\u63a8\u9001\u5408\u8f91<\/strong><\/strong><\/section>\n
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\u80bf\u7624\u514d\u75ab\u5b66\u6700\u65b0\u6587\u732e<\/span><\/a>
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\u514d\u75ab\u5b66\u62fe\u9057\u7cfb\u5217<\/a><\/span><\/p>\n

\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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\u5173\u6ce8\u672c\u53f7~<\/span>
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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":"

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