肝癌的免疫综合治疗_夏景林

FUDAN UNIVERSITYFUDAN UNIVERSITY 肝癌的免疫综合治疗 复旦大学附属中山医院 复旦大学肝癌研究所 夏景林 2010-8 X FUDAN UNIVERSITYFUDAN UNIVERSITY Topic v免疫治疗在肿瘤治疗中的作用 v胸腺肽（日达仙）的作用与机理 v肝癌治疗方法的合理选择与综合应用 FUDAN UNIVERSITYFUDAN UNIVERSITY 免疫治疗分类 v非特异性主动免疫治疗-免疫增强剂 卡介苗，左旋咪唑，沙培林、胞必佳及灵芝 孢子粉（含多糖） 胸腺激素类制剂日达仙、胸腺五肽等。 v特异性主动免疫治疗-瘤疫苗 来自肿瘤细胞、或细胞提取物、或纯化的肿 瘤抗原，经放疗或化疗药灭活处理 新型肿瘤疫苗：抗独特型抗体分子疫苗 多核苷酸疫苗 v过继性免疫治疗 细胞因子：INF、IL2、 TNF；GMCSF 免疫活性细胞：LAK, TIL, DC FUDAN UNIVERSITYFUDAN UNIVERSITY 免疫综合治疗成功个案 v肝癌 手术+LAK (Ye Yanjin) v肝癌 手术+干扰素(Zhou Hanrong)+介入 v肝癌 射频后食道胸膜瘘+日达仙 v肾癌 手术+干扰素 FUDAN UNIVERSITYFUDAN UNIVERSITY FUDAN UNIVERSITYFUDAN UNIVERSITY 抗重度感染 成功治疗食道胸膜瘘 esophageoplueral fistula FUDAN UNIVERSITYFUDAN UNIVERSITY 个体化治疗 结合具体病例探讨选择正确的治疗方法 An average of 17 years is required for new knowledge generated by RCT to be incorporated into practice. Even then, application is highly uneven” Balas E, SA Borens. Yearbook of Informatics. 2000 FUDAN UNIVERSITYFUDAN UNIVERSITY v1965年从动物胸腺中分离，生物活性多肽 v固相多肽合成法生产，冻干粉，纯度高 v1996年，日达仙进入中国 v二维空间结构是与淋巴细胞膜结合的首要条件 v注射1.6mg后，T1水平提高50-100倍，半衰期 2小时 1.诱导胸腺T细胞分化发育 2.增强成熟T细胞对抗原或其它刺激的反应 胸腺肽1的特点 FUDAN UNIVERSITYFUDAN UNIVERSITY Thymosin 1 & Immnue Therapy v肿瘤治疗 v对多种肿瘤有治疗作用(Lung, Liver, Lymphoma, Melanoma, etc) v减少毒副反应（Reduce Side effects) v机理 (mechanism) v抗感染 v重度感染 v抗病毒 v机理 FUDAN UNIVERSITYFUDAN UNIVERSITY 日达仙 提高多种肿瘤疗效 FUDAN UNIVERSITYFUDAN UNIVERSITY 比 率 疗效评定：完全缓解CR；部分缓解PR；稳定SD；进展PD 日达仙治疗非小细胞肺癌（上海胸科医院） *王慧敏等 中国癌症杂志2005,(3): 244247 FUDAN UNIVERSITYFUDAN UNIVERSITY 生存时间比较 组别MST 一年生存率2年生存率3年生存率 治疗组22.1月84.21% *43.56% *27.72% * 对照组12月50.00%28.57%14.29% P值0.0235 *王慧敏等 中国癌症杂志2005,(3): 244247 日达仙治疗非小细胞肺癌（上海胸科医院） FUDAN UNIVERSITYFUDAN UNIVERSITY TACE + Ta1 TACE P8cm介入综合治疗后力争二步切除 若有癌栓、卫星灶、包膜不全、或术后2个月AFP 未转阴介入。 多个(3)手术多不彻底,移植不佳，介入为 佳。 3cm、3个以下PEI，RF 综合、 序贯、 个体化 FUDAN UNIVERSITYFUDAN UNIVERSITY Longest Survival in Zhongshan 43 years FUDAN UNIVERSITYFUDAN UNIVERSITY Long Term Recurrence 28-y After Resection 25-y After Lung Metastasis Resection v FUDAN UNIVERSITYFUDAN UNIVERSITY Recurrence -4 years after OLP zhangpeizhi FUDAN UNIVERSITYFUDAN UNIVERSITY Multiple Recurrence after OLP FUDAN UNIVERSITYFUDAN UNIVERSITY Tumor With Echinococcosis v FUDAN UNIVERSITYFUDAN UNIVERSITY Secondly Liver Cancer? Epiendothelioma v FUDAN UNIVERSITYFUDAN UNIVERSITY Tumor Spread After 2 Step Resection v FUDAN UNIVERSITYFUDAN UNIVERSITY Residual Tumor After Resection v FUDAN UNIVERSITYFUDAN UNIVERSITY The Best Indication of RFA v FUDAN UNIVERSITYFUDAN UNIVERSITY RFA ： Hemopneumothorax 肿瘤位于膈顶，射频后并发气胸 FUDAN UNIVERSITYFUDAN UNIVERSITY RFA: Needle tract seeding FUDAN UNIVERSITYFUDAN UNIVERSITY RFA +PEI v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE + RFA for Patient with Server Cirrhosis v FUDAN UNIVERSITYFUDAN UNIVERSITY Server Cirrhosis v FUDAN UNIVERSITYFUDAN UNIVERSITY PEI for HCC 4Cm v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for Huge Tumor：Survival 5 y v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE + Resection Palliative +Palliative= Curative v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for Multiple Tumor v FUDAN UNIVERSITYFUDAN UNIVERSITY Complete Remission after TACE v FUDAN UNIVERSITYFUDAN UNIVERSITY Huge, Elderly, with History Of MCI, Plural Effusion v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for Patient with Jaundice v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for Portal Vein Embolus v FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for PVTT FUDAN UNIVERSITYFUDAN UNIVERSITY Radical eradication of HCC with PVTT after TACE FUDAN UNIVERSITYFUDAN UNIVERSITY 68 Cases of HCC with PVTT treated with TACE 6, 12, 18month survival rate 76%, 47%,23% FUDAN UNIVERSITYFUDAN UNIVERSITY Well (25/68, 37%) VS Poor (43/68) precipitation of lipiodol Survival( %) 6m12m18m Well-lip 876734 Poor-lip 643118 Medium survival (m) 16.2 6.8 FUDAN UNIVERSITYFUDAN UNIVERSITY Well- Lip Poor- lip FUDAN UNIVERSITYFUDAN UNIVERSITY TACE for Patients with Ascites v FUDAN UNIVERSITYFUDAN UNIVERSITY Decrease of Ascites after TACE FUDAN UNIVERSITYFUDAN UNIVERSITY Lipiodol in IVC Embolus v FUDAN UNIVERSITYFUDAN UNIVERSITY Arterial blood supply to tumor thrombosis in IVC FUDAN UNIVERSITYFUDAN UNIVERSITY Shrinkage of RA Tumor thrombosis /survive 16 month FUDAN UNIVERSITYFUDAN UNIVERSITY 10- year old boy with RA tumor thrombosis FUDAN UNIVERSITYFUDAN UNIVERSITY -Knife +TACE FUDAN UNIVERSITYFUDAN UNIVERSITY -Knife +TACE