MD安德森癌症中心
日期：04/01/2011
丽莎加文：欢迎癌症时事开讲，来自得克萨斯州医学博士安德森癌症中心的大学每周播客系列。巨蟹座时事开讲帮助您获得最新的癌症研究，诊断，治疗和预防的新闻，提供减少你的家人的癌症风险的最新信息。乐动体育LDsports中国我是主持人丽莎加文。今天，我们的嘉宾是尼扎尔Tannir。他是泌尿生殖系肿瘤内科副教授在这里医学博士安德森和肾癌专家，肾癌今天是我们的主题。欢迎Tannir博士。
尼扎尔M. Tannir，MD，FACP：早上好。谢谢你邀请我。谢谢你给我的机会。
丽莎加文：让我们来谈谈一般肾癌。有多少人，每年一般都诊断为肾癌的一种形式？
尼扎尔M. Tannir，MD，FACP：在美国据估计，大约有50000人与肾癌每年诊断。约90％的情况下都是我们称之为肾细胞癌和10％，其他肿瘤比这罕见。
丽莎加文：：又是什么肾细胞癌，是影响肾脏的衬里或又是什么样的呢？
尼扎尔M. Tannir，MD，FACP：肾细胞癌不是一种疾病。这是一种异质性疾病。有肾细胞癌的几种亚型。通常，大多数情况下从肾脏的皮质产生，所以它是外侧，肾脏的外周。最常见的类型是透明细胞肾细胞癌，或马上将其称为传统类型肾细胞癌。也有一些是在肾脏的中央部分更紧密地出现罕见的肿瘤类型，但这些都是罕见的形式。
丽莎加文：什么是存活率，你认识的人有两个肾，我在想，很少有双侧肾脏受到影响，但人们普遍具有良好的生存率肾癌？
尼扎尔M. Tannir，MD，FACP：唔，由于是与任何肿瘤的情况下，存活依赖于几个因素，最重要的是该疾病在初始诊断时的阶段。那么，是谁被诊断患有I期患者预后良好。这意味着肿瘤局限于肾脏，体积小，还没有通过外肾囊破裂。所以，对第一阶段的存活率超过90％，95％左右;对于第二阶段，生存是约88％;阶段III，数字下降到在60，围绕该号码;和IV期，不幸的是，生存仍然只有20％，5年内不会出现不好。所以，这一切都是取决于癌症的阶段作出诊断时。
丽莎加文：你能抓住他们的早期，或者他们早期发现大部分的时间？
尼扎尔M. Tannir，MD，FACP：是的，当肿瘤仍局限在肾肾细胞癌的约75％被诊断。约四分之一，这些案件的25％，遗憾的是，当他们被诊断，病人已具备了IV期疾病，晚期疾病。而即便是那些接受手术与治疗意图，即肾切除术，切除肾脏或肾部分切除术，切除肿瘤，那是在肾脏中留下的残余这是健康的，不幸的是，这些患者中大约也有30％复发后患者-手术。所以，最后，我们看的是谁最终拥有先进的疾病和需要为他们的晚期疾病的全身治疗的患者约30％左右。
丽莎加文：我明白太那个复发，也可以是相当高的肾癌。
尼扎尔M. Tannir，MD，FACP：是的，正如我说，你知道，大约有三分之一的肿瘤左右会复发。因此，患者需要提高警惕和他们的医生需要跟随他们，所以我们自己的肾切除后打电话监测研究。现在很明显，复发的风险取决于在癌症被诊断阶段。你知道第三阶段有较高的复发率较第二阶段，而第二阶段有较高的复发率比一期
丽莎加文：现在，什么是无肾透明细胞癌？
尼扎尔M. Tannir，MD，FACP：好了，正如我所说，肾细胞癌不是一种疾病。因此，它是一种异质性疾病，并有不同的亚型。最常见的是透明细胞，它是所有病例的80％左右。其余的20％都是非透明细胞。这是一个多元化的群体本身。有一种被称为乳头也可以有两种不同类型的类型。有I型乳头状并且在肾细胞癌II型乳头状。有这就是所谓嫌色另一个罕见的形式，另一种就是所谓的集合管。以下是有关我们真的无法得到精确的类型，所以我们把它作为未分类的情况下，5％。这时候，即使使用最先进的技术immunostage病理学家，试图找出起源的肿瘤，无法精确定位，不能直截了当地肾细胞癌的类型，以便他们可以将此报告为机密。 That's when it has features of clear cell and also clear features of say, papillary or chromophobe or collecting duct or otherwise, you know, the other subtypes. So, that's a challenge sometimes. We hope that in the future, we would have better tools available to be able to categorically identify each type by molecular diagnostic tools.
丽莎加文：作为一名肿瘤科医生，您会使用化疗。化疗是关于手术什么角色使用。我的意思是，它通常是手术化疗，然后或没有手术化疗有时用？
尼扎尔M. Tannir，MD，FACP：那么，化疗发挥了重要作用，因为我们知道在很多实体瘤和血液系统恶性肿瘤。你知道，当实体肿瘤的类型，其中化疗有疗效是生殖细胞肿瘤，但我们知道化疗在乳腺癌的治疗，大肠癌的治疗，以及其他重大作用。但对于肾细胞，它似乎是在我们提到的这些其他类型的肿瘤化疗一样不是很有效。所以，在肾细胞癌化疗的作用是有限的。没有FDA批准的化疗或化疗剂肾细胞癌的治疗。However, at M.D. Anderson, we have conducted several studies looking at the role of chemotherapy in renal cell cancer and I can tell you that there are patients who would benefit from chemotherapy and these are particularly those patients with clear cell renal cell carcinoma who have not responded to target therapy or immunotherapy. And even if they responded to immunotherapy or target therapy, unfortunately, the response in the majority of patients is limited and then they have progressive disease and that's when we've seen some patients respond to chemotherapy. In fact, we've reported several studies showing the benefit of chemotherapy. But in general, chemotherapy is not used upfront in patient with renal cell cancer, any type, except for the type that we call sarcomatoid renal cell carcinoma where it seems like chemotherapy does play an important role there, although unfortunately this is a very aggressive disease and incurable disease, but chemotherapy seems to be important in that area.
丽莎加文：告诉我开始试用，显然，你是对肾细胞癌尝试一些化疗药物。
尼扎尔M. Tannir，MD，FACP：：所以，我再次想太多，所以我们定义的术语，而化疗对患者和外行，这是给予任何药物，他们称之为化疗作为区分辐射和作为区分手术。所以，从手术和放射分化，任何药物被称为化疗，但正如我所说，在化疗的远期应保留对已开发的传统靶向肿瘤细胞本身的途径的细胞毒素。Now, the START Trial, the acronym stands for Sequential Two-agent Assessment in Renal Cell Carcinoma Therapy, this is the trial that we have upfront and is up and running at M.D. Anderson with the hope that this will be also open at other centers and so, we will make it a multicenter trial. This trial is looking at recruiting patients with clear cell renal cell carcinoma who had not had pro-systemic therapy. They should have had product nephrectomy, so these are patients who have advanced disease, had their surgery already with removal of the kidney and not had any systemic therapy. And those patients get randomized, meaning randomly assigned to receive one of six sequential treatments. So, the three drugs we are using in the START Trial are FDA approved and these are Bevacizumab, Everolimus, and Pazopanib. We chose these three drugs because each has a different mechanism of action. We chose these design because until now it is not clear what is the best drug to give upfront, what is the best drug to give in the second line. And while these target therapies that are FDA approved have really changed the landscape of the treatment of renal cell carcinoma and helped a lot of patients, a lot of patients benefit from this, unfortunately, they are still not producing the ultimate goal which is curing patients. So, while patients respond and benefit, unfortunately eventually the disease does progress. So, our approach has been and this is now, you know in the clinic, is to treat the patient with one agent upfront and then at the time of progression to proceed and give them a second line therapy. But as I said, patients, we do not know which patients respond to what drug and this trial is looking at answering many questions, what would be the best sequence among the several sequences available and when you are using three drugs and the protocol is treating patients and the same protocol sequentially twice in the first line and then in the second line, you get six sequences. So, this trial will answer which sequence is best and also, as importantly, we are looking at several biomarker studies, both tissue based, blood borne and also functional imaging to try to see which patients respond best to which therapies. So, this would be the ultimate personalized medicine where we are trying to identify those patients who would respond better to, say, Bevacizumab versus Pazopanib versus Everolimus. So, patients will have blood drawn, blood test at baseline, and then at different time points during the trial, and will have also a baseline functional imaging study that consists of a CAT scan perfusion, Perfusion CAT scan at baseline and then at different time points after treatment started. And so, we will be looking at the CAT scan, the Perfusion CAT scans and the blood that we will look at, test circulating biomarkers in the blood of patients receiving these target agents with the idea of correlating what we find in the blood and what we see on these Perfusion CAT scans, correlate that with their response to therapy. And the hope is to identify a signature or a change in the perfusion CAT scans that will tell us this agent works best for this type of patient. And through mathematical modeling, we will be looking at identifying, assessing the change in blood flow, permeability, blood volume, et cetera with the Perfusion CAT scans.
丽莎加文：：非常感谢您今天和我们在一起。如果你对你今天所听到癌症时事开讲，接触askMDAnderson 1-877-MDA-6789或在线www.windowstask.com/ask什么问题。感谢您听这个情节癌症时事的。在下周在我们系列的下播客。