引领胰腺癌的革命

Home / 澳门第一赌城在线娱乐的治疗领域 / 肿瘤学 /引领胰腺癌的革命

胰腺癌是第4位^th leading cause of cancer death in western countries and the 6^th 全球癌症死亡的主要原因, largely due to the complexities in its biology and management.^1,2,3It also has one of the worst survival rates of all ‘common’ cancers, 只有9%的晚期(转移性)疾病患者在诊断后存活超过5年.^2,4 胰导管腺癌(PDAC)是最常见的胰腺癌(占85%)。,^⁵ compared with pancreatic neuroendocrine tumours (PNETs), which are far less common and account for less than 10% of cases.⁶

PDAC是最具侵袭性的癌症之一.⁷由于基因突变的多样性和密集的结缔组织形成了胰腺, PDAC is also one of the most chemo-resistant and radio-resistant type of cancer.^1,8,9PDAC预后极差，在疾病的所有阶段，只有约20%的患者存活一年.¹⁰ The causes of pancreatic cancer are still not well understood, 尽管某些危险因素，比如吸烟, 糖尿病, obesity and chronic pancreatitis have been identified.²

多亏了专门的科学研究, there have been positive developments to better manage this high morbidity cancer. To understand why pancreatic cancer presents such an intricate and complex challenge, 澳门第一赌城在线娱乐必须首先了解胰腺在调节身体机能方面所起的关键作用.

胰腺——给身体带来平衡

扩大信息图表

The pancreas itself is a gland organ located in the abdomen near the liver. The pancreas plays a dual role in regulating bodily functions:^11,12

内分泌系统——胰腺分泌激素, including the blood sugar-regulating hormones insulin and glucagon, 直接进入血液.
外分泌系统-胰腺分泌酶通过管道进入十二指肠进入消化道, which is responsible for breaking down food and absorbing nutrients.

胰腺肿瘤

胰腺癌主要分为两种肿瘤类型——取决于肿瘤是否在外分泌细胞中形成, 或者内分泌细胞.

PNETs, 俗称“胰岛细胞肿瘤”, are a rare type of cancer that form in the endocrine cells.¹³ PNETs have a better prognosis, compared to more common types of cancer.¹¹

Exocrine tumours account for 95% of pancreatic cancers 最常见的是 PDAC.^5,14 PDAC develops from the cells which line the ducts in the pancreas. 这些导管输送消化液, 包含酶, into the main pancreatic duct and then into the first part of the small intestine.¹²

由于这种疾病有可能迅速传播，并且通常直到疾病处于晚期才出现症状, 超过50%的胰腺癌患者在疾病已经扩散到身体其他器官时才被诊断出来，这些患者的平均生存期是 less 不到一年.^5,15

There are multiple reasons for the potentially quick spread of this disease, including the close proximity of major blood vessels in the pancreas, 哪些容易被癌细胞入侵.¹⁶ 因为PDAC症状是非特异性的, 诊断是非常有挑战性的, which significantly reduces the chances of survival. 这导致PDAC被称为“沉默的杀手.’¹⁷

扩大信息图表

A limited treatment landscape highlights urgent unmet need

从历史上看, 与其他肿瘤类型相比，由于疾病的侵袭性和有限的治疗进展，晚期胰腺癌患者面临着不良的结果, particularly lagging behind other common cancers with regards to precision therapy.^2,4,18,19

Only approximately 20% of patients with advanced disease are eligible for surgery, due to the metastatic (advanced) stage of their cancer at the time of diagnosis, while treatment options including chemotherapy and radiotherapy are often limited.^19,20 The high burden of symptoms in advanced pancreatic cancer presents further challenges, as symptoms can interfere with treatment efficacy and quality of life.²¹

Pancreatic cancer – is it possible this difficult disease could be biomarker-driven?

在了解生物标志物对乳腺癌等癌症的意义方面，澳门第一赌城在线娱乐已经取得了长足的进步, 前列腺癌, ovarian, 肺和胃, 举几个例子. With the emergence of genomic profiling technologies, 选择性分子靶向治疗, 生物标志物在胰腺癌患者的临床治疗中发挥着越来越重要的作用.²²

In PDAC, 一些肿瘤抑制基因(积极防止癌症的形成)通常会发生突变，导致肿瘤的侵袭性生长.²³ 这些基因包括 BRCA1/2, PRSS1 and CDKN2A, are just some of the predictive biomarkers for metastatic pancreatic cancer, and have uses far beyond diagnosis; they may also be used to predict potential treatment outcomes and help identify familial risk of developing PDAC.^5,24

靶向癌症治疗是一种干扰与癌细胞生长和存活有关的特定分子的药物. 了解靶向治疗是如何起作用的, it’s important to understand the mechanisms of cancer cells.²⁵

The BRCA1/2 genes form part of the DNA damage response (DDR), or a process through which various pathways work to repair DNA damage. 当BRCA基因发生突变时, 阻碍DDR修复进程, 患癌症的风险也会增加.²⁶ 预计约5-10%的家族性PDAC患者和3%的散发性PDAC患者携带种系BRCA突变. 了解患者是否携带这种突变可能有助于确定合适的治疗方案.²⁷

癌细胞的DNA损伤程度很高, loss of one or more DNA repair pathways increased DNA replication stress. These properties may be exploited as potential therapeutic targets. By researching agents that can target these particular dependencies, 治疗可能会积极地针对癌细胞的一个基本特征，并使其与自身对抗, 导致癌细胞死亡.²⁷

For more information on exploiting cancer-specific DDR-dependencies 点击这里

The future for pancreatic cancer research and development

如果澳门第一赌城在线娱乐在诊断和治疗方面没有进一步的突破，胰腺癌的患病率将继续增加. 目前改善治疗效果的策略侧重于通过筛选和生物标志物检测进行早期检测，从而更有效地提高治疗效果, 有针对性的治疗.^28,29

brca突变的转移性胰腺癌是一种毁灭性的难以治疗的疾病，具有严重的未满足需求, 但随着基因检测的不断创新, 生物标志物的使用, potential targeted therapies and continuous research, we are making progress in helping to change patients’ prognoses.³⁰ 澳门在线赌城娱乐致力于推动这一进展，澳门第一赌城在线娱乐坚信将加快胰腺癌生存进展的步伐, we must push forward as a community to help raise awareness of unmet needs, and to activate change where we know improvements can be made.

参考文献

1. Zeng S, et al. 胰腺癌的化疗耐药. 生物医学杂志. 2019 Sep; 20(18): 4504.

2. Rawla P, et al. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. 世界卫生组织. 2019 Feb; 10(1): 10–27.

3. International Agency for Research on Cancer, World Health Organization. 今日巨蟹座:2022年全球癌症协会:所有巨蟹座. 可以在: http://gco.iarc.who.int/media/globocan/factsheets/cancers/39-all-cancers-fact-sheet.pdf. 2024年5月发布.

4. Tiriac H, et al. Organoid Models for Translational Pancreatic Cancer Research. 当前意见及发展. 2019年2月,54:7-11.

5. Tonini V, et al. Pancreatic cancer in 2021: What you need to know to win. 世界J胃肠醇. 2021年9月21日;27(35):5851-5889.

6. 胰腺癌行动网络. 胰腺神经内分泌肿瘤(PNETs). 可以在 http://www.pancan.org/facing-pancreatic-cancer/about-pancreatic-cancer/types-of-pancreatic-cancer/endocrine-pancreatic-neuroendocrine-tumors/. 2024年5月发布.

7. Truong L, et al. 胰腺癌微环境和细胞组成:当前的认识和治疗方法. Cancers (Basel). 2021 Oct 8;13(19):5028.

8. Chen S, et al. 益生菌乳酸菌对吉西他滨治疗胰腺癌转基因小鼠模型的协同抑瘤作用. 科学报告. 2020;10:20319.

9. 最小的行星, et al. 克服胰腺导管腺癌的纤维化堡垒:挑战与机遇. 癌症(巴塞尔). 2023;15(8):2354.

10. Siddappa P, et al. ca19 -9在胰管腺癌接受Eus治疗的患者中的应用:20多年的单中心经验. 胃肠病学. 2019;156;(6)1:331-332.

11. 美国癌症协会. (2020). 什么是胰腺神经内分泌肿瘤? 可以在 http://www.cancer.org/cancer/pancreatic-neuroendocrine-tumor/about/what-is-pnet.html. 2024年5月发布.

12. 大英百科全书. 十二指肠. 可以在 http://www.Britannica.com/science/duodenum. 2024年5月发布.

13. 胰腺癌的作用. 胰腺神经内分泌肿瘤. 可以在 http://pancreaticcanceraction.org/about-pancreatic-cancer/what-is-pancreatic-cancer/pancreatic-neuroendocrine-tumours/. 2024年5月发布.

14. 英国胰腺癌协会. 胰腺癌的类型. 可以在 http://www.pancreaticcancer.org.uk/information-and-support/facts-about-pancreatic-cancer/types-of-pancreatic-cancer/. 2024年5月发布.

15. Azar I, et al. 退伍军人医院IV期胰腺癌的治疗和存活率:一项全国性研究. 胃肠肿瘤学杂志. 2019;10(4):703-711.

16. McGuigan, et al. Pancreatic cancer: A review of clinical diagnosis,epidemiology, treatment and outcomes. 世界胃肠病学杂志. 2018;24(43):4846-4861.

17. 南卡罗来纳医科大学. 胰腺癌:沉默的杀手. 可以在 http://muschealth.org/medical-services/geriatrics-and-aging/healthy-aging/pancreatic-cancer. 2024年5月发布.

18. 罗斯太, et al. Recent advances in the treatment of pancreatic cancer. F1000Research. 2020;9(131):1-7.

19. Regel我, et al. Current Strategies and Future Perspectives for Precision Medicine in Pancreatic Cancer. Cancers. 2020;12(4):1042.

20. 爱好者W, et al. 有效化疗时代少转移性胰腺癌的手术与局部治疗理念. 欧洲的手术. 2019;51:153–164.

21. Gilbertson-White年代, et al. Understanding Symptom Burden in Patients With Advanced Cancer Living in Rural Areas. 肿瘤护士论坛. 2019;47(3):305-317.

22. 奥尼尔RS, et al. 生物标志物在胰腺癌诊断中的应用:澳门第一赌城在线娱乐离找到黄金彩票更近了吗? 世界J胃肠醇. 2021;27(26);4045-4087.

23. Wang S, et al. 胰腺腺癌的分子生物学:转化的挑战和临床观点. 信号转导和靶向治疗. 2021;6(249):1-23

24. Earl J, et al. 对家族性胰腺癌家族候选基因的综合分析揭示了潜在致病性种系变异的高频率. 《澳门在线赌城娱乐》. 2020;53:102675.

25. 国家癌症研究所. 靶向治疗癌症. 可以在 http://www.cancer.gov /对Br J Cancer治疗/类型/靶向治疗. 2024年5月发布.

26. 黄R, et al. DNA损伤修复:历史视角, mechanistic pathways and clinical translation for targeted cancer therapy. 信号转导和靶向治疗. 2021;6(254):1-35.

27. Lai E, et al. brca突变型胰腺导管腺癌. 癌症. 2021;125:1321–1332.

28. Yang J, et al. Early screening and diagnosis strategies of pancreatic cancer: a comprehensive review. 癌症的通信. 2021;41:1257-1274.

29. 萨兰提斯等人. 胰腺导管腺癌:治疗障碍、肿瘤微环境和免疫治疗. 世界胃肠病杂志. 2020;12(2):173-181.

30. Rosen M, et al. BRCA突变的胰腺癌:一种变化即将到来. 世界J胃肠醇. 2021;27(17):1943-1958.