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编者按:肾细胞癌的辅助治疗曾长期处于“无药可用”的困境,因其对放化疗不敏感,而靶向治疗在辅助阶段的尝试亦未达预期。KEYNOTE-564研究的成功犹如破晓之光,引领肾癌辅助治疗迈入免疫治疗新时代。肿瘤瞭望-泌尿时讯特邀香港中文大学吴志辉(Ng Chi Fai)教授深入解读从免疫单药到联合治疗的研究进展,并探讨如何借助液体活检、类器官模型等前沿技术,推动治疗决策向更精准的个体化方向迈进。
01
《肿瘤瞭望-泌尿时讯》
请您介绍一下近期肾细胞癌辅助治疗领域取得的一些重要研究进展,以及这些进展在治疗理念上展现出了哪些重要意义?
吴志辉 教授
香港中文大学
肾细胞癌是一类在医学领域颇具研究价值和临床探讨意义的癌症。当我们回溯过往的临床治疗情况,在对肾细胞癌患者实施手术治疗之后,如果术后的病理检查结果明确提示患者存在高危因素,那么可供选择的临床干预手段就极为有限。这其中的主要原因在于,肾细胞癌这种疾病对放疗和化疗这两种常见的癌症治疗方式均缺乏敏感性。大约二十年前,尽管针对转移性疾病的靶向治疗方法终于得以问世,这在当时被视为一种新的希望。然而,当将此类靶向治疗药物应用于肾细胞癌的辅助治疗时,实际的治疗效果却并未达到预期的目标。这一令人困扰的临床困境一直持续着,直到近期才终于得以突破。
KEYNOTE-564研究的开展具有标志性的重大意义,该研究经过严谨的实验和数据分析,清晰地表明了采用帕博利珠单抗进行辅助治疗能够显著延长肾细胞癌患者的无病生存期(DFS)以及总生存期(OS)。这一重要的研究成果标志着肾癌辅助治疗正式步入了免疫治疗的崭新阶段,为借助免疫疗法来助力高危术后的肾细胞癌患者改善长期预后开辟了一条崭新的路径,让患者看到了更多生存和康复的希望。
上下滑动查看英文对话
Oncology Frontier- UroStream: Professor Wu, could you please introduce some of the recent significant research advancements in the field of adjuvant therapy for renal cell carcinoma and discuss their importance in terms of evolving treatment philosophies?
Dr. Ng Chi Fai : Renal cell carcinoma is a malignancy of significant research value and clinical importance. Historically, therapeutic interventions following surgical resection were extremely limited if postoperative pathology indicated high-risk factors. This was primarily because RCC is notably insensitive to conventional radiotherapy and chemotherapy. Although targeted therapies for metastatic disease emerged approximately two decades ago—representing a new hope at the time—their application in the adjuvant setting did not achieve the expected clinical outcomes. This clinical impasse persisted until recent breakthroughs.
The KEYNOTE-564 study is of landmark significanc. Through rigorous experimentation and data analysis, it clearly demonstrated that adjuvant treatment with pembrolizumab can significantly prolong both disease-free survival (DFS) and overall survival (OS) in RCC patients. This achievement marks the formal entry of RCC adjuvant treatment into the era of immunotherapy, opening a new pathway to improve long-term prognosis for high-risk postoperative patients and offering them renewed hope for survival and recovery.
02
《肿瘤瞭望-泌尿时讯》
从KEYNOTE-564到RAMPART,再到KEYMAKER-U03等其他研究,未来可能会有免疫、免疫联合免疫、免疫联合TKI等不同组合的辅助治疗策略。您认为在这种情况下应如何进行个体化的临床决策?
吴志辉 教授
香港中文大学
当前研究正致力于探索不同的联合策略。例如,RAMPART研究表明,双免疫联合治疗可改善无病生存期。然而,结合既往辅助治疗的经验,仍需等待其长期总生存期的随访数据,以最终确定其疗效。与此同时,其他研究也在探寻免疫治疗联合靶向治疗等方案在辅助治疗阶段的应用潜力。
尽管这些联合方案在晚期转移阶段已被证实具有有效性,但在辅助治疗领域,仍需开展更多研究予以验证。不过,这些探索无疑为病理结果欠佳的高危患者提供了新的治疗途径。目前,筛选需要辅助治疗的患者主要依据临床和病理参数。
展望未来,个体化决策的关键在于生物标志物的发展。期望未来能更多地运用液体活检技术(如循环肿瘤DNA),或借助KIM - 1等标志物,更为精准地识别出高复发风险的患者,从而实现早期干预。此外,利用类器官培养技术,在体外对患者的肿瘤细胞进行培养和药物敏感性测试,有望助力筛选出对个体患者最为有效的治疗方案。这种基于生物标志物和功能性检测的个体化治疗策略,在未来具有极高的应用价值。
上下滑动查看英文对话
Oncology Frontier- UroStream: From KEYNOTE-564 to RAMPART and beyond, future adjuvant strategies are becoming increasingly diverse, including immunotherapy monotherapy, dual immunotherapy combinations, and immunotherapy combined with tyrosine kinase inhibitors (TKIs). Given this landscape, how should individualized clinical decisions be made?
Dr. Ng Chi Fai : Current research is dedicated to exploring various combination strategies. For instance, the RAMPART study indicated that dual immunotherapy can improve disease-free survival. However, based on past experience with adjuvant therapy, we must await long-term overall survival follow-up data to definitively confirm its efficacy. Simultaneously, other studies are investigating the potential of combinations such as immunotherapy plus targeted therapy (IO + TKI) in the adjuvant phase.
While these combination regimens have proven effective in the advanced metastatic stage, further research is required to validate them in the adjuvant setting. Nevertheless, these explorations undoubtedly provide new therapeutic avenues for high-risk patients with unfavorable pathological results. Currently, the selection of patients requiring adjuvant therapy relies primarily on clinical and pathological parameters.
Looking ahead, the key to individualized decision-making lies in the development of biomarkers. We anticipate the broader application of liquid biopsy technologies (such as circulating tumor DNA) or the use of markers like KIM-1 to more accurately identify patients at high risk of recurrence, thereby enabling early intervention. Furthermore, utilizing organoid culture technology to grow a patient’s tumor cells in vitro for drug sensitivity testing holds promise for screening the most effective treatment plans for individual patients. This individualized treatment strategy, based on biomarkers and functional assays, holds immense potential for future application.
03
《肿瘤瞭望-泌尿时讯》
最后,能否请您介绍一下贵中心在未来肾细胞癌围手术期治疗方面的研究探索与临床经验?
吴志辉 教授
香港中文大学
我中心长期秉持多学科诊疗(MDT)模式,与肿瘤内科资深专家保持密切且高效的协作。术前与术后,均投入大量时间与精力,审慎筛选具有高危疾病特征的患者。针对此类患者,开展深入且全面的研讨,共同研判是否需进行新辅助治疗或辅助治疗。同时,团队已积极开展前沿性探索,尝试利用手术切除的肿瘤组织进行类器官培养。期望在类器官培养技术成熟后,针对需接受辅助治疗的肾细胞癌患者,先对其肿瘤细胞进行类器官培养并建立专属数据库。当患者未来需接受系统治疗时,可借助其自身的“替身”肿瘤,即通过类器官培养获得的类似肿瘤组织,在体外为其精准筛选最为适宜、有效的治疗方案,切实达成“量体裁衣”式的个体化精准医疗。
上下滑动查看英文对话
Oncology Frontier- UroStream: Finally, could you introduce the research explorations and clinical experience of your center regarding the perioperative treatment of renal cell carcinoma?
Dr. Ng Chi Fai : Our center has long adhered to a multidisciplinary team (MDT) model, maintaining close and efficient collaboration with senior medical oncology experts. We invest significant time and effort both pre- and post-operatively to meticulously screen patients with high-risk disease characteristics. For these patients, we conduct in-depth, comprehensive discussions to determine the necessity of neoadjuvant or adjuvant therapy.
Concurrently, our team has initiated pioneering explorations into organoid culture using surgically resected tumor tissues. Once organoid culture technology matures, we aim to culture tumor cells and establish dedicated databases for RCC patients requiring adjuvant therapy. Should these patients require systemic treatment in the future, we can utilize their own "proxies"—the tumor-like tissues obtained via organoid culture—to accurately screen for the most suitable and effective treatment regimens in vitro, truly achieving "tailor-made" individualized precision medicine.
吴志辉 教授
香港中文大学
学术资格:
香港中文大医学博士
英国爱丁堡皇家外科医学院泌尿科院士
香港医学专科学院院士(外科)
英国爱丁堡皇家外科学院院士
香港外科学院院士
香港中文大学内外全科医学士
现任职位:
香港中文大学何子梁泌尿科教授
香港中文大学外科学系泌尿外科主任
香港中文大学外科教授
奖项:
最优秀青年泌尿外科医生奖,2010年在台湾举行的亚洲泌尿外科年会
最佳有关前列腺疾病研究报告,2012年在泰国举行的亚洲泌尿外科年会
Mae Joan Islami 奖学金,国际访客学人,美国外科学院
世界华人泌尿外科学会成就奖,2014年美国泌尿外科协会
杰出贡献奖,2017年国际尿石症联盟
(来源:《肿瘤瞭望-泌尿时讯》编辑部)
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