了解转移性肾癌的治疗

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You’re probably reelingafter learning that you have metastatic kidney disease. This diagnosis might even have you thinking there’s little you can do to fight the spread of this cancer. In fact, though, the field is rapidly changing, providing more treatment options than ever before. We’re here to help guide you through the various treatments available for advanced kidney cancer, including what’s most-often recommended, for whom, and how they work.

什么是晚期肾癌？

让我们从基础知识开始：肾细胞癌，最常见的肾癌形式，在肾脏中生长，但它可以超越肾脏本身。如果癌症蔓延，它被称为IV阶段肾癌或转移性肾癌。肾癌可以从靠近和远处涂抹于肾脏侧面的肾上腺到散落在身体周围的淋巴结腺。肿瘤蔓延的最常见的位点包括骨骼，肺和脑。这是可怕的东西，但肯定的是，但有几条不同的路线治疗晚期肾癌。你所采取的道路将是您与医生讨论的事情。

“When a patient has metastatic kidney cancer, we review multiple factors to determine the best treatment options,” says Jorge A. Garcia, M.D., an assistant professor at the Case Western Reserve University School of Medicine and chief of solid tumor oncology, based in Cleveland, OH. These factors include where the cancer has spread, whether you have other health conditions, and what medications you’re taking. For example, you’ll want to tell your physician if you have an autoimmune condition, such as celiac disease or multiple sclerosis; if you’ve had an organ transplant; or if you’re taking a steroid or other medications that affect the immune system, says Sandy T. Liu, M.D., assistant professor, hematology-oncology at the David Geffen School of Medicine at UCLA in Los Angeles. All of these variables can reduce the likelihood that you’re a good candidate for immunotherapy, a broad category of drugs used to treat metastatic kidney cancer.

什么时候手术选择？

“虽然不常见，但有一些情况可能向转移性肾癌患者推荐手术，”芝加哥大学医学助理教授兰迪F. Sweis说。SWEIS博士说，一个例子是只有几个肿瘤蔓延，它们可以随时消除癌症或至少延长患者的目标，直到您需要进一步治疗。另一个例子是当存在肿瘤时导致疼痛或其他问题，例如出血或骨骼损坏。

“The decision for surgery in patients with metastatic kidney cancer requires a close discussion between the patient, medical oncologist, and surgeon,” says Moshe Ornstein, M.D., a kidney cancer medical oncologist at the Cleveland Clinic. In some cases where the cancer has spread to only a few body parts, Dr. Ornstein will first treat with immunotherapy for a few months and then determine (via computed tomography—CT scans) if the tumor has shrunk. “[I can then]重新考虑手术是否合适。这样我就不会不必要地将患者送到手术，但同时没有把它从桌子上取下。“

Medication Options: What Are Targeted Therapies?

There are two general types of medications doctors use to curtail or slow the growth of cancer cells or reduce the size of tumors. One is a category called targeted therapies. Most are given as pills, and they focus on (or target) specific proteins or other molecules found on the surface of or inside the cancer cell in order to battle the cancer. There are two main categories of targeted therapies: VEGF inhibitors (vascular endothelial growth factor) and mTOR (mammalian target of rapamycin) inhibitors. According to Dr. Liu: “VEGF inhibitors are the workhorse for kidney cancer treatment.” These drugs (such as cabozantinib and sunitinib) work by preventing blood vessels in and around the tumor from growing—something that’s necessary for cancer cells to multiply. Some of the most-common side effects include diarrhea, headaches, hair loss, numbness, or a stuffy nose.

MTOR抑制剂是药物（例如everolimus和Temsolorimus），其通过阻碍肿瘤细胞生长和分裂所需的蛋白质。但是，“mtor单疗法[A.K.A.单独拍摄，不与另一种药物相结合]is less effective than a VEGF inhibitor,” says Dr. Liu. Your doctor might prescribe this as a second line of treatment when other drugs aren’t working. Side effects include mouth sores, loss of appetite, fatigue, swelling in the arms or legs, or breathing problems.

Medication Options: How Can Immunotherapy Help?

除了我们刚覆盖的有针对性的疗法外，最常用于治疗晚期肾癌的其他第一线治疗是称为检查点抑制剂的免疫疗法。检查点抑制剂（如Nivolumab和Pembrolizumab）阻断“检查点” - 在T细胞表面（一种免疫细胞）表面上发现的特异性蛋白质。(Normally, when the T cell binds to a healthy cell, the checkpoint proteins allow the T cell to recognize it as “self” and, therefore, it doesn’t attack. But cancer cells can trick the immune system into accepting them as healthy cells.) With checkpoint inhibitors, when the T cell encounters the cancer cell, the checkpoint proteins are shut off, allowing the immune system to recognize the cancer cells as “foreign” and then destroy them. The side effects of checkpoint inhibitors include skin rash, joint pain, fatigue, or fever.

药物选择：什么是组合治疗？

如果您的医生用药物治疗您的疾病，那么它最有可能是有针对性疗法和免疫疗法的组合，它只是它听起来像的那样：两种不同的药物同时开。它可能是两种免疫疗法药物的组合或一种具有靶向治疗药物的一种免疫治疗药物的组合。像这种技术这样的医生因为当药物一起工作时，他们经常提高生存率。

根据刘博士的说法：“联合免疫疗法是在2021年治疗肾癌的主干。”她补充说，该处理的骨干是PD-1免疫疗法（如Nivolumab或Pembrolizumab），一种检查点抑制剂，其中，例如，Nivolumab可以与另一种检查点抑制剂（例如Ipilimumab）或Pembrolizumab组合可以与Axitinib组合，有针对性的治疗。（组合治疗中使用的一些药物是药丸，而其他药物需要输注静脉）。然而，组合治疗可以具有更大的阵列和副作用程度，因此医生可以向那些健康的人提供联合治疗。

如何管理药物副作用？

这一切都是关于保持与医生的开放式沟通。刘博士说，让你的医生解释前面的潜在副作用让你能够在寻找范围内，以便如果他们发生，你可以立即让你的医生知道。有很多方法可以处理副作用，包括减少剂量，将药物放在临时暂停，或使用其他药物来管理免疫相关副作用。

刘博士补充说：“拥有一支来自与免疫相关副作用的多学科团队也很重要[since]they can be very challenging to manage.” So in addition to your oncologist—your lead cancer doc and the expert when it comes to managing severe immune side effects—you might also have input from MDs who specialize in immunology, dermatology, infectious disease, and other subspecialties to help your oncologist treat your side effects.

What About Radiation Therapy?

放射疗法A.K.A.放射疗法涉及靶向用高剂量的X射线传播的肿瘤，这杀死癌细胞。通常，如果肿瘤很小并且没有蔓延到身体的许多地方，则完成该程序，也不能通过手术去除。

通常，身体外部的机器聚焦在肿瘤部位上的辐射，从而减少对周围组织的损伤。“辐射是[typically]用于大脑和骨转移，“M.D.Indistalo Medicesota Medical School大学和Minneapolis Meance Fairview的泌尿科医生Subodh Regmi说。副作用包括脱发，恶心，疲劳或皮肤发红。

......和消融治疗？

消融是一种避免对周围组织损害的治疗方法。它涉及使用极端寒冷（例如液氮）或热（由射频的能量波产生）纯度通过探针或针通过皮肤递送 - 以破坏肿瘤。Regmi博士说，消融治疗可以在身体的一部分中使用，如骨骼，在骨骼中不能进行手术以去除肿瘤。副作用可能包括疼痛和出血。

Bottom Line

任何时候癌症扩散,这是可怕的和先进的kidney cancer is no exception. The key is to get informed about the range of treatments available and to consider the options that might be right for your particular disease. And that means having an ongoing, open dialog with your doctor and asking all your questions—big and small. From an array of medication options to surgery, radiation or ablation, your outlook with advanced kidney cancer has never been better.

Meet Our Writer

珍珠的黑石

珍珠的黑石is a scientist and journalist with an eclectic background. She’s a nutritionist and exercise physiologist who regularly writes about travel, health, fitness, and food for numerous top-tier publications. Jeanine enjoys active travel, especially long-distance cycling and cross-country skiing.

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