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免疫治疗不能延长已播散皮肤癌病人的生命 |
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作者：未知 文章来源：丁香园 点击数： 更新时间：2007-3-9 1:26:03  |
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The addition of immunotherapy to chemotherapy for malignant skin cancer that has spread does not improve survival rates, researchers have found, and patients have more serious side effects, such as anemia, when the two treatments are combined.
研究者发现，免疫疗法与化学治疗相结合治疗皮肤癌方法的流行没有改善患者的生存率，并且，两种疗法结合后使病人出现更为严重的不良反应比如贫血。
Malignant melanoma develops when cancer grows in the cells responsible for skin color, and is one of the most aggressive forms of skin cancer. Having unusual moles, exposure to sunlight and being fair-skinned are thought to place people at higher risk.
恶性黑色素瘤发生在若干个细胞水平时，会反应在皮肤颜色的变化上，这也是皮肤癌最具侵袭力的形式之一。具有较大的痣，接受阳光暴晒和较浅肤色者被认为是皮肤癌的高危人群。
The use of oral or injected chemotherapy drugs to kill melanoma cancer cells can be effective if the cancer is diagnosed early, but once it has spread metastasized it is almost always fatal.
如果早期诊断后应用口服或注射化疗药物以消灭黑素瘤恶性细胞是有效的，但是一旦发生远处转移则被认为是几乎可以致死的。
According to the National Cancer Institute, each year about 53,600 people in the United States are diagnosed with melanoma and 7,400 die from it. The incidence of melanoma has risen an alarming 3 percent a year since 1981, according to the Centers for Disease Control and Prevention.
据美国国立癌症研究所的数据，在美国被诊为黑素瘤的53,600人中会有7，4000人死于此病。据疾病控制和预防中心统计数据，黑素瘤的发生率自1981年以来以惊人的百分之三的速率增长。
Researchers have hoped that a combination of immunotherapy treatment that bolsters or stimulates patients' immune systems and chemotherapy might be an option for people with malignant melanoma.
研究者曾期望通过免疫治疗与化疗的结合而支持或刺激病人的免疫系统，从而使之成为恶性黑素瘤病人的治疗选择。
Authors led by Andre Sasse, M.D., at the research center Onco Evidencias in Sao Paolo, Brazil, reviewed 18 studies of 2,625 patients who were treated with either chemotherapy alone or a combination of chemo- and immunotherapy.
巴西圣保罗Onco Evidencias研究中心的学者在Andre Sasse医学博士的带领下，综述了针对2，625个病人的18项进行单独化疗或化疗与免疫治疗结合的研究。
"No difference was seen in survival rate and toxic effects were increased" when immunotherapy was added to chemotherapy, the researchers write.
研究者写道，当免疫治疗与化疗结合时，“未发现生存率的差异而毒性反应却增加了”。
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
综述刊登在Cochrane合作组织的出版物Cochrane图书馆的现刊杂志上，该组织为评估医疗研究的国际机构。考虑到现存同一课题医疗试验的内容和质量，通过系统回顾得出医疗实践的循证结论。
The review examined two kinds of immunotherapy combined with chemotherapy, interferon and interleukin-2. Of the 11 studies that reported on side effects from chemoimmunotherapy, eight showed blood disorders and flu-like symptoms resulting from the combined treatment. In four studies that used interleukin-2 without interferon, patients had more blood side effects after treatment.
综述验讫了结合化疗的2种免疫治疗方法，干扰素和白细胞介素-2。11项研究报告了化学免疫疗法的副作用，8项发生由于结合治疗而致的血液不良反应和感冒样症状。在4项研究中单独应用白介素—2治疗后病人发生更多的血液不良反应。
Jedd Wolchok, M.D., an oncologist at Memorial Sloan-Kettering Cancer Center, said that it is difficult to tease out which of the two immunotherapy agents might be responsible for the side effects to patients' blood.
Jedd Wolchok医学博士，Memorial Sloan-Kettering癌症中心的肿瘤专家，说很难剔出两个免疫治疗因子中哪一个导致了病人的血液不良反应。
"Both immunotherapies have considerable side effects," Wolchok said. "Interleukin-2 is likely more difficult since it can lower blood pressure and cause fluid to build up in the body. These side effects are a consequence of what these immune hormones were originally designed to do for example, interferon is a natural antiviral agent, so the fact that it causes flu-like symptoms very commonly is not a surprise."
“两种免疫治疗均具有相应较显著的不良反应”，Wolchok说，“由于白介素-2可以降低血压和促进液体在体内积聚，似乎更少一些。这些不良反应是免疫激素原始作用的结果，例如，干扰素是天然抗病毒因子，因此它通常引起感冒样症状就不足为奇了。”
Sasse said, "The interleukin is more toxic and needs hospitalization for its administration. It is also known to promote more systemic reactions than interferon. But the adverse effects of either drug are dose dependent."
Sasse说，“白细胞介素更具毒性，需住院应用。比及干扰素更能导致全身反应。但是任一药物的不良反应均属剂量依赖性的。”
Wolchok said, "This area should definitely continue to be investigated. My hypothesis is that chemotherapy may be used to modulate and potentiate newer immunotherapy drugs."
Wolchok说，“这一领域需要持续地进行研究。我的假想是化疗能用调整和使新的免疫治疗药物成为可能。”
Sasse, however, said, "There are some controversies about the use of chemotherapy in advanced melanoma the chemotherapy does not save lives and additionally, there is doubt that it prolongs the survival of these patients."
Sasse说，“无论如何，对于晚期黑色素瘤病人应用化疗存在争议，化疗不能挽救生命并且对于延长生存期尚有疑问。”
"My opinion is that there are enough studies in this subject and therefore, no need of new trials," Sasse added. "At the moment, the focus should be given to the development of new therapeutic approaches to melanoma." He cited advances in molecular biology and the carcinogenesis of melanoma as possible avenues for new treatment in the future.
“我的观点是关于此课题已经有足够的研究，因此不需要开展新的试验，”Sasse补充道。“目前焦点应集中在发展针对黑色素瘤的新的治疗策略。”他引证黑色素瘤分子生物学和发生机制的进展说明未来新可能的治疗前景。
Sasse AD, et al. Chemoimmunotherapy versus chemotherapy for metastatic malignant melanoma (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.
Sasse AD,等。化学免疫治疗对比化学治疗转移性恶性黑色素瘤（综述）。Cochrane Database of Systematic Reviews 2007, 第1期 .
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
Cochrane合作组织是国际性非盈利、独立组织，生产和传播关于卫生保健干预和促进搜索临床试验证据及其他研究干预的系统性综述。请访问http://www.cochrane.org以获得更多信息。
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