PDF

摘要/Abstract

摘要：

头颈部鳞状细胞癌（squamous cell carcinoma of the head and neck，SCCHN）是最常见的一类头颈部肿瘤。由于早期症状不典型，大多数SCCHN患者确诊时已处于局部晚期。以标准剂量顺铂为基础的同期放化疗（chemoradiotherapy，CRT）是局部晚期SCCHN患者的标准非手术治疗模式。但同期CRT的近期和远期毒性问题不容忽视，对于无法耐受标准治疗强度的患者，在治疗策略的选择上要兼顾疗效、器官毒性和器官功能。几乎所有的SCCHN都会存在表皮生长因子受体（epidermal growth factor receptor，EGFR）过表达。抗EGFR单抗通过与EGFR结合，竞争性阻断内源性EGFR天然配体，阻碍EGFR二聚体的形成，抑制肿瘤细胞生长；此外，抗EGFR单抗可通过影响细胞周期、DNA损伤修复及血管生成等多种途径发挥放疗增敏作用。既往Ⅲ期临床研究表明，对比单纯放疗，放疗联合西妥昔单抗可显著改善局部晚期SCCHN患者的局部区域控制，延长总生存期。临床工作中合理地应用抗EGFR单抗仍面临诸多挑战，包括适用人群的判定标准、应用时机、联合方案的选择及不良事件管理等都需要进一步明确和规范。本共识专家组以循证医学证据为基础、相关指南为依据，经充分讨论形成《抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）》。根据本共识的专家建议，局部晚期SCCHN患者在同期CRT前，应评估患者对标准剂量顺铂治疗的耐受性和治疗毒性。对于无法耐受标准剂量顺铂治疗的患者，或在接受多西他赛+顺铂+5-氟尿嘧啶（TPF）方案诱导化疗后出现顺铂相关毒性的患者，可选择放疗联合西妥昔单抗方案。对于有降期或器官功能保留需求、拟行诱导治疗的患者，标准诱导治疗方案为TPF方案，不能耐受TPF方案毒性的患者，可用西妥昔单抗替代5-氟尿嘧啶，采用TPE方案。安全性方面，放疗联合西妥昔单抗相关常见不良反应包括痤疮样皮疹、口腔黏膜炎、放射性皮炎等，可以通过治疗前预防、治疗过程中早期识别和及时干预进行全面、分级管理。

关键词: 抗EGFR单抗, 局部晚期, 头颈部鳞状细胞癌, 临床共识

Abstract:

Squamous cell carcinoma of the head and neck (SCCHN) is the most common head and neck tumor. Patients are generally diagnosed with advanced stage attributed to no clinically evident symptom at the early stage. For locally advanced SCCHN, cisplatin-based concurrent chemoradiotherapy (CRT) is the standard non-surgical treatment. However, the tolerance to high-dose cisplatin is poor owing to the high prevalence of comorbidities in patients with SCCHN. There are also concerns on the acute and late toxicities of CRT. Epidermal growth factor receptor (EGFR) is proved to be overexpressed in most SCCHN and it is associated with resistance to cytotoxic agents and radiotherapy leading to poor prognosis. Anti-EGFR antibody, which competes with EGFR ligands, can lead to receptor internalization, antibody-receptor complex down-regulation and tumor death. In addition, anti-EGFR antibody can play a role in radiosensitization by affecting cell cycle, DNA damage repair and angiogenesis. Radiotherapy combined with anti-EGFR antibody was demonstrated to improve survival when compared to radiotherapy alone, while consensus on anti-EGFR antibody delivery in the eligible patients, optimal intervention time and the management of adverse effects when combined with radiotherapy are yet warranted. According to the current recommendations, all patients with locally advanced SCCHN should be assessed for the tolerance of standard dose cisplatin prior to CRT. Radiotherapy with cetuximab is an alternative for patients who cannot tolerate. For those who received induction chemotherapy with the purpose of tumor downstaging or organ preservation, the standard regimen is TPF (docetaxel+cisplatin+5-fluorouracil) scheme. TPE scheme, using cetuximab as a substitution for fluorouracil, is an option for toxicities reducing. Managements of skin reactions, oral mucositis and radiation dermatitis are proposed.

Key words: Anti-EGFR monoclonal antibody, Locally advanced, Squamous cell carcinoma of the head and neck, Clinical consensus

中图分类号:

R739.91

许婷婷, 胡超苏, 李宝生. 抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）[J]. 中国癌症杂志, 2023, 33(1): 81-94.

XU Tingting, HU Chaosu, LI Baosheng. Clinical consensus on the treatment of locally advanced squamous cell carcinoma of the head and neck with anti-EGFR monoclonal antibody (2023 edition)[J]. China Oncology, 2023, 33(1): 81-94.

导出引用管理器 EndNote|Reference Manager|ProCite|BibTeX|RefWorks

链接本文: http://www.china-oncology.com/CN/10.19401/j.cnki.1007-3639.2023.01.010

http://www.china-oncology.com/CN/Y2023/V33/I1/81

[1]	庄晗, 凌池芳, 王佳舟, 韩序, 姜睿, 胡伟刚. 局部晚期胰腺癌75 Gy同步加量放射治疗的剂量可行性研究[J]. 中国癌症杂志, 2023, 33(1): 54-60.
[2]	孙迪, 孙郁青, 张鑫, 黄丽莎, 林岩松. 局部晚期或转移性儿童及青少年分化型甲状腺癌的基因特征与临床特征及¹³¹I疗效的关系[J]. 中国癌症杂志, 2022, 32(5): 380-387.
[3]	马光, 区晓敏, 胡超苏, 宋少莉, 杨忠毅. 治疗前¹⁸F-FLT和¹⁸F-FDG PET/CT摄取异质性在局部晚期鼻咽癌疗效预测中的价值[J]. 中国癌症杂志, 2022, 32(4): 309-315.
[4]	郭　晔, 张陈平 . 抗EGFR单抗治疗复发/转移性头颈部鳞状细胞癌临床共识（2021年版）[J]. 中国癌症杂志, 2021, 31(12): 1220-1232.
[5]	卢大松, 冯勇军, 王武峰, 牟忠林, 赵　娜. 个体化营养干预对局部晚期鼻咽癌患者生活质量及生存预后的影响[J]. 中国癌症杂志, 2021, 31(12): 1202-1208.
[6]	沈　洁, 莫　淼, 袁　晶, 周昌明, 王泽洲, 张志红, 温　灏, 吴小华, 郑　莹 . 1 313例局部晚期宫颈癌患者的长期生存报告：以医院为基础的真实世界研究[J]. 中国癌症杂志, 2020, 30(3): 192-198.
[7]	郑营营,徐俊彦,张建平,等. ¹⁸F-FDG PET/CT纹理分析预测局部晚期直肠癌新辅助放化疗疗效的价值[J]. 中国癌症杂志, 2018, 28(8): 590-594.
[8]	刘晓文,龙子雯,蔡　宏,等. 局部进展期胃癌术前化疗与术前放化疗的对比研究[J]. 中国癌症杂志, 2018, 28(10): 762-768.
[9]	刘晓文,龙子雯,蔡宏,等. 表柔比星联合奥沙利铂及氟尿嘧啶的化疗方案提高局部进展期胃癌根治性手术机会的研究[J]. 中国癌症杂志, 2017, 27(11): 890-895.
[10]	马雄辉,梁彩霞,江丹贤,等. TPF诱导化疗或PF诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的临床观察[J]. 中国癌症杂志, 2016, 26(12): 1018-1024.
[11]	郭晔. 局部晚期头颈部鳞癌的靶向治疗进展[J]. 中国癌症杂志, 2013, 23(12): 949-953.

抗EGFR单抗治疗局部晚期头颈部鳞状细胞癌临床共识（2023年版）

PDF

摘要/Abstract

引用本文

使用本文

相关文章