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Interviewed experts: He Zhixuan, Deputy Director of the Institute of Urology, Peking University, Peking University, The First Hospital, Director of Urology, Professor
specializes in treatment: urology tumor diagnosis and treatment, as well as urology minimally invasive treatment
the first domestic treatment of urinary skin cancer immune tumor immune tumor immune tumor drug dillijuzumab was approved, rewriting the domestic late urinary tract skin cancer treatment for nearly 30 years without breakthrough pattern. Interestingly, there are five PD-1/PD-L1 immunocheckpoint inhibitors worldwide that have been approved by the FDA for the treatment of local late or metastatic urinary path skin cancer, why pD-1, PD-L1 have obtained indications on urinary path cancer?
urine road skin cancer many people are not familiar with, it actually refers to the upper skin structure from the kidneys exported to the urethra tumor, about 90% to 95% from the bladder, the typical symptom is urine blood. With common stones, urinary system infection caused by urine blood, urine on the road skin cancer blood is painless, will not be accompanied by urinary frequency, urinary urgency, urinary pain and other discomfort, urine blood is intermittent, sometimes no, with the disease aggravated the frequency of urine blood will be more and more, each urine blood will last longer and longer.
for O drug, K drug, dereliate zumas and other immunotherapy drugs, while the approved adaptability only urinary skin cancer, in Beijing University First Hospital urology master any Professor Zhixuan, one is from the urethra skin cancer itself, in the genetic test has a very important indicator called "tumor mutation load." It detects different tumors by means of second-generation sequencing, and the more new antigens are produced, the stronger the antigen, indicating that the body's immunity is more important to its recognition and killing ability. Of all the solid tumors, the urethra skin cancer is probably in the top three or four positions, so its tumor mutation load is higher, so PD-1, PD-L1 should have a better mechanism of action on it.
on the other hand, for the treatment of late-stage urinary tract skin cancer, which has occurred metastasis, in the past 30 years is almost a stable state, with cisplatin-based mature chemotherapy program, the objective mitigation rate can reach nearly 50%, the survival period of almost a year and a half, no new progress for many years. But in the failure of chemotherapy or chemotherapy intolerance, as well as renal dysfunction or patients old and infirm, can not tolerate platinum chemotherapy is likely to be drug-free, this time PD-1, PD-L1 can be a big show. Although the newly approved tetra-relitadrug appears after immunotherapy drugs abroad, it has made a unique modification of the antibody structure so that it cannot be combined with the Fc-R receptor on macrophages, thus eliminating the phagocytopharycation of antibody-dependent cell-mediated, and avoiding the effect of anti-tumor efficacy due to the reduction of T-cell population.Professor ho Chi-ho,
, stressed that immunotherapy and chemotherapy are not a substitute relationship, the mechanism of their function is different, hoping to achieve the effect of 1 plus 2. Because chemotherapy works quickly and violently, but it lasts for a short period of time, and immunotherapy is relatively slow, but it is effective for long-term.
in addition, because chemotherapy is acting in the cell growth cycle level, it is more directly trying to kill tumor cells, then killing tumor cells is easy to release new antigens, antigens by the body's immune system to identify, capture, and then the immune system attack, and PD-1, PD-L1 is to lift the suppression of the human immune. From this point of view, the combination of the two is very promising.
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