[ILCA2014]肝癌临床试验与综合治疗研究进展——大会主席Peter R. Galle访谈
专家简介:Peter R. Galle, MD, PhD,世界肝癌学会(ILCA)主席,美国肝病研究学会(AASLD)、欧洲肝脏研究学会(EASL)成员,Journal of Hepatology杂志编委。
《肿瘤瞭望》:作为大会主席,您如何评价今年的这次会议?
Prof. Galle:我认为这次会议举办得非常成功。今年我们预计参会人数在700~800人左右。从目前的注册人数来说非常乐观。
<International Hepatology>: Professor, thank you for speaking with us today. As president of the ILCA how do you feel so far about this year’s conference?
Prof. Galle : I think it has been very successful. We expect to have something like 700 to 800 participants and the perception so for has been very good.
《肿瘤瞭望》:据了解,在ILCA年会前您主持召开了一个由多位肝病学界著名学者参加的工作会议。通过这个会前会,您给我们带来哪些重要信息?
Prof. Galle:这次会前会上有许多亮点。一方面,我们召开了一个关于临床试验设计的讨论会。之所以重点讨论肝癌临床试验设计的问题,是由于近几年来的7项Ⅲ期临床试验中,多数都宣告失败。这引起了我们的高度关注,并达成了一份共识性文件。在会上,我们进行了密切地讨论,取得了非常大的成果,并有望将其写入最新的指南当中。另一方面,我们针对目前临床上具有争议的焦点话题,邀请各方专家进行了精彩的现场辩论。例如,目前肝切除术的手术切除范围的问题,目前在东西方存在很大的争议,东方学者倾向于扩大手术治疗,而在西方则相对保守。
<International Hepatology>: So far has there been any particular take home messages in any particular areas of either agreement or disagreement that are particularly worth thinking about?
Prof. Galle:Well there are a couple of highlights. One thing is we had a workshop on clinical trial design because we have seen quite a few failures in recent years among 7 phase III trials, which has been the topic of our workshop and that resulted in a consensus paper. That was a very intense discussion which we had yesterday and it was very fruitful and hopefully it reflects recent guidelines. Then we tried to capture all the controversies, for example, particularly here in Asia, the extent of resection. There is more in Asia and less in Europe and this is an ongoing discussion and I think it has been very fruitful.
《肿瘤瞭望》:您在大会中做了一项关于肝癌综合治疗模式的报告。请您谈谈您心中最理想的综合治疗模式是怎样的?
Prof. Galle:截至目前来说,基本上还没有建立起肝癌的综合治疗模式,直到我们在宏观上能把患者的疾病进展与手术治疗的疗效看作是一个整体,在治疗策略上精心设计,合理布局。例如,我们按部就班地在一开始对患者进行TACE治疗,接下来又进行其他治疗,最后我们只好考虑全身化疗。这种情况下我们很难说的综合治疗模式真正确立起来了。当然,我们也可以说它是一种序贯性治疗。通常,我们倾向于给患者所有可能的治疗手段,事实也是如此。然而大多数患者还是进展到晚期,他们并没有从所有的治疗选择中得到真正的获益。
<International Hepatology>:To address some more specific questions, what in your opinion is the optimal pattern of multimodality treatment for HCC?
Prof. Galle:Well there is basically no multimodality treatment established so far unless you consider it as a sequence of events for new patients as they migrate from stage to stage and the effects they get from surgery. In the beginning you get TACE and later on in the end you get systemic treatment but multimodality or the combination of treatments has not yet been established.
It is a sequential treatment options of course. You like to offer the patients all of what is available and in some cases this is indeed taking place, however as the majority of the patients are still captured late, the patients typically are not really getting the opportunity through all the treatment options.
《肿瘤瞭望》:您是否有进行患者分层的相关研究,筛选出可以从综合治疗获益的患者?
Prof. Galle:我们正在进行这方面的研究,将局部消融术/TACE联合全身化疗治疗联合,然而目前这项临床试验进行得并不顺利。
<International Hepatology>:Are there still groups of patients who are suitable for being picked for these multimodality trials?
Prof. Galle:We are investigating this. The combination of the local ablation or the TACE plus systemic therapy is an ongoing topic however the clinical trials that have been performed so far have not been particularly successful.
《肿瘤瞭望》:您认为这当中的主要问题是什么?
Prof. Galle:主要问题是联合治疗,尤其是TACE联合全身化疗,只在一部分亚组的患者中有效。这意味着可能仅用这两种治疗手段的联合模式不太容易达到效果。
<International Hepatology>:What have been the main difficulties do you think?
Prof. Galle: The problem is that the combinational therapy, particularly TACE and systemic therapy, has only been successful in subgroups. What it means properly is that it is not easy to treat patients with the 2 modes of therapy. It is physical and it can be beneficial for the patient but on average it is not resulting in a benefit.
《肿瘤瞭望》:您如何看未来几年有关综合治疗研究的进展?
Prof. Galle:我认为全身化疗对于晚期肝癌患者来说是一个选择,也可联合TACE治疗以减轻局部肿瘤对机体的负担。以上这仅是我个人观点,目前它还没有得到全面地研究,然而却是值得深入探讨的。
<International Hepatology>:In terms of the near future, is it just to keep going and see how it goes or are you thinking in pursuing other avenues?
Prof. Galle:I consider to an option is to be to use systemic therapy in advanced stages and add space in order to control the local tumor burden in the body. That is for me an option which has not been thoroughly investigated and is worthwhile to do so.