肝癌科普课堂【第八期】：肝癌的靶向药治疗方式（一）
觅友们，下午好。和大家说了好几期的基础知识，今天该进阶啦。所以，这一节的科普课程，互助君和大家聊聊如何治疗肝癌：
【肝癌科普】第八期：肝癌的靶向治疗（一）
一、肝癌的靶向药有哪些？
1、索拉非尼
乐伐替尼或者E7080，是一款多靶点的酪氨酸激酶受体抑制剂。同样获批用于治疗晚期肝癌的一线靶向药，它的出现改变了肝癌一线治疗药物少的尴尬局面，为肝癌患者提供了其他的选择。","0:"#3f3f3f""],[20,"n","24:"0cLQ"|7:3"],[20,"n","24:"29Pi"|7:3"],[20,"仑伐替尼的临床试验效果显示，使用仑伐替尼治疗组的中位OS为13.6个月（索拉非尼对照组为12.3个月），中位FPS为7.3个月，中位TTP为8.9个月，ORR为24%。","0:"#3f3f3f""],[20,"n","24:"pSMA"|7:3"],[20,"n","24:"qmDP"|7:3"],[20,"是否进医保：","0:"#3f3f3f"|27:"11"|8:1"],[20,"已进医保，价格为3240元/盒。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"Pl9X"|27:"11"|7:3|bullet-id:"JPTW"|bullet:"circle""],[20,"肝癌患者是否可以报销：","0:"#3f3f3f"|27:"11"|8:1"],[20,"是","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"wffk"|27:"11"|7:3|bullet-id:"JPTW"|bullet:"circle""],[20,"医保报销适应症为：","0:"#3f3f3f"|27:"11"|8:1"],[20,"限既往未接受全身系统治疗的不可切除的肝细胞癌患者","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"L7a4"|27:"11"|7:3|bullet-id:"JPTW"|bullet:"circle""],[20,"n","24:"kq8b"|7:3"],[20,"3、瑞戈非尼","8:1"],[20,"n","24:"2Opz""],[20,"n","24:"uAkt"|7:3"],[20,"是一种口服多激酶抑制剂，首款获批二线治疗既往接受过索拉非尼治疗进展后晚期HCC患者。","0:"#3f3f3f""],[20,"n","24:"Kt3v"|7:3"],[20,"n","24:"cpzT"|7:3"],[20,"RESORCE结果显示，瑞戈非尼可显著延长患者的中位OS为10.7个月（对照组为7.8个月），ORR为10.6%，DCR（疾病控制率）为65%，可减低38%的死亡风险。","0:"#3f3f3f""],[20,"n","24:"HRPU"|7:3"],[20,"n","24:"FLiJ"|7:3"],[20,"是否进入医保：","0:"#3f3f3f"|27:"11"|8:1"],[20,"已进医保，价格为5488元/盒。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"SNJ4"|27:"11"|7:3|bullet-id:"ZCRe"|bullet:"circle""],[20,"肝癌患者是否可以报销：","0:"#3f3f3f"|27:"11"|8:1"],[20,"是。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"2hVf"|27:"11"|7:3|bullet-id:"ZCRe"|bullet:"circle""],[20,"医保报销适应症为：","0:"#3f3f3f"|27:"11"|8:1"],[20,"用于治疗既往接受过索拉非尼治疗的肝细胞癌（HCC）患者。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"1qsd"|27:"11"|7:3|bullet-id:"ZCRe"|bullet:"circle""],[20,"n","24:"zQLw"|7:3"],[20,"4、卡博替尼","8:1"],[20,"n","24:"wkgu""],[20,"n","24:"enA6"|7:3"],[20,"俗称XL184，也是一款多靶点的光谱抗癌药。2019年1月在美国获批用于治疗先前经索拉非尼治疗过的HCC患者。","0:"#3f3f3f""],[20,"n","24:"nUnU"|7:3"],[20,"n","24:"f9Cy"|7:3"],[20,"Ⅲ期临床试验CELESTIAL结果显示，卡博替尼组的中位OS为10.2个月（对照组为8.0个月），中位PFS为5.2个月，ORR为4%，DCR为64%。","0:"#3f3f3f""],[20,"n","24:"ALSd"|7:3"],[20,"n","24:"vo0t"|7:3"],[20,"是否进入医保：","0:"#3f3f3f"|27:"11"|8:1"],[20,"否。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"kAXq"|27:"11"|7:3|bullet-id:"ZCRe"|bullet:"circle""],[20,"n","24:"l1IR"|7:3"],[20,"5、雷莫芦单抗","8:1"],[20,"n","24:"Nzy3""],[20,"n","24:"15vl"|7:3"],[20,"2019年5月，美国FPA批准了雷莫芦单抗用于二线治疗基线AFP≥400ng/ml，既往接受过索拉非尼治疗进展后晚期HCC患者（国内未获批）。","0:"#3f3f3f""],[20,"n","24:"t587"|7:3"],[20,"n","24:"md3B"|7:3"],[20,"临床试验效果显示，雷莫芦单抗组的中位OS为8.5个月（对照组为7.3个月），中位PFS为2.7个月，ORR为4.6%，DCR为59.9%。","0:"#3f3f3f""],[20,"n","24:"RQ2s""],[20,"n","24:"jcfI""],[20,"是否进入医保：","0:"#3f3f3f"|27:"11"|8:1"],[20,"否。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"E0kW"|27:"11"|7:3|bullet-id:"ZCRe"|bullet:"circle""],[20,"n","24:"lMNJ""],[20,"6、","8:1"],[20,"阿帕替尼","0:"#3f3f3f"|8:1"],[20,"n","24:"MXmD"|7:3"],[20,"n","24:"YPZA"|7:3"],[20,"2020年12月31日在我国获批用于治疗既往接受过至少一线系统性治疗后失败或不可耐受的晚期肝细胞癌（HCC），","0:"#3f3f3f""],[20,"是肝癌的二线治疗","0:"#dc7a23"|8:1"],[20,"。","0:"#3f3f3f""],[20,"n","24:"unE2"|7:3"],[20,"n","24:"X8nm"|7:3"],[20,"2020ASCO大会，公布了阿帕替尼用于晚期HCC二线及以上治疗的Ⅲ期临床研究结果，结果显示阿帕替尼组中位总生存期（mOS）为8.7个月，高于安慰剂组的6.8个月。","0:"#3f3f3f""],[20,"n","24:"S2xS"|7:3"],[20,"n","24:"IR0k"|7:3"],[20,"是否进医保：","0:"#3f3f3f"|27:"11"|8:1"],[20,"已进医保，价格为1150元/盒（250mg，10片装）。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"FD27"|27:"11"|7:3|bullet-id:"qpqI"|bullet:"circle""],[20,"肝癌患者是否可以报销：","0:"#3f3f3f"|27:"11"|8:1"],[20,"否。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"uBs2"|27:"11"|7:3|bullet-id:"qpqI"|bullet:"circle""],[20,"阿帕替尼无肝癌的医保适应症，肝癌患者无法经过医保报销。","0:"#3f3f3f"|27:"11"|8:1"],[20,"n","0:"#3f3f3f"|24:"z7Fq"|27:"11"|7:3|bullet-id:"qpqI"|bullet:"circle""],[20,"n","24:"J1vo""],[20,"n","24:"BYpN"|7:1"],[20,"二、靶向药物的不良反应及处理方式","8:1"],[20,"n","24:"wgge"|7:1"],[20,"n","24:"QnQF""],[20,"1、皮疹","8:1"],[20,"n","24:"xvW0""],[20,"n","24:"nzkD"|7:3"],[20,"皮疹是肝癌靶向药物EGFＲ抑制剂“索拉非尼”的常见不良反应，","0:"#3f3f3f""],[20,"发生率高达79%～88%","0:"#dc7a23"|8:1"],[20,"。多表现为痤疮样皮疹、皮肤脱屑、皮肤干燥瘙痒等。","0:"#3f3f3f""],[20,"n","24:"ysMW"|7:3"],[20,"n","24:"Cjef"|7:3"],[20,"针对这些不良反应，患者平时应注意护理，避免抓挠，尽量避免日晒，预防感染。对于局部皮肤受损，症状轻微的患者，推荐使用皮肤外用药，如","0:"#3f3f3f""],[20,"皮质激素、四环素","0:"#494949"|8:1"],[20,"和","0:"#3f3f3f""],[20,"皮肤保湿剂","0:"#494949"|8:1"],[20,"等。","0:"#3f3f3f""],[20,"n","24:"923y"|7:3"],[20,"n","24:"cNVU""],[20,"2、腹泻","8:1"],[20,"n","24:"8GPc""],[20,"n","24:"RlY7"|7:3"],[20,"服药两三周后常会出现腹泻的症状，但大多数人只是轻度腹泻，不会对生活造成严重的影响，有一部分人可能会出现中度或重度腹泻。","0:"#3f3f3f""],[20,"n","24:"Nu7g"|7:3"],[20,"n","24:"7jtu""],[20,"腹泻的严重程度划分为三级","0:"#dc7a23"|8:1"],[20,"：","0:"#dc7a23""],[20,"n","24:"mAEV"|7:3"],[20,"n","24:"5UX9"|7:3"],[20,"轻度腹泻：不成形大便不多于每日3次，相关临床症状轻微。","0:"#3f3f3f""],[20,"n","24:"nXLJ"|7:3"],[20,"中度腹泻：不成形大便达到每日4-6次，可伴有全身症状。","0:"#3f3f3f""],[20,"n","24:"6xn7"|7:3"],[20,"重度腹泻：不成形大便多余每日6次，或体温38.5℃、里急后重、血便、或便中检出脓细胞。","0:"#3f3f3f""],[20,"n","24:"aFQC"|7:3"],[20,"n","24:"4eMw""],[20,"日常护理需从这几方面入手：","8:1"],[20,"n","24:"LkcI""],[20,"n","24:"2NTA""],[20,"n","24:"sST7""],[20,"少食多餐，多吃清淡和流质的食物，如牛奶、粥等，并且补充足够的水分；","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"VJej"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"常用的对症治疗药物有易蒙停和泄特灵，一出现腹泻即需对症用药；","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"PHVQ"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"腹泻严重者应当禁食，通过静脉补充营养和水分；","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"hcEU"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"排便次数过多，需时常用温水清洁臀部和肛门周围，避免皮肤损害和感染；","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"Gjxx"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"多注意腹部的保暖，可用暖水袋热敷；","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"DlTO"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"严重腹泻易导致脱水，可以补盐、糖水，检测补充电解质，以免发生肝性脑病，危及生命。","0:"#3f3f3f"|27:"11""],[20,"n","0:"#3f3f3f"|24:"AaAm"|27:"11"|7:3|bullet-id:"z00z"|bullet:"circle""],[20,"n","24:"nPlt""],[20,"3、恶心呕吐","8:1"],[20,"n","24:"zthA""],[20,"n","24:"APGU"|7:3"],[20,"在靶向药治疗时，药物的毒副作用会对胃肠道产生很多不良营养，造成患者消化道的不良反应，","0:"#3f3f3f""],[20,"如食欲不振、恶心、呕吐","0:"#dc7a23"|8:1"],[20,"。然而因恶心呕吐，患者对摄入食物的欲望愈发降低，循环往复，身体机能难以正常支撑。","0:"#3f3f3f""],[20,"n","24:"Imr6"|7:3"],[20,"n","24:"S6Mj"|7:1"],[20,"出现此类状况，最正确的是对症处理，依据自身的肝功能情况适量补充高蛋白，选用高蛋白、高热量食物，少食多餐。中度患者可以使用","0:"#3f3f3f""],[20,"胃复安、地塞米松","0:"#dc7a23"|8:1"],[20,"控制恶心呕吐，也可使用","0:"#3f3f3f""],[20,"甲氧氯普胺","0:"#dc7a23"|8:1"],[20,"增加胃动力，严重时可以服用 ","0:"#3f3f3f""],[20,"5 - HT3","0:"#dc7a23""],[20,"受体拮抗剂进行治疗。","0:"#3f3f3f""],[20,"n","24:"jTrY"|7:3"],[20,"n","24:"I7cN""],[20,"4、乏力","8:1"],[20,"n","24:"db8j""],[20,"n","24:"xE7n"|7:3"],[20,"乏力是用药后的常见症状，不少使用过索拉非尼和瑞戈非尼的患者都出现过乏力和疲劳的全身性症状。与平常人的乏力疲劳不同的是，癌症患者一旦出现乏力与疲劳后，","0:"#3f3f3f""],[20,"更容易情绪低落","0:"#dc7a23""],[20,"，其相关性的乏力程度也更加严重。即使有充足的睡眠和休息也很难完全缓解，并且这种","0:"#3f3f3f""],[20,"乏力感会持续很长时间","0:"#dc7a23""],[20,"。","0:"#3f3f3f""],[20,"n","24:"QxIX"|7:3"],[20,"n","24:"OMNZ""],[20,"对于乏力的最佳处理办法仍是需转变自身的健康观念，加之合理适量的运动。","0:"#3f3f3f""],[20,"以健康的作息、均衡的饮食和适量的运动抵抗癌症带来的乏力感","0:"#dc7a23"|8:1"],[20,"，如每周2-3次、每次30分钟的散步，不要因过长时间的运动或游戏消耗自身体力，加重乏力的状况。","0:"#3f3f3f""],[20,"n","24:"GxAg"|7:3"],[20,"n","24:"L7gS""],[20,"5、手足综合症","8:1"],[20,"n","24:"RQce""],[20,"n","24:"DC8i"|7:3"],[20,"部分患者会在手掌和足底出现","0:"#3f3f3f""],[20,"红斑、红肿、脱皮、角化、红肿疼痛","0:"#dc7a23""],[20,"等症状，甚至可能","0:"#3f3f3f""],[20,"手足麻木","0:"#dc7a23""],[20,"，症状逐渐加重，严重者会出现溃疡、水泡、疼痛，严重影响日常生活。","0:"#3f3f3f""],[20,"n","24:"wRdv"|7:3"],[20,"n","24:"3net"|7:3"],[20,"服用靶向药期间需注意日常手足皮肤护理，避免用冷水洗手足，穿着宽松透气的鞋子，可使用维生素B6防止手足症状发生。一旦出现手足综合征，需减轻疼痛，可使用","0:"#3f3f3f""],[20,"尿素软膏和水杨酸制剂","0:"#dc7a23"|8:1"],[20,"防止脱皮。","0:"#3f3f3f""]]" style="color: #3F3F3F;">也是肝癌的一线靶向治疗用药之一。
是否可以报销：是。
付费价格：
医保报销的适应症为：
2、仑伐替尼
乐伐替尼、E7080
是否可以报销：是。
付费价格：
医保报销的适应症为：
3、瑞戈非尼
是否可以报销：是。
付费价格：
医保报销适应症为：
4、卡博替尼
是否进入医保：
5、雷莫芦单抗
是否进入医保：
6、阿帕替尼
是肝癌的二线治疗
是否进医保：
肝癌患者是否可以报销：
阿帕替尼无肝癌的医保适应症，肝癌患者无法经过医保报销。
二、靶向药物的不良反应及处理方式
1、皮疹
发生率高达79%～88%
皮质激素、四环素皮肤保湿剂
2、腹泻
腹泻的严重程度划分为三级
日常护理需从这几方面入手：
3、恶心呕吐
如食欲不振、恶心、呕吐
胃复安、地塞米松甲氧氯普胺
4、乏力
更
以健康的作息、均衡的饮食和适量的运动抵抗癌症带来的乏力感
5、手足综合症
尿素软膏和水杨酸制剂
以上就是肝癌科普课堂的第八节课啦！
虽然有点难，但是认真学习，还是会有收获的！
到月底，互助君会出题来考考大家，看看大家掌握的怎么样~
如果觅友们有什么想要了解的内容，也可以留言评论，互助君会努力去准备的！
就酱，大家下期见。
收藏
回复(0)参与评论
评论列表
