美国国家公共电台 NPR Old-Style Chemo Is Still A Mainstay In The Age Of Targeted Cancer Therapy

 

DAVID GREENE, HOST:

Today in Your Health, we're taking a close look at chemotherapy. It's been a mainstay of cancer treatment for decades, but that method is slowly being edged aside in medical research as new treatments, like immunotherapy, grab the spotlight¹.

This is not the end of the road for chemotherapy, though. For one thing, doctors are coming to realize that some of these drugs are useful for more than just killing² cancer cells. NPR's Richard Harris has the story.

RICHARD HARRIS, BYLINE³: For Dr. Robert Comis, the first inkling that chemotherapy drugs did more than simply kill cancer cells came during a study 30 years ago. It combined chemo with radiation therapy, and some patients did surprisingly well even though they had nothing like a full course of chemotherapy.

ROBERT COMIS: Well, how could these two cycles of chemotherapy mean anything? And the only explanation was that there was this large effect that it involved the whole body.

HARRIS: Comis, at the ECOG-ACRIN Cancer Research Group in Philadelphia, realized that chemotherapy wasn't simply killing cancer cells. It was apparently⁴ stimulating⁵ the patients' immune systems.

COMIS: And lo and behold⁶ now, 30 years later, that's probably the explanation for what we saw then.

HARRIS: Chemotherapy is still used a lot for its ability to kill cancer cells, even in clinical trials that involve next-generation treatments like immunotherapy. Sometimes, fast-acting chemotherapy can help slow an aggressive cancer and give the slower-acting immunotherapy treatments a chance. For instance, researchers at Johns Hopkins are testing out new immunotherapy agents paired with traditional chemotherapy.

DEVON ISAAC: So how have you been since last treatment?

DEBORAH MAZIA: Fine, except - you know, I had the cold. I don't anymore.

ISAAC: OK, good.

MAZIA: I was pretty exhausted⁷.

ISAAC: OK.

HARRIS: Deborah Mazia has volunteered for a study of the Hopkins hospital in Baltimore.

ISAAC: All right. Your vital signs look good. Your heart rate's a little high, but I'm guessing that's because we're on the radio.

(LAUGHTER)

HARRIS: After nurse Devon Isaac leaves to check on the status of Mazia's infusion⁸, the 69-year-old Maryland woman tells her story. Around Thanksgiving, she noticed a lump in her breast and swelling⁹ under her arm.

MAZIA: So my daughter said - 'cause I thought maybe it's nothing. There's no cancer in my family, no nothing. So she said, I think you should get it checked out.

HARRIS: The news was bad. Her doctor told Mazia that she had triple-negative breast cancer. That's a cancer that responds poorly to conventional treatment.

MAZIA: So she held my hand. And she goes listen, it's stage 4. And if you want to do anything, do it now.

HARRIS: So Mazia ended up here in a trial that combines a potent¹⁰ chemotherapy drug with either an immunotherapy agent or a placebo¹¹.

MAZIA: And it's a double-blind study, which means I don't know if I'm getting the immunotherapy or I'm getting a placebo.

HARRIS: How does that feel, sort of being part of an experiment where you're not even sure what you're getting?

MAZIA: I don't care. I'm excited 'cause I think that this is, like, where things are going researchwise. So I'm thrilled.

HARRIS: Immunotherapy sometimes produces dramatic results. But most of the time, it doesn't work at all. So for a clinical trial like this, it makes sense to give standard chemotherapy along with the experimental treatment.

Dr. Leisha Emens, who's running this study, says she and her colleagues are also exploring the underappreciated role of chemotherapy agents - and that is their ability to affect the immune system.

LEISHA EMENS: And in fact, it can either help or hurt the immune response to cancer.

HARRIS: She's interested in the helpful part, of course. Certain chemotherapy drugs can kill T-cells. These immune system cells can make cancers more resistant¹² to treatment. It also appears that after chemotherapy kills cancer cells, the debris¹³ that's left over can sometimes stimulate¹⁴ an immune reaction that targets the remaining cancer cells.

EMENS: Where you sort of get a vaccine-like effect.

HARRIS: And Emens says, in some cases, doctors can use lower doses of these highly toxic¹⁵ and often unpleasant drugs.

EMENS: These lower doses of chemotherapy are not designed to treat the cancer directly the way you typically think of chemotherapy. But they're designed specifically to harness the immune system.

HARRIS: The interplay of immunity¹⁶ and chemotherapy is an active area of research with effects dependent on the specific drugs and dosages.

EMENS: So we really need to learn more about all of these different types of standard cancer drugs and how they interact with the immune system in order to harness their ability to synergize with immunotherapies most effectively.

HARRIS: The National Cancer Institute is focusing research dollars on that question. They're also phasing out traditional studies that involve only chemotherapy drugs. For decades, they'd been funding research to find new combinations and doses and have made incremental¹⁷ improvements in cancer treatments.

Dr. Elad Sharon at the cancer institute says there's a natural shift toward the next frontier of cancer treatments, so-called targeted therapies. Unlike chemotherapies, these drugs don't blindly kill fast-growing cells. They home in on specific vulnerabilities within cancer cells. Immunotherapy is one type of targeted therapy.

ELAD SHARON: That's something that has really captured the imagination of the field. And so most new clinical trials or experimental regimens seem to be either looking at that or some other form of targeted therapy.

HARRIS: So are we looking at the end of the road for chemotherapy? Not so fast, Sharon says.

SHARON: I think there are some diseases where chemotherapy has really been very effective and has led to significant cures that are probably going to be very hard for any targeted agents to beat them. But as time goes on, definitely. I mean, I think we are seeing more and more of these targeted agents actually become the standard that people expect to receive.

COMIS: We're in a transition state right now where the types of available treatments are changing.

HARRIS: Again, Robert Comis.

COMIS: But we can't lose sight of the fact that cytotoxic chemotherapy has cured many, many patients.

HARRIS: And Comis says there are still ways to make these old standby drugs more effective.

COMIS: We just completed a study which showed that in metastatic prostate cancer, the addition of a chemotherapy drug, God forbid, increased survival by 18 months in the highest-risk groups - 18 months.

HARRIS: That's much better than the improvements reported for most targeted agents. In an ideal world, highly toxic chemotherapy drugs would give way altogether to gentler and more effective treatments for patients like Deborah Mazia. But Comis, for one, doesn't see that day coming anytime soon. Richard Harris, NPR News.

1 spotlight   

n.公众注意的中心，聚光灯，探照灯，视听，注意，醒目

参考例句：

• This week the spotlight is on the world of fashion.本周引人瞩目的是时装界。
• The spotlight followed her round the stage.聚光灯的光圈随着她在舞台上转。

2 killing   

n.巨额利润；突然赚大钱，发大财

参考例句：

• Investors are set to make a killing from the sell-off.投资者准备清仓以便大赚一笔。
• Last week my brother made a killing on Wall Street.上个周我兄弟在华尔街赚了一大笔。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 apparently   

adv.显然地；表面上，似乎

参考例句：

• An apparently blind alley leads suddenly into an open space.山穷水尽，豁然开朗。
• He was apparently much surprised at the news.他对那个消息显然感到十分惊异。

5 stimulating   

adj.有启发性的，能激发人思考的

参考例句：

• shower gel containing plant extracts that have a stimulating effect on the skin 含有对皮肤有益的植物精华的沐浴凝胶
• This is a drug for stimulating nerves. 这是一种兴奋剂。

6 behold   

v.看，注视，看到

参考例句：

• The industry of these little ants is wonderful to behold.这些小蚂蚁辛勤劳动的样子看上去真令人惊叹。
• The sunrise at the seaside was quite a sight to behold.海滨日出真是个奇景。

7 exhausted   

adj.极其疲惫的，精疲力尽的

参考例句：

• It was a long haul home and we arrived exhausted.搬运回家的这段路程特别长，到家时我们已筋疲力尽。
• Jenny was exhausted by the hustle of city life.珍妮被城市生活的忙乱弄得筋疲力尽。

8 infusion   

n.灌输

参考例句：

• Old families need an infusion of new blood from time to time.古老的家族需要不时地注入新鲜血液。
• Careful observation of the infusion site is necessary.必须仔细观察输液部位。

9 swelling   

n.肿胀

参考例句：

• Use ice to reduce the swelling. 用冰敷消肿。
• There is a marked swelling of the lymph nodes. 淋巴结处有明显的肿块。

10 potent   

adj.强有力的，有权势的；有效力的

参考例句：

• The medicine had a potent effect on your disease.这药物对你的病疗效很大。
• We must account of his potent influence.我们必须考虑他的强有力的影响。

11 placebo   

n.安慰剂；宽慰话

参考例句：

• The placebo has been found to work with a lot of different cases.人们已发现安慰剂能在很多不同的病例中发挥作用。
• The placebo effect refers to all the observable behaviors caused by placebo.安慰剂效应是指由安慰剂所引起的可观察的行为。

12 resistant   

adj.(to)抵抗的，有抵抗力的

参考例句：

• Many pests are resistant to the insecticide.许多害虫对这种杀虫剂有抵抗力。
• They imposed their government by force on the resistant population.他们以武力把自己的统治强加在持反抗态度的人民头上。

13 debris   

n.瓦砾堆，废墟，碎片

参考例句：

• After the bombing there was a lot of debris everywhere.轰炸之后到处瓦砾成堆。
• Bacteria sticks to food debris in the teeth,causing decay.细菌附着在牙缝中的食物残渣上，导致蛀牙。

14 stimulate   

vt.刺激，使兴奋；激励，使…振奋

参考例句：

• Your encouragement will stimulate me to further efforts.你的鼓励会激发我进一步努力。
• Success will stimulate the people for fresh efforts.成功能鼓舞人们去作新的努力。

15 toxic   

adj.有毒的，因中毒引起的

参考例句：

• The factory had accidentally released a quantity of toxic waste into the sea.这家工厂意外泄漏大量有毒废物到海中。
• There is a risk that toxic chemicals might be blasted into the atmosphere.爆炸后有毒化学物质可能会进入大气层。

16 immunity   

n.优惠；免除；豁免，豁免权

参考例句：

• The law gives public schools immunity from taxation.法律免除公立学校的纳税义务。
• He claims diplomatic immunity to avoid being arrested.他要求外交豁免以便避免被捕。

17 incremental   

adj.增加的

参考例句：

• For logic devices, the incremental current gain is very important. 对于逻辑器件来说，提高电流增益是非常重要的。 来自辞典例句
• By using an incremental approach, the problems involving material or geometric nonlinearity have been solved. 借应用一种增量方法，已经解决了包括材料的或几何的非线性问题。 来自辞典例句