恶性胸膜间皮瘤治疗的研究现状与展望

赵锴乐; 王磊; 耿健雄; 崔成伟; 于雁

doi:10.19401/j.cnki.1007-3639.2025.03.009

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恶性胸膜间皮瘤治疗的研究现状与展望

综述 | 更新时间：2025-12-31

- 恶性胸膜间皮瘤治疗的研究现状与展望
- Research status and prospects of treatment for malignant pleural mesothelioma
- 中国癌症杂志 2025年35卷第3期页码：326-332
- 作者机构：
  
  哈尔滨医科大学附属肿瘤医院呼吸内科，黑龙江哈尔滨 150000
- 作者简介：
  
  [ "赵锴乐（ORCID: 0009-0008-0299-0681），硕士在读。" ]
  于雁（ORCID: 0000-0001-5598-763X），博士，主任医师、教授，哈尔滨医科大学附属肿瘤医院呼吸内科三病房科主任、内科教研室主任。
- 基金信息：
  
  国家自然科学基金面上项目(82373041);黑龙江省发展和改革委员会重点项目(2112-230000-04-05-388351)
- DOI：10.19401/j.cnki.1007-3639.2025.03.009
  中图分类号： R734.3
- 收稿：2024-10-07，
  
  修回：2024-12-03，
  
  纸质出版：2025-03-30
- 稿件说明：
移动端阅览
赵锴乐, 王磊, 耿健雄, 等. 恶性胸膜间皮瘤治疗的研究现状与展望[J]. 中国癌症杂志, 2025,35(3):326-332.

Kaile ZHAO, Lei WANG, Jianxiong GENG, et al. Research status and prospects of treatment for malignant pleural mesothelioma[J]. China Oncology, 2025, 35(3): 326-332.
赵锴乐, 王磊, 耿健雄, 等. 恶性胸膜间皮瘤治疗的研究现状与展望[J]. 中国癌症杂志, 2025,35(3):326-332. DOI： 10.19401/j.cnki.1007-3639.2025.03.009.

Kaile ZHAO, Lei WANG, Jianxiong GENG, et al. Research status and prospects of treatment for malignant pleural mesothelioma[J]. China Oncology, 2025, 35(3): 326-332. DOI： 10.19401/j.cnki.1007-3639.2025.03.009.

摘要

恶性胸膜间皮瘤（malignant pleural mesothelioma，MPM）的发生主要与石棉接触史有关，主要特点为恶性程度高、死亡率高、预后差。目前治疗MPM的手段有限、效果不甚理想，导致MPM患者的中位总生存期（overall survival，OS）仅为1年左右。现有治疗手段（包括手术、放疗、化疗、免疫治疗和靶向治疗等）在不断发展，为MPM患者带来了新的希望。TNM分期为早期的MPM患者可行手术治疗，能够提高生存率和改善生活质量。但目前MPM的最佳手术方式仍然存在争议。除了手术，放疗也是MPM治疗中的重要一环。放疗通常用于疾病的预防性治疗或疾病晚期时缓解局部症状，并且放疗也可作为手术的新辅助、辅助治疗手段。对于经全身治疗后出现局部进展或孤立的远处转移的患者，放疗是一种可行的选择。随着调强适形放疗（intensity-modulated radiotherapy，IMRT）和容积弧形调强放疗（volumetric intensity-modulated arc therapy，VMAT）等新型放疗技术的出现，显著提高了放疗的精准性和治疗效果，减少了正常组织的损伤。另有粒子植入可以缓解疼痛或作为局部补充治疗。化疗仍是MPM的标准治疗手段，培美曲塞联合铂类药物被广泛应用于一线治疗，并能显著延长患者的生存期，然而临床上常用的二线治疗方案效果都不甚理想。免疫治疗近几年发展迅猛，纳武利尤单抗联合伊匹木单抗的双免疫疗法在临床疗效及安全性方面展现出优势。免疫治疗联合化疗的方案也明显延长了患者的中位生存期，现已有多项临床试验表明，免疫治疗联合化疗可使患者获益。MPM现有的靶向药物多针对血管生成，其中贝伐珠单抗与化疗的联合奠定了其一线治疗的地位，相关研究表明，雷莫芦单抗和甲磺酸阿帕替尼具有一定的疗效及安全性。除了临床常见治疗方案外，UV1癌症疫苗联合双免疫治疗为患者带来了福音。嵌合抗原受体T（chimeric antigen receptor T，CAR-T）细胞疗法作为一种新型治疗方法，已有Ⅰ期临床试验表明其具有良好的抗肿瘤效果。一些抗体药物偶联物类药物正在通过精准特定靶点成为MPM患者的治疗选择。此外，电场治疗联合化疗在延长患者生存期方面也取得一定效果。尽管MPM的治疗手段不断丰富，其诊断和治疗仍面临诸多问题，包括早期起病隐匿、治疗过程中耐药的发生及缺乏大样本的循证医学证据支持等。未来研究应集中于提高早期诊断率、探索新型治疗策略、克服耐药性及推进个体化治疗，并进一步加强基础研究与临床试验的衔接。通过多学科协作和持续创新，为患者提供更有效、更安全的治疗选择，实现改善预后的最终目标。

Abstract

Malignant pleural mesothelioma (MPM) is strongly associated with a history of asbestos exposure and is characterized by high malignancy

high mortality

and poor prognosis. Current treatments for MPM are limited and generally suboptimal

resulting in a median overall survival (OS) of approximately one year for MPM patients. However

advancements in treatment options

including surgery

radiotherapy

chemotherapy

immunotherapy and targeted therapy

have brought new hope to patients with MPM. For early-stage MPM patients categorized under the TNM staging system

surgical treatment is feasible and can improve survival rates and quality of life. However

there is still debate regarding the optimal surgical approach for MPM. In addition to surgery

radiotherapy plays a vital role in MPM treatment. It is often used as prophylactic treatment or for alleviating local symptoms in advanced stages. Radiotherapy can also serve as neoadjuvant or adjuvant therapy in surgical contexts. For patients experiencing local progression or isolated distant metastases after systemic treatment

radiotherapy is a viable option. The advent of advanced radiotherapy techniques

such as intensity-modulated radiotherapy (IMRT) and volumetric intensity-modulated arc therapy (VMAT)

has significantly improved the precision and efficacy of radiotherapy while minimizing damage to healthy tissues. Furthermore

brachytherapy can relieve pain or act as a localized supplemental therapy. Chemotherapy remains the standard treatment for MPM. The combination of pemetrexed and platinum-based drugs is widely applied as first-line therapy and has been shown to significantly extend survival. However

commonly used second-line regimens often yield suboptimal results. In recent years

immunotherapy has developed rapidly. Dual immunotherapy with nivolumab and ipilimumab has demonstrated impressive clinical efficacy and safety. The combination of immunotherapy and chemotherapy has also notably extended patients' median survival. Multiple clinical trials have confirmed that this combination therapy benefits patients. Currently available targeted therapies for MPM primarily focus on anti-angiogenesis. Bevacizumab combined with chemotherapy has established its position as a first-line treatment. Research on ramucirumab and apatinib suggests that these drugs have certain efficacy and safety profiles. Beyond conventional treatment options

the UV1 cancer vaccine combined with dual immunotherapy offers new hope for patients. Chimeric antigen receptor T (CAR-T) cell therapy is an emerging treatment method being investigated in MPM patients

with phase Ⅰ clinical trials demonstrating good antitumor effects. Additionally

some antibody-drug conjugates are becoming therapeutic options for MPM through precise targeting. Tumor treating fields combined with chemotherapy has also shown efficacy in extending survival. Despite the increasing variety of treatment options for MPM

its diagnosis and treatment still face numerous challenges

including difficulties in early detection

treatment resistance

and a lack of large-scale evidence-based clinical studies. Future research should focus on improving early diagnosis rates

developing new treatment strategies

overcoming resistance

and advancing personalized therapy. Strengthening the integration of basic research and clinical trials will also be essential. Through multidisciplinary collaboration and continuous innovation

it is hoped that more effective and safer treatment options will become available

ultimately improving the prognosis of MPM patients.

关键词

Keywords

references

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