| 屈国伦,陈 勇,曲兴龙,等.软组织肉瘤一线化疗失败后的应对策略与研究进展[J].肿瘤学杂志,2026,32(3):250-256. |
| 软组织肉瘤一线化疗失败后的应对策略与研究进展 |
| Management Strategies and Advances Following First-Line Chemotherapy Failure in Soft Tissue Sarcomas |
| 投稿时间：2025-04-01 |
| DOI：10.11735/j.issn.1671-170X.2026.03.B010 |
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| 中文关键词: 软组织肉瘤 药物疗法 靶向治疗 免疫治疗 |
| 英文关键词:soft tissue sarcoma drug therapy targeted therapy immunotherapy |
| 基金项目: |
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| 摘要点击次数: 31 |
| 全文下载次数: 11 |
| 中文摘要: |
| 摘 要：软组织肉瘤是一类罕见的间叶源性恶性肿瘤，阿霉素和异环磷酰胺为目前公认的一线化疗方案。一线化疗失败后的策略调整尤为重要，临床医师应迅速对患者病情进行评估，根据肿瘤分子分型和生物学特性，考虑多模式治疗策略。二线化疗仍是基础方案，常用药物包括吉西他滨、多西他赛或联合方案（如多柔比星耐药后换用达卡巴嗪联合抗血管靶向药），但需评估患者骨髓储备及既往用药毒副作用。靶向治疗为关键补充，针对特定分子异常（如血小板衍生生长因子受体、成纤维细胞生长因子受体、KIT突变或NTRK融合）选择对应抑制剂（如阿昔替尼、培唑帕尼）可提高疗效。免疫治疗（程序性死亡受体1/程序性死亡配体1抑制剂）在高度微卫星不稳定或高肿瘤突变负荷亚型中显示出潜力。此外，局部治疗措施，如手术、介入、放疗等也有一定的价值，特别是对有限病灶的局部控制。另外，新的临床试验还可以获取潜在的新型治疗方案。未来，根据患者的基因、肿瘤分子的表型、免疫状态等因素，定制个性化方案和对不同软组织肉瘤亚型药物的开发与应用，将为软组织肉瘤患者在一线化疗失败后找到新出路。 |
| 英文摘要: |
| Abstract： Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin， for which doxorubicin and ifosfamide constitute the standard first-line chemotherapy. The management of patients after first-line chemotherapy failure requires careful strategy adjustment. A prompt and comprehensive assessment of the patient’s condition is essential to guide subsequent therapy. Treatment decisions should incorporate multimodal strategies， taking into account the tumor’s molecular subtype and biological characteristics. Second-line chemotherapy remains a cornerstone， with options including gemcitabine， docetaxel， or combination regimens (e.g.， dacarbazine with anti-angiogenic agents for doxorubicin-refractory disease)， though patient tolerance and prior treatment toxicities must be evaluated. Targeted therapy represents a critical complementary approach. Inhibitors (e.g.， axitinib， pazopanib) directed against specific molecular alterations (e.g.， in platelet-derived growth factor receptor， fibroblast growth factor receptor， KIT， or NTRK genes) can enhance treatment efficacy. Immunotherapy， particularly programmed death-1/programmed death-ligand 1 inhibitors， has demonstrated promise in STS subtypes characterized by high microsatellite instability (MSI-H) or high tumor mutational burden (TMB). Local therapeutic modalities， including surgery， interventional therapy， and radiotherapy， retain value for controlling limited disease. Additionally， enrollment in clinical trials offers access to novel investigational therapies. Looking forward， the development of personalized treatment strategies based on genetic， molecular， and immunologic profiling， coupled with the advancement of subtype-specific agents， holds significant potential for improving outcomes for STS patients following first-line chemotherapy failure. |
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