比利时鲁汶大学Bertrand Tombal教授访谈

　　Oncology Frontier: How’s your experience has been so far that there is any particular presentations or discussions that grab your interest?

　　《肿瘤瞭望》：目前此次会议的报告或讨论中有什么内容吸引你的兴趣？

　　Prof. Tombal: As for today in the meeting， I am a prostate cancer person， working a lot with advanced cancer disease including bone metastases disease. So one of most interesting drugs for prostate cancer for bone disease right now is the radium-223. Let’s say， it is a radionuclide targeting the bone metastases phenotype， so we show overall of survival benefit like 1 year ago， and now we have a long-term data showing really good safety profile， really the way that can help people with advanced bone disease， that’s really where I feel that we have made the largest progress so far.

　　Tombal教授：在今天的会议中，我作为前列腺癌医生，致力于进展期疾病包括骨转移。目前最感兴趣的是一种治疗前列腺癌骨转移的药物镭-223，这是一种针对骨转移的放射性核素。大约1年前该药物已显示有总生存获益，现在我们获得了长期数据，显示出非常好的安全性。这确实是一个帮助进展期骨疾病患者的方法，我认为是目前我们获得的最大进步。

　　Oncology Frontier: What about new ESMO guidelines of bone health?

　　《肿瘤瞭望》：请介绍一下骨健康方面ESMO的最新指南。

　　Prof. Tombal: Bone diseases have been neglected for many years. So although it is very common in many cancers including prostate， breast and lung， and it was time that people from different office of joined forces， to come with an update management for these patients. Working in the area of prostate cancer， 80% of my patients have bone metastases， 50% have osteoporosis from the androgen deprivation therapy， and these absolute are recognized. If you take small countries， like mine， roughly 22000 patients on hormonotherapy， we do estimate less than 50% are actually， properly monitored in term of  monitor and treatment for osteoporosis and bone metastases disease， and simply because it was left behind as orphan disease. So really， we hope these guidelines will changes this， which people will move to a more comprehensive approach for cancer at advanced stage. Because if you look at the cost that bone diseases presented a huge cost in my country.  So there are ways like we have been showing this character of economy effect， and try to disseminate some guidelines， but beyond the guideline， what is important that it is taking over by very large scientific organization， like ESMO. To find that ESMO said ‘Oh， for it is very important. We want guidelines to properly monitor these patients， this is extremely important.

　　Tombal教授：骨疾病多年来被忽视。虽然它在多种肿瘤非常常见，包括前列腺癌、乳腺癌和肺癌，也曾经有多部门协作致力于为患者更新治疗策略。根据我在前列腺癌领域的经验，我的患者中有80%存在骨转移，50%存在雄激素剥夺治疗相关的骨质疏松，这些情况已经被认识到了。在比利时这种比较小的国家，大约有22 000例患者正在接受内分泌治疗，估计只有不到50%的患者接受了骨转移和骨质疏松方面的适当监测和治疗，仅仅是因为这一疾病被认为是“孤儿”疾病而被落在最后。因此，我们希望这些指南能改变现状，促使对进展期肿瘤患者采取更加全面的措施。因为治疗骨疾病的花费在我国是巨额的。有一些途径，例如公布相关药物经济学数据，尝试推广一些指南。此外重要的是由非常大型的科学组织像ESMO来牵头。ESMO说：“这是非常重要的，我们希望出台指导这些患者适当监测的指南。”这是非常重要的。

　　Oncology Frontier: What about prevention? Do ESMO guidelines identify some assays for prevention from prostate cancer disease?

　　《肿瘤瞭望》：如何进行预防？ESMO指南中是否提供了前列腺癌骨转移的相关预防措施？

　　Prof. Tombal: In prostate， we usually use Denosumab in that setting. The preventive trial with zoledronic acid and denosumab， when more women with breast cancer who are beneficial from it， and patients with lung cancer， and prostate cancer. So once again， that are what should be done. If you look at proportion of patients， why risks of bone metastasis in recieving are these drugs are very low. So this strategy is extremely cost effective that we need absolutely to implement them.

　　Tombal教授：在前列腺癌通常用地诺单抗来预防骨转移。预防性治疗的临床研究有采用唑来磷酸和地诺单抗的，在乳腺癌、肺癌以及前列腺癌中越来越多的患者从中获益。因此，再一次强调，这一措施需要被采纳，接受这些药物治疗的患者出现骨转移的风险非常低。因此这些措施是非常经济的，我们绝对应当实行之。

　　Oncology Frontier: What would be new approach in terms of treatment?

　　《肿瘤瞭望》：谈到骨转移的治疗，有没有新进展？

　　Prof. Tombal: Clearly， at least in prostate and breast cancers， happily emerging the most interesting strategies are the new generation of radio-labeling bone –seeking agent and the α-emitting radium，  are really the number one. It is approved in prostate cancer. There are impressive results in breast and in lung cancer. So really these are drugs will change the way that we treat these patients in a very short term.

　　Tombal教授：至少在前列腺癌和乳腺癌，我们很高兴地看到出现了非常有吸引力的新治疗方法，即新一代核素标记的亲骨药物和能放射α射线的镭，这些是首要的。这些治疗在前列腺癌已获得批准，在乳腺癌和肺癌方面也获得了令人印象深刻的疗效。因此这些药物将在很短的时间内改变我们治疗这些患者的方法。

　　Oncology Frontier: We just need to have more trials?

　　《肿瘤瞭望》：我们需要进行更多临床研究吗？

　　Prof. Tombal: No， it is just a matter of time. I mean， the trial is good. Once again， it is really about physician recognizing the importance of the bone， not necessarily as an overall survival issue but is one of most important quality of life issues and really looking at， besides all chemotherapy targeted agents they have， paying attention to the bone that is important.

　　Tombal教授：不用，这只是个时间的问题。当然我认为临床研究是好的。再次强调，这事关临床医师认识到骨的重要性，不仅是影响总生存的事件，更是影响生活质量的最重要的事件。让他们除了关注现有的化疗药物，更要提高对骨的重视程度。

　　Oncology Frontier: mm， what about the length of treatment that there must be some discussions of how long patients should be on the bisphosphonates?

　　《肿瘤瞭望》：这些治疗应当持续多长时间？一定有关于双磷酸盐治疗时间的讨论吧？

　　Prof. Tombal: All the trials we have done on bisphosphonate are conducted on a， that I would say， a quite defined period of time. As a result of having more treatment patients live longer， we realized that we have patient treated for very long period of time. So we need to assess a long term safety， and we need to monitor all these patients， because with longer exposure indeed， we may increase side effect， especially， the level of renal side effect and osteonecrosis of the jaws， that is extremely important.

　　Tombal教授：我们进行的所有双磷酸盐的临床研究都设定了固定的治疗时间。由于治疗手段的增多，患者得以长期生存，我们意识到有患者已经接受双磷酸盐治疗很长时间了。因此我们需要评估长期用药的安全性，需要监测所有这些患者，因为药物暴露时间越长越有可能增加副反应，尤其是肾脏方面和下颌骨坏死等副反应，这是非常重要的。