This is the 4878th article of Da Yi Xiao Nursing
Text: Wang Aman
Department of Oncology, The First Affiliated Hospital of Dalian Medical University
For a long time, the means of human resistance to tumors has been the "three-plate axe" treatment mode, that is, surgery, radiation therapy, and chemical drug treatment. If a cancer patient is compared to a bad apple, then surgery, radiation therapy, and chemotherapy are used to peel off the bad part of the apple. Although it is effective, it is inevitable that "innocent" pulp will be implicated in the process of treatment, which is the side effect of our clinical practice, and it is also an important factor that causes many cancer patients to give up treatment or have poor treatment results. It was not until the 90s of the 20th century that this problem finally took a turn for the better, and with the development of genetic testing technology, targeted drugs were developed to change the treatment landscape of tumors. Patients receiving targeted drug therapy do not need to be hospitalized, do not have to go through painful radiation therapy, chemotherapy treatment, and only need to take oral drugs on time to effectively fight the tumor. More importantly, targeted drugs, as the name suggests, target tumor cells for attack, so the harm to normal cells in the human body is minimal, which also greatly reduces the pain of patients during treatment.
Are targeted drugs really omnipotent?
No one is perfect, and even targeted drugs, which are drugs that precisely hit tumor cells, are not omnipotent. There is also a "common disease" in targeted drugs that all drugs have, that is, drug resistance that we often talk about in clinical practice. What is drug resistance? We can understand drug resistance as the "survival of the fittest" in Darwin's "Theory of Evolution" - if you want to survive, you must adapt to the environment. Drug resistance is the result of "bad things" such as bacteria and viruses changing themselves in order to survive in the face of drug encirclement. When these "bad things" complete their transformation, they can escape the pursuit of drugs. The same is true for tumor cells, which are not sitting still while targeted drugs attack tumor cells. On the contrary, in order to save themselves, tumor cells will slowly learn to transform, which is medically referred to as adaptive change. The blow to targeted drugs is undoubtedly huge. Because the reason why targeted drugs can precisely hit tumor cells is mainly done by targeting the targets on tumor cells. However, when the tumor cells are transformed, the targeted drugs will not recognize the targets on the tumor cells, and naturally they will not be able to accurately attack the tumor cells, and the problem of drug resistance will arise.
When drug resistance occurs, the therapeutic effect of targeted drugs on tumors will be reduced to varying degrees, and even recurrence and deterioration of the disease will occur. Therefore, the problem of drug resistance is a problem that cancer patients need to pay attention to.
How can patients tell if drug resistance has developed?
The occurrence of drug resistance will affect the efficacy of targeted drugs, so how to determine whether drug resistance has occurred is a problem of great concern to all patients. The occurrence of drug resistance is not silent, and we can judge whether drug resistance occurs through the changes in our own conditions. In clinical practice, drug resistance is divided into three categories according to the different degrees of drug resistance of patients, namely slow drug resistance, local drug resistance and complete drug resistance.
What are the characteristics of the first type of patients who are slowly resistant? Although the patients with slow drug resistance receive normal treatment, the size of the patient's tumor volume will hardly change, and the level of tumor markers in the patient can be significantly increased by means of blood tests, and these abnormal signals tell us that the patient may have developed slow drug resistance.
The second type of drug resistance is local drug resistance, and the naming of local drug resistance is very vivid and vivid. Because locally resistant patients can effectively control the lesions in the process of receiving treatment, the tumor volume will be reduced to varying degrees. But at the same time, cunning tumor cells quietly metastasize to other organs. For example, in the process of receiving targeted drug therapy, although the lung cancer was effectively controlled, after a period of time, the tumor cells slowly metastasized to the patient's brain, forming brain metastases. Therefore, we refer to this local development of drug resistance in the body as local drug resistance. In practice, if a cancer patient suddenly has pain symptoms in some parts of the body and cannot be relieved for a long time, it is necessary to be alert to the emergence of local drug resistance.
The third type of resistance is complete resistance. Complete drug resistance means that the front line of targeted drug treatment for tumors has collapsed. Through imaging and blood tests, we can clearly find that the patient's tumor will enlarge, tumor markers will increase significantly, and the tumor may metastasize at multiple sites. This means that the targeted drugs currently used are no longer able to control the patient's condition.
How to solve the problem of drug resistance of targeted drugs?
What should we do if we find drug resistance after a systematic examination? For patients, we must not panic, what we need to do is to actively communicate with the doctor and strictly follow the doctor's instructions for treatment. Because the most taboo of targeted drug therapy is to change or stop the drug without permission, which not only does not help the condition, but also increases the difficulty of subsequent treatment. Generally speaking, after the resistance of targeted drugs, it is also necessary to discontinue and change drugs according to the actual situation of the patient.
For the patients with slow drug resistance mentioned above, we usually do not recommend immediate drug changes, but recommend regular re-examination, and increase the dose of targeted drugs or combine them with other targeted drugs as appropriate. For patients with local drug resistance, the original targeted drug therapy can also be continued, and other appropriate means can be taken for targeted treatment for metastatic lesions. In short, for these two types of patients, drug resistance does not mean that the drug is immediately stopped and changed. For patients who are completely resistant to drugs, we generally recommend a replacement therapy with a change of targeted agent. Targeted drug therapy is a model of "one key opens one lock", that is, a targeted drug corresponds to a target on the tumor. For example, if drug A is resistant, we cannot target the target of drug A. However, there are still other targets on tumor cells, and at this time, we can find other targets on tumor cells through genetic testing technology, and select targeted drug B paired with the target for treatment, so as to overcome the problem of drug resistance of targeted drugs.
Of course, these strategies do not work for all patients. In order to truly solve the problem of drug resistance, it is necessary to consider the individual situation of the patient, and it is also necessary to analyze the type of tumor and other factors, and the doctor will consider it more clearly and in the long term than the patient. Therefore, after the problem of drug resistance is discovered, the doctor should be informed in time, follow the doctor's advice, and actively treat, and must not blindly change or stop the drug by itself.
About the Author
Wang Aman
Doctor of Medicine, Master Supervisor
Deputy Chief Physician of the Department of Oncology, The First Affiliated Hospital of Dalian Medical University
Member of the Biliary Tract Tumor Committee of the Chinese Society of Clinical Oncology
Member of the Oncology Cardiology Committee of the Chinese Society of Clinical Oncology
Youth member of the Tumor Professional Committee of Integrated Traditional Chinese and Western Medicine of Chinese Anti-Cancer Association
Member of the Young Expert Committee of the Lung Cancer Medical Committee of the Beijing Medical Award Foundation
Member of the Special Committee on Targeted and Immunotherapy of Lung Cancer Cells of Liaoning Provincial Society of Cell Biology
Young editorial board member of Chinese Journal of Cancer Prevention and Treatment and Chinese Clinical Oncology
The content of this article is reprinted from the WeChat public account of "Health World Magazine".
所有人名和地名均为化名，如有雷同，纯属巧合。