关于PD1在胆管的使用，请bluest给个建议

最近一直在关注PD1，也请教了香港的邵医生，确实胆管还没有人试用过，所以没有数据。我妈妈手术完一个月了，三十年前结石手术时就做了胆肠吻合，转移到吻合的肠，手术病理肝和淋巴都好的，但是肠壁那里切缘是阳性。这样是不是就算是姑息术了？先不管PD1能不能在我们身上起到效果，我是愿意去尝试这四个疗程的，但是现在有点担心，PD1用后原来的肿瘤可能会先变大，有效果的才会再变小，那么如果我妈妈这种情况会不会出现使用以后肠道那里肿瘤变大的可能呢，如果PD1在我妈身上没有效果，但是肠道那里肿瘤变大岂不是有梗阻的危险？不知道我的理解有没有错，也不知道有没有胆管的患者用过PD1了，请教bluest，有这种可能吗？要不要尝试用一下呢？

Interaction of B7-H1 on intrahepatic cholangiocarcinoma cells with PD-1 on tumor-infiltrating T cells as a mechanism of immune evasion.
Ye Y1, Zhou L, Xie X, Jiang G, Xie H, Zheng S.
Author information

    1Key Lab of Combined Multi-organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.

Abstract
BACKGROUND AND OBJECTIVES:

The B7-H1/PD-1 pathway has recently been found to contribute to immune evasion of cancer cells from host immune system. This study aimed to investigate the expression of B7-H1 and its receptor PD-1 and to explore their significance in the progression of intraheptic cholangiocarcinoma (ICC).
METHODS:

Thirty-one surgically resected ICC tissues and the corresponding cancer adjacent tissues were enrolled from 2006 to 2007. Immunohistochemical studies were performed with antibody of B7-H1, PD-1, CD8, and CD4. Apoptosis status of tumor-infiltrating lymphocytes (TILs) was detected by TUNEL assay.
RESULTS:

Expression of B7-H1 and PD-1 was found to be up-regulated in ICC tissues compared with the cancer adjacent tissues. Tumor-related B7-H1 expression was significantly correlated with both tumor differentiation and pTNM stage and was inversely correlated with CD8+ TILs but not CD4+ TILs. TILs in primary carcinoma showed a high level of apoptosis.
CONCLUSION:

B7-H1/PD-1 pathway may be linked to malignant potential of ICC and contribute to tumor immune evasion by promoting CD8+ TILs apoptosis. Thus, this pathway may indeed be a potential therapeutic target in the treatment of this disease.
----------------------------------------------------

只搜到一个浙大医院做的非人体实验，对治疗没有参考价值。

谢谢，安德森最近在做胆管的基因突变治疗实验，过几周就能出结果了，可能是受NCI之前那个病例的影响。安德森网站查到Keytruda实验的时候也有二十个胆管的，有几个缓解的，有个加利福尼亚的效果很好，说明还是有有效的可能性，就是后面怎么样不知道

tracyzhou 发表于 2015-2-27 11:23
谢谢，安德森最近在做胆管的基因突变治疗实验，过几周就能出结果了，可能是受NCI之前那个病例的影响。安德 ...

如果有效率能达到30%以上就值得一试

bluest 发表于 2015-2-27 11:47
如果有效率能达到30%以上就值得一试

30%肯定不到

tracyzhou 发表于 2015-2-27 13:02
30%肯定不到

那不如2992和化疗

bluest 发表于 2015-2-28 00:35
那不如2992和化疗

我想乘手术后恢复这段期间试下PD1在我妈身上是否有效果，因为化疗对全身伤害毕竟大，基因检测的结果还没有出来，正在学靶向的知识。靶向和化疗贯序使用会不会耐药时间拉长一点呢

tracyzhou 发表于 2015-3-2 13:55
我想乘手术后恢复这段期间试下PD1在我妈身上是否有效果，因为化疗对全身伤害毕竟大，基因检测的结果还没 ...

靶向副作用比化疗小，恢复快，即使无效代价也比较小。反正胆管癌有效率都很低，就首选副作用小的吧。

bluest 发表于 2015-3-2 16:18
靶向副作用比化疗小，恢复快，即使无效代价也比较小。反正胆管癌有效率都很低，就首选副作用小的吧。

我主要看胆管的对靶向的耐药时间非常短，一旦停下来好像就会长得很快，需要不停尝试到有效药控制

tracyzhou 发表于 2015-3-4 17:52
我主要看胆管的对靶向的耐药时间非常短，一旦停下来好像就会长得很快，需要不停尝试到有效药控制

是啊，胆管癌还是没有找到关键点