在Teoh博士看来，今年ASCO会议上妇科肿瘤领域的兴奋点很多，特别是在生物标志物指导治疗方面的进展。因为妇科肿瘤包括宫颈癌、卵巢癌和子宫癌等多种类型的肿瘤，很难找到一个能适用于各方面的标志物，因此一直以来，在妇科肿瘤生物标志物方面的研究落后于其他领域。而这次会议传递给大家这样一个信息：生物标志物可帮助确定妇科肿瘤的治疗方案，帮助靶向治疗的开展，并确定最可能从靶向治疗中获益的人群。Teoh博士以PARP抑制剂为例进一步解释，一些研究者回过头去对这个老生物标志物进行研究，观察哪些患者能从贝伐珠单抗治疗中获益，而另一些研究者则寻找新的靶标。进入 研究者视线的不仅有BRCA胚系突变，还有所谓的BRCA样肿瘤。这些不同类型的肿瘤对应着可能从靶向治疗中获益的患者。

　　“因此，我们必须记住，妇科肿瘤不是一种肿瘤。除此之外，我们还需要观察生物标志物，根据肿瘤的生物学而不是肿瘤类型来治疗疾病。我想未来我们还会有持续发展。”

　　老年肿瘤患者的管理也是本次会议上的热点之一。Teoh博士认为，对于无法耐受高强度治疗的老年患者，临床医生不能只盯着代表年龄的那几个数字，而是要关注患者的功能状态。“一个90岁的患者可能各方面功能都不错，相反，一个50岁或60岁的患者却可能近乎完全无功能。这些患者的治疗必须有所差异。”

　　Teoh博士建议对患者的基线功能状态和共病进行仔细评估，并充分了解患者的需求和治疗目标，了解患者是希望接受更积极的治疗，以获取更长时间的存活，还是选择温和的姑息治疗，以保证更好的生活质量和生命尊严。

　　在采访中，作为微创外科专家，Teoh博士还介绍了妇科恶性肿瘤微创外科技术方面近来最重要的进展，即前哨淋巴结定位在宫颈癌活检和子宫内膜癌中的应用。“通过这些技术，我们有望在获得同样的诊断信息和预后信息的同时，降低如淋巴水肿等副作用的风险——这些副作用对患者的生活质量有明显影响。”

访谈原文：

　　Oncology Frontier: Could you summarize the latest important updates concerning minimally invasive surgical techniques for gynecological malignancies?

　　《肿瘤瞭望》：在如何尽可能降低妇科恶性肿瘤手术侵袭性方面，近来最重要的进展是什么？

　　Dr Teoh: One of the exciting things we are developing is the introduction of sentinel lymph node mapping in biopsies for cervical cancer. There is also work looking at it in endometrial cancer. This will allow use tohopefully get the same diagnostic and prognostic information but with a decreased risk of side effects like lymphedema which can really impact on the quality of life for patients.

　　Oncology Frontier: For ovarian cancer particularly in the elderly， aggressive therapy may not be as well tolerated. How do you make the decision on the strategy to use in older patients?

　　《肿瘤瞭望》：卵巢癌患者，特别是老年卵巢癌患者可能无法耐受高强度的治疗，您如何为她们制定治疗方案？

　　Dr Teoh: This is an ongoing debate in the field. I think it is inevitable that we do undertreat these patients in some cases， but it is true that patients in the age group older than 70， do not tolerate therapy as well. One approach is to not be looking at the age as a number but instead the functional status of the patient. You can have a 90 year old who is functioning very well and on the other hand， a 50 or 60 year old who is not functioning anywhere near as well. These patients need to be treated very differently. So for me， I would look at what the patient’s baseline functional status is and what their comorbidities are. If there is heart disease or diabetes pre-existing， then it is harder to be aggressive with therapy compared to someone who is healthy， even if they are older. It also depends on how the patient feels. Some patients want to be more aggressive as they feel they have a lot to live for. Others really want more palliation， preferring a comfortable life to a longer life. Decisions have to be made on an individual basis and the discussion between the doctor and patient needs to include consideration of what the patient’s goals are.

　　Oncology Frontier: What have you found to be the exciting areas of development in the field of gynecological malignancies at this year’s ASCO?

　　《肿瘤瞭望》：在您看来，今年ASCO上妇科方面最令人激动的领域有哪些？

　　Dr Teoh: There are some really exciting aspects at ASCO this year. One of those is where we are seeing how biomarkers could be used to direct therapy. We have been a little behind in this regard partly because it is such a heterogeneous tumor and it is hard to single out one factor that defines all of them. The PARP inhibitors are an exciting area of therapy. There are some going back to work on known older biomarkers to see who will benefit from bevacizumab and then others looking at targets we haven’t used before. The message from this meeting is that biomarkers may be helpful in determining treatment for this disease， that they may help us target therapies and decide who is going to benefit most from specific therapies.

　　Oncology Frontier: Can you elaborate on some of those biomarkers that may be useful in the future?

　　Dr Teoh: With regard to the PARP inhibitors， researchers are not only looking at BRCA germ lines but also the so-called BRCA-like tumors. Now we are identifying these different tumor types we are finding that we are able to benefit patient populations that hadn’t been targeted before.

　　Oncology Frontier: What do you see as the take home message from ASCO 2015?

　　Dr Teoh: The take home message is that it is an exciting time and we are going to see further improvements in the field which will benefit patients. We should not be treating gynecological malignancies as one disease but as cervical， ovarian and uterine cancer. And instead of just looking at the tumor， we need to look at the markers and treating patients based on their tumor biology rather than just the disease type. I think we can only expect continuing advances in the future.