比利时布鲁塞尔鲁格曼大学医院内科学和转移性骨病教授Jacpue Jean Body教授采访

　　Oncology Frontier: Could you please update to the ESMO Bone health guidelines that are coming out this year?

　　《肿瘤瞭望》：请您介绍一下今年欧洲肿瘤内科学会骨骼健康指南的有哪些更新？

　　Prof. Body: well， we thought it is important， to update the guidelines， so， because there has been lots， lots of progress， with interaction with new compound， denosumab， which is of course the most important one， it’s evident that these compounds act increasingly important role in which metastases patients with metastases is in bone， breast cancer has been well known for these years， but also for prostate cancer， and now more and more evidences for other cancer as well， such as lung cancer， which often has bone metastases as well. It is important to give you a basic database diagnoses bone metastasis. Follow up an appropriate patient with metastases which is not so easy; but also develop some guidelines on the particular indication of patients. You know the words， when you have to start， when do you have to stop， what kind of effect can you expect， what can you do about cancer treatment with bone loss， all those kinds of things. So the purpose is trying to give you that entire database to refer.

　　Body教授：我们认为对骨骼健康指南更新是很重要的。因为近年来有很多进展。随着对药物的作用研究，比如地诺单抗，这当然是一个最重要的药物，有证据显示，这些药物在癌转移患者骨转移治疗中起着越来越重要的作用。乳腺癌是这些年来众所周知的，还有前列腺癌，而现在有越来越多关于其他癌症的证据，比如肺癌，这也往往产生骨转移。指南是很重要的，能给你提供一个诊断骨转移患者的基本的数据库。随访诊断为骨转移的患者是很不容易的，还需要完善对实践操作的一些指南准则。比如，什么时候是开始治疗的最佳时期，什么时候要停药，能够期望得到什么样的治疗效果，在癌症治疗方案中伴随的骨质流失应该怎样处理，以及所有这些各种各样的问题。因此，更新的目的就是想提供给临床所有的研究结论，进行参考。

　　Oncology Frontier: Does it touch on specific uses or particular medicines such as bisphosphonates or such as Zoledronic acid?

　　《肿瘤瞭望》:在更新进展中是否有涉及特殊应用或者特别的药物，比如双膦酸盐，或者唑来膦酸？

　　Prof. Body: Yes， what we want to insist the impact that we have to start this compound as soon as the bone metastases are diagnosed， in breast cancer， and in prostate cancer at least. Then you have the choice， you have the choice between pamidronate， zoledronic acid， and denosumab. ASCO does not make any difference between these compounds. This is not our opinion. I guess denosumab is more efficient than zoledronic acid for preventing further event， also preventing for further subsequent event， in the breast cancer and prostates cancer as well. But it doesn’t’t mean that zoledronic acid resulted in … it only means we have superior compound now. We knew the bisphosphonates administered very well for many years now， Certainly the choice is important， but what was even more important is to give at least a kind of compounds as soon as patient’s bone metastasis are diagnosis， and then of course to continue therapy. Then the question often comes ok. You say to start  when the metastasis are diagnosis， but how long should you take， and for that， we do know the ASCO  guidelines， the ASCO guidelines show that  you have to take almost till the death of the patients. That is probably not true. You have to adjust the duration of treatment to your individual patients

　　Body教授： 是的，我们所做的就是想加强这种影响力，就是当骨转移诊断一旦确立时，就要进行这类药物治疗，至少在乳腺癌和前列腺癌患者当中。然后你在有所选择，比如帕米膦酸、唑来膦酸或地诺单抗，虽然这些化合物之间的效果并没有显示任何差别。当然这不是我们的观点，我想地诺单抗与唑来膦酸相比在乳腺癌和前列腺癌中，对预防事件的发生和预防随之而来的进一步临床事件发生更有效。但这只意味着我们有了更好的药物而已。双膦酸盐已经应用了多年，疗效很好。选择哪种药物当然很重要，但是更重要的是一旦患者诊断为骨转移，就要至少应用一种药物，然后当然是进行持续治疗。然后问题就出现了，当远处转移一旦诊断，就开始进行治疗，那治疗应该持续多久呢？对于这一点，我们知道美国临床肿瘤学会指南指出要治疗到直至患者死亡。这恐怕并不合理，你要根据自己的具体患者制定治疗期限。

　　Oncology Frontier: And are there any specific patient groups which certain compounds are more effective， for example， Zoledronic acid， are there particular groups with more effective compound?

　　《肿瘤瞭望》:请问是否有针对特殊群体中显示某种治疗药物更有效，比如唑来膦酸，是否有显示特定人群有更显著的疗效？

　　Prof. Body: I guess， definitely for the moment the only compound which shows activity to prevent the occurrence of metastases is in the postmenopausal patients setting. Of course， We moved patients with metastases from that situation to patients adjuvant setting， so for the preventable metastases， we have next meeting in two weeks from now， where we give you evidence for the preventable metastasis in postmenopausal women with the bisphosphonates， zoledronic acid， clodronate as well， which works also. We do not show any data yet， with new compound， denosumab. But we have adding very solid data， but it hasn’t complemented yet， but I guess in a few months I hope we can come up with some consensus， statement consensus paper about this.

　　Body教授：目前各种临床观察显示，有明确证据显示能阻止远处转移发生的情况见于绝经后妇女。这样，我们就从针对远处转移的治疗转变到了辅助治疗。对于预防远处转移，在我们约两星期后的下一次会议中会提交一些在绝经期妇女中应用双膦酸盐，如唑来膦酸和氯膦酸盐的数据。虽然我们还没有关于地诺单抗的证据，但是我们已经增加了很可靠的证据，虽然还没有完成，但我想在几个月之内我希望能制订出一些共识类的文件。

　　Oncology Frontier: Have you addressed quality of life surroundings using difference of compound?

　　《肿瘤瞭望》:请问您对于患者应用不同药物对生命质量的改善有什么评价？

　　Prof. Body: Yes we have several people now; some of them data were many years ago. I was one of the first to show these bisphosphonates， Bonefos， to improve the quality of life of patients with metastases.  This has been also with other bisphosphonates， improve definitely the quality of life， also with denosumab now. It is clear that all these bisphosphonates compound options，  improve the quality of life of patients，relief the bone pain， prevent the fracture and additional therapy，but it is social  evidently extremely important to the quality of life of the patients.

　　Body教授：是的，我们现在有很多同行，他们中的一些数据记录了很多年，我是最早之一显示这些双膦酸盐，如氯甲双磷酸盐，能够提高远处转移的癌症患者的生命质量，其他双膦酸盐，也证实能提高生命质量，当然现在也包括地诺单抗。所有这些双膦酸盐都能够提高患者的生命质量，能够缓解疼痛、预防骨折、减少相关的额外治疗，有明显的证据显示能提高患者的生命质量。

　　Oncology Frontier: Anything else in terms of whether protection or treatment you like to comment on this stage?

　　《肿瘤瞭望》：请问在现阶段里，就保护和治疗而言您还有哪些评价？

　　Prof. Body: I guess the most important message is for oncologists to consider this therapy. Because oncologists， of course， hit cancer， but they have to consider it immediately as diagnosed to use of compound. Because the problem is that we do not know when the first event， when the first complication of metastases we actually care， we do not particularly affect us， you can find patients with simple bone metastases， that then you say， well ok， it is only simple bone metastases， then we might not start the compound， but that is a mistake because an event could occur one month or two months after. When the first event occurs， there is a higher risk for the second and third event. So it is better to start immediately. I guess it is the main message.  If you patient are doing quite well， if he or she is with no bone pain or no high risk of getting in a SRE， then you can visit to stop after one or  two year or lower the frequency of infusion in future for example. But the main message to think about this compound and to start them as soon as metastases are diagnosed.

　　Body教授：我想最重要要传递的信息就是对肿瘤学者来说，要考虑这项治疗措施。肿瘤科医生，不用说，是要抗击癌症，但一旦诊断就要马上想到这项治疗。这是因为，我们不知道我们真正关心的远处转移的并发症事件首次发生是在什么时候，什么时候能影响到我们。你可能会遇到只有骨转移的患者，然后你可能会说，好吧，只有单纯的骨转移，我们可以不使用这种化合物。但这是错误的，因为并发症可能在一、两个月后出现，而一旦出现第一个事件，第二个、第三个事件发生的概率就大大增加。所以最好就是立即进行治疗，我想这就是要传达的主要信息。举个例子：如果你的患者全身状况，各项指标都很好，比如没有骨痛，那么1年以后你就可以考虑停药。但是最主要的信息是在远处转移被诊断时就要想到这类药物并开始治疗。