“美国非小细胞肺癌NCCN指南，该指南旨在给患者提供治疗信息，帮助患者从“0”到“1”认识肺癌，找到适合的治疗方案。本指南有些建议也许不适合你，你的医生可能会根据你的情况和其他因素制定不一样的治疗方案。”
本公众号将非小细胞肺癌NCCN指南重新整理拆分，将以中英文在公众号连载的方式发布，本指南不能做任何商业用途，转载请联系本公众号。
译者：朱志华、梅伟健
Part5.6 免疫治疗
免疫系统是人体的自然防御疾病。它包括许多由你身体制造的化学物质和蛋白质。免疫疗法增加免疫系统的活性。你的身体会更好地摧毁癌细胞。
The immune system is the body’s natural defense against disease. It includes many chemicals and proteins made by your body. Immunotherapy increases the activity of your immune system. Your body can better find and destroy cancer cells.
1、PD-1和PD-L1*制剂抑**
PD-L1存在于一些正常细胞。它附着在T细胞上的pd-1并阻断免疫应答。当不再需要免疫应答时，这是正常的生理过程带有PD-L1的癌细胞也可以阻断免疫应答。这可以防止免疫系统攻击肿瘤。PD-L1和PD-1*制剂抑**（如向导7中所示）被用于阻止带有PDL1的癌细胞。
PD-L1 is found on some normal cells. It attaches PD-1 on T cells to turn off an immune response.This is a normal when a response is no longer needed.Cancer cells with PD-L1 can also turn off the immune response. This prevents the immune system from attacking the tumor. The PD-L1 and PD-1 inhibitors listed in Guide 7 are used to stop cancer cells with PD-L1.
PD-L1*制剂抑**附着在 PD-1 T细胞。PD-1*制剂抑**附在癌细胞上的PD-L1。这两种*制剂抑**都能阻止带有PD-L1的癌细胞附着在T细胞上。因此，T细胞能够攻击癌细胞。参见图20所示。
PD-L1 inhibitors attach to PD-1 on T cells. PD-1 inhibitors attach to PD-1 on cancer cells. Both types of inhibitors stop cancer cells with PD-L1 from attaching to T cells. Thus, T cells are able to attack cancer cells. See Figure 20.
2、将会发生什么
PD-1和PD-L1*制剂抑**用过注射进入体内。Durvalumab和纳武单抗每两周给予一次，每次需要60分钟。派姆单抗每3周给予一次，每次需要30分钟。阿特朱单抗每3周时间给予一次，每次需要60分钟。
PD-1 and PD-L1 inhibitors are given by infusion. Durvalumab and nivolumab are given every 2 weeks for 60 minutes. Pembrolizumab is given every 3 weeks for 30 minutes. Atezolizumab is given every 3 weeks for 60 minutes.
3、副作用
免疫治疗的副作用比化疗小。一般的副作用包括在睡觉时感到疲倦。便秘、恶心、不饿也很常见。你可能有肌肉或骨骼疼痛。
Most people have fewer side effects with immunotherapy than chemotherapy. Common side effects for immunotherapy include feeling tired despite sleep. It is also common to feel constipated, nauseated, and not hungry. You may have muscle or bone pain.
当你使用免疫疗法时，任何器官都可以会感染。罕见但严重的副作用，包括肺、肠、肝、肾、内分泌或皮肤的损害。如果你怀孕了，想怀孕，或母乳喂养，不要接受免疫疗法，它可能会伤害你的宝宝。
Any organ can become inflamed while taking immunotherapy. This is rare but can cause severe side effects involving the lung, gut, live, kidney, hormones, or skin. Don’t take immunotherapy if you are pregnant, trying to get pregnant, or breastfeeding. It may harm your baby.
并不是所有副作用是列在这里。请向您的治疗小组询问一份常见和罕见副作用清单。如果身边有烦恼困扰你，告诉你的治疗团队。也许有方法可以让你感觉更好。还有一些方法可以避免某些方面的影响。
Not all side effects of immunotherapy are listed here. Please ask your treatment team for a complete list of common and rare side effects. If a side effect bother you, tell your treatment team. There may be ways to help you feel better. There are also ways to prevent some side effects.
Part5.7 临床试验
你的治疗选择之一是加入一个临床试验。参加临床试验会被大力提倡。NCCN相信在临床试验中你会得到最好的管理。
One of your treatment choices may be to join a clinical trial. Joining a clinical trial is strongly supported. NCCN believes that you will receive the best management in a clinical trial.
新的测试和治疗并不会马上向公众推广。他们需要学习和验证。临床试验是研究人员进行试验或治疗的一种研究。
New tests and treatments aren’t offered to the public as soon as they’re made. They first need to be studied. A clinical trial is a type of research that studies a test or treatment in people.
临床试验研究这些治疗和检查对人们是否安全／有帮助。如果被证明是安全的和有帮助的，它们可能成为新的标准治疗。由于临床试验，这本书中介绍的检查和治疗现在被广泛用于帮助肺癌患者。未来的测试和治疗可能有更好的结果，这将取决于临床试验。
Clinical trials study how safe and helpful tests and treatments are for people. When found to be safe and helpful, they may become tomorrow’s standard treatment. Because of clinical trials, the tests and treatments in this book are now widely used to help people with lung cancer. Future tests and treatments that may have better results will depend on clinical trials.
新的检查和治疗将经过一系列的临床试验。这些试验旨在确保它们的安全性和有效性。没有临床试验，就无法知道检查或治疗是否安全或有效。临床试验分为四个阶段。以下是这四个阶段的例子:
New tests and treatments go through a series of clinical trials. These trials aim to ensure they’re safe and work. Without clinical trials, there is no way to know if a test or treatment is safe or helpful. Clinical trials have four phases. Some examples of the four phases of treatment are:
一期试验的目的是找到一种最安全、最好的新药。另一个目的是找到药物的最佳使用方法，以最少的副作用。这些试验通常涉及20个人。
Phase I trials aim to find the safest and best dose of a new drug. Another aim is to find the best way to give the drug with the fewest side effects.These trials often involve about 20 people.
二期试验评估药物是否对某个类型的癌症有效。这些试验通常涉及20至100人。
Phase II trials assess if a drug works for a specific type of cance. These trials often involve 20 to 100 people.
三期试验将比较新药和标准治疗的疗效。这些试验通常涉及成百上千的人。
Phase III trials compare a new drug to a standard treatment head-to-head. These trials often involve hundreds or thousands of people.
四期试验将测试通过美国FDA(食品及药物管理局)批准的药物，研究他们长期使用的副作用。
Phase IV trials test drugs approved by the U.S. FDA (Food and Drug Administration) to learn more about side effects with long-term use.
参加临床试验有许多好处.首先，你可以接触到目前最先进的癌症治疗。然而，请注意，如果有新疗法的话，它的效果是未知的。其次，你会得到最好的护理。第三，你的治疗结果——好的和坏的都会被仔细的追踪。第四，你可以帮助其他将来患癌症的人。
Joining a clinical trial has benefits. First, you’ll have access to the most current cancer care. However, please note that it is unknown how well new treatments will work, if at all. Second, you will receive the best management of care. Third, the results of your treatment—both good and bad—will be carefully tracked. Fourth, you may help other people who will have cancer in the future.
临床试验也有风险。就像所有的测试或治疗一样，可能也会有副作用。另外，新的测试或治疗可能会或不会改善你的健康。事实上，你的健康状况在试验中可能会恶化。其他的不利因素可能包括更多的前往医院、文书工作和额外的费用。
Clinical trials have risks, too. Like any test or treatment, there may be side effects.Also, new tests or treatments may or may not improve your health. In fact, your health may worsen during a trial. Other downsides may include more hospital trips, paperwork, and extra costs for you.
参加临床试验,必须满足临床试验的条件。在临床试验中，病人的癌症和一般健康状况都很相似。因此，如果病人改善了，那是因为治疗，而不是因为他们之间差异。
To join a clinical trial, you must meet the conditions of the study. Patients in a clinical trial are often alike in terms of their cancer and general health. Thus, if patients improve, it’s because of the treatment and not because of differences between them.
想要加入，您将需要审查和签署知情同意书。这种形式详细地描述了研究的事项。该研究的风险和获益应该被描述，并且尽可能包含更多内容。
To join, you’ll need to review and sign an informed consent form. This form describes the study in detail. The study’s risks and benefits should be described and may include others than those described above.
问问你的治疗小组是否有你可以加入的开放的临床试验。在你接受治疗的地方或者附近的治疗中心可能会有临床试验，你也可以通过第八部分的网站查找临床试验。
Ask your treatment team if there is an open clinical trial that you can join. There may be clinical trials where you’re getting treatment or at other treatment centers nearby. You can also find clinical trials through the websites listed in Part 8.
综述
➢射频消融术依靠热量杀死癌细胞。
Radiofrequency ablation kills cancer cells using heat.
➢放疗治疗通常使用高能x射线治疗肺癌。
Radiation therapy most often uses high-energy x-rays to treat lung cancer.
➢化疗阻止癌细胞完成其生命周期,这样他们就不能增殖。
Chemotherapy stops cancer cells from completing their life cycle so they can’t increase in number.
➢靶向治疗药物阻止癌细胞得到生长的信号。
Targeted therapy drugs stop cancer cells from getting food or signals to grow.
➢免疫疗法激活身体的免疫系统摧毁癌细胞。
Immunotherapy activates your body’s diseasefighting system to destroy cancer cells.
➢临床试验让人们获得尝试新的检查和治疗的机会,这些治疗暂不能向公众推广。这些新的检测和治疗方法可能会及时得到FDA的批准。
Clinical trials give people access to new tests and treatments that otherwise can’t usually be received. These new tests and treatments may in time be approved by the FDA.
