Taken taron shekara-shekara na NCCN na 2019 shine fadada gwajin kwayoyin halitta don jagorantar ainihin maganin cutar kansa, da kuma sabbin canje-canje ga jagororin cutar kansa (CRC). Yawan rayuwa na shekaru 5 na ciwon daji na launin fata shine kawai 11%, kuma ana sa ran sabunta tsarin jiyya na jagororin jiyya na NCCN zai inganta rayuwa.
Currently, the FDA has approved a variety of drugs to treat colorectal cancer, of which only four are related to genetic mutations, and biomarkers need to be tested. The 2019 update of NCCN treatment guidelines for maganin ciwon daji adds treatment methods based on detection of biomarkers, including EGFR, MSI-H / dMMR, BRAF + MEK, and NTRK fusion targets.
Bari mu bincika takamaiman mahimman bayanai da bayanai masu nauyi:
mFOLFOXIRI + EGFR
Based on the phase II phase VOLFI trial, mFOLFOXIRI (fluorouracil + leucovorin + oxaliplatin + irinotecan) plus panitumumab for the EGFR inhibitor, for patients with unresectable metastatic colorectal cancer, these The patient’s genetic test must be: KRAS / NRAS / BRAF wild type and only the left tumo ba a nan ba.
A cikin gwaji na VOLFI, marasa lafiya 96 da ke da RAS mai kama da kansar daji an ba da izini ga mFOLFOXIRI haɗe tare da panitumumab (n = 63) ko mFOLFOXIRI kawai (n = 33) a cikin rabo na 2: 1. Panungiyar panitumumab da aka haɗu tana da tasiri mai inganci na 85.7%, yayin da mFOLFOXIRI shi kaɗai ya kasance 54.5%.
MSI/MMR
Kodayake rashin zaman lafiya na microsatellite (MSI) da gyaran gyare-gyare (MMR) yawanci ba gado bane, wannan baya cire ciwace-ciwacen da Lynch ya haifar, wanda ke samuwa a cikin 1% na BRAF V600E ciwon daji na launi. Idan kuna da tarihin iyali mai ƙarfi, dole ne ku gudanar da gwajin kwayoyin halitta.
Sabbin jagororin sun nuna amfani da immunohistochemistry don gano kwayoyin halittar mutant huɗu da ke cikin cutar Lynch: MLH1, MSH2, MSH6 da PMS2.
A cikin jagororin jiyya na ciwon daji na ci gaba na NCCN ko metastatic, layin farko immunotherapy options for patients with MSI-H and dMMR are nivolumab (nivolumab, Opdivo) or pembrolizumab (pembrolizumab, Keytruda), or nivolumab and ipilimumab (Iraq Combined therapy with Pitimab, Yervoy). These recommendations are category 2B recommendations and apply to patients who are not suitable for a combination cytotoxic chemotherapy regimen. These immunotherapy drug options are also listed in the guidelines as second- and third-line treatment recommendations for dMMR / MSI-H patients.
Na NTRK
Larotrectinib (Larotinib, Vitrakvi) yanzu shine zaɓin magani na layin na biyu don marasa lafiya masu fama da cutar kansa. Gwajin kwayar marasa lafiya yana bukatar gano ingantaccen kwayar halittar NTRK. An buga bayanan binciken asibiti na maganin a cikin Jaridar Magunguna ta New England ta 2018.
Saboda haka, a cikin Nuwamba Nuwamba 2018, FDA ta amince da amfani da larotinib don kula da manya da yara kanana tare da kumburi mai kauri. Muddin mai haƙuri yana da haɗin jini na NTRK kuma babu wani sanannen maye gurbi da ya samo, cutar ta ƙaddara kuma tiyatar tiyata na iya haifar da Tsananin haɗarin mutuwa, babu wani tsari mai gamsarwa madadin magani ko ci gaba ya faru bayan jiyya.
A cikin wannan cikakkiyar fitina ta asibiti, marasa lafiya 4 da ke fama da cutar sankarau suna cikin rajista, kuma mai haƙuri 1 ya amsa da kyau.
Ga BRAF da MEK
A cikin wannan sabuntawar na jagororin NCCN, an ƙara hanyoyin kwantar da layi biyu na wannan mai nazarin halittun, waɗanda sune:
(1) dabrafenib (dalafinib, Tafinlar; BRAF) + trametinib (trametinib, Mekinist; MEK), haɗe tare da cetuximab ko panitumumab (EGFR monoclonal antibody);
(2) Encorafenib (Braftovi; BRAF) plus binimetinib (Mektovi; MEK) plus cetuximab or panitumumab.
The encorafenib / binimetinib and EGFR inhibitor treatment regimens are supported by data from the introduction of phase III BEACON trials. In 30 patients with metastatic colorectal cancer with BRAF V600E mutation, combined treatment with encorafenib / binimetinib plus cetuximab was followed up for 18.2 months, with an estimated overall survival of 15.3 months. According to local evaluation results, the combined The effective rate of treatment was 48%, and 3 patients achieved complete remission.
Wannan sabuntawa na ka'idodin NCCN na ciwon daji na launin fata ya sake tabbatar da muhimmiyar rawar gwajin kwayoyin halitta a cikin maganin ciwon daji. Tare da ƙarin zaɓin magani, akwai ƙarin bege! Abokan ciwon daji yakamata su daina shakkar matsayin gwajin kwayoyin halitta. Labari mai dadi shine cewa akwai da yawa da aka amince da magungunan da aka yi niyya don ciwon daji na colorectal. Da fatan za a kula da abin da ke hannun ku.
