Kafin farkon labarin, farkon kallon kimiyya.
Fahimtar MSI-H, MSS, MSI-L
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MSS (MicroSatellite kwanciyar hankali), kwanciyar hankali na microsatellite, idan aka kwatanta da MSI, babu MSI a bayyane.
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MSI-H (MicroSatellite rashin zaman lafiya-High, high-mita microsatellite rashin zaman lafiya), wato, mitar microsatellite rashin zaman lafiya yana da girma, gabaɗaya sama da 30%;
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MSI-L (MicroSatellite rashin zaman lafiya-Low, ƙananan mitar microsatellite rashin zaman lafiya), wato, mitar rashin zaman lafiyar microsatellite yana da ƙasa, gabaɗaya ƙasa da 30%.
Abokan da suka damu game da sabon ci gaba a cikin maganin ciwon daji sun san cewa an yarda da magungunan anticancer pembrolizumab da nivolumab don kula da duk marasa lafiya da ciwon daji tare da MSI-H (babban microsatellite rashin zaman lafiya). Musamman ga marasa lafiya masu launin launi, adadin gano MSI-H yana da yawa, don haka wasu masu ciwon daji suna amfana da irin wannan nau'in magani don tsawaita rayuwa.
A cikin jagororin jiyya na ciwon daji na ci gaba na NCCN ko metastatic, zaɓuɓɓukan rigakafin rigakafi na farko don marasa lafiya tare da MSI-H da dMMR sune nivolumab (nivolumab, Opdivo) ko pembrolizumab (pembrolizumab, Keytruda), ko nivolumab da ipilimumab (Iraq Combined therapy with Pitimab). , Yervoy).
Waɗannan shawarwarin shawarwarin rukuni ne na 2B kuma suna aiki ga marasa lafiya waɗanda ba su dace da tsarin tsarin chemotherapy na cytotoxic ba. Ana kuma jera waɗannan zaɓuɓɓukan maganin rigakafi a cikin jagororin azaman shawarwarin jiyya na layi na biyu da na uku don marasa lafiya dMMR/MSI-H.
Ga marasa lafiya masu ci gaba a cikin gida ko ciwon daji mai ƙazanta waɗanda suka kamu da cuta ko kuma suna da aƙalla juriya ga tsarin chemotherapy guda biyu da suka gabata, 95% na su na iya gano MSS maimakon MSI-H. Don haka, ta yaya za a zaɓi majinyata ciwon daji na MSS?
Kwanan nan, an buga gwajin IMblaze370 a matsayin gwaji na buɗaɗɗen lakabi na III, da kuma marasa lafiya 363 tare da ciwon daji na metastatic colorectal wanda sakamakon gwajin kwayoyin MSS aka ba da izini ga atezolizumab (atezolizumab) a hade tare da cobimetinib (cobititib) a 2: 1: 1 Ni, MEK da aka yi niyya magani) ƙungiyar, ƙungiyar attuzumab monotherapy, ƙungiyar regorafenib (regorafenib, mai hanawa kinase mai yawan manufa). Marasa lafiya masu fama da ciwon daji na MSS a tarihi ba su amsa maganin rigakafi ba.
Sakamakon wannan binciken ya tabbatar da sake: MSS marasa lafiya marasa lafiya ba su amsa da kyau ga maganin rigakafi (PD-L1) atuzumab. Tsakanin rayuwa gaba ɗaya na atezumab tare da ƙungiyar cobtinib shine watanni 8.87, idan aka kwatanta da watanni 7.10 a cikin ƙungiyar atezumab kaɗai da watanni 8.51 a cikin rukunin regofenib, ko da kuwa ko immunotherapy kaɗai ko a hade Babu wani fa'idar rayuwa mai mahimmanci.
Don rayuwa marar ci gaba na tsaka-tsaki, ƙungiyoyin jiyya guda uku sun kasance watanni 1.91, watanni 1.94, da watanni 2.00, ba tare da bambanci ba. Adadin abubuwan da suka faru mara kyau na sa 3/4 shine 61% a cikin rukunin jiyya na haɗin gwiwa, 31% a cikin rukunin atuzumab monotherapy, da 58% a cikin rukunin regofenib.
"Wadannan sakamakon suna nuna bambance-bambancen ilimin halitta mai ƙarfi tsakanin MSS da MSI-H, kuma suna jaddada buƙatun jiyya daban-daban tsakanin waɗannan nau'ikan cututtukan guda biyu," in ji Dokta Cathy Eng, mai bincike a Jami'ar Texas Anderson Cancer Center.
Wato masu cutar kansar launin fata waɗanda aka samo MSS ta hanyar gwajin ƙwayoyin cuta ba su ba da shawarar zaɓin rigakafi ba, kuma suna amfani da wasu hanyoyin maimakon. A halin yanzu, maƙasudi da magungunan da aka yi niyya waɗanda marasa lafiya da ke fama da ciwon sankara za su iya cimma su:
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VEGF: Bevacizumab, Apsip
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VEGFR: ramucirumab, rigofinib, fruquintinib
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EGFR: cetuximab, panitumumab
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PD-1 / PDL-1: pembrolizumab, nivolumab
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CTLA-4: Ipilimumab
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BRAF: Velofini
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NTRK: Larotinib
Idan an gano wasu maye gurbi masu ma'ana, ana iya zaɓar madaidaicin maganin magani.
Don masu ciwon daji na launi, za ku iya zaɓar daidaitaccen tsari na chemotherapy-FOLFOXIRI (fluorouracil + leucovorin + oxaliplatin + irinotecan), wanda shine haɗuwa da ƙungiyar cytotoxic chemotherapeutic jamiái, dace da dukan mutane.
Bayan juriya na miyagun ƙwayoyi, sakamakon gwajin kwayoyin ba shine MSI-H ba. Hakanan zaka iya zaɓar masu hanawa kinase masu yawa regorafenib (regorafenib, Stivarga) da TAS-102 (trifluridine / tipiracil; Lonsurf).
Cetuximab kuma magani ne na tauraro wanda sau da yawa marasa lafiya masu launin launin fata ke zaɓa, wanda shine magani wanda galibi yana bayyana a cikin tsare-tsaren jiyya na mutum ɗaya. Hanyoyin tantancewa sun haɗa da: Ciwon daji na hagu ne ko dama? Ya ƙunshi maye gurbin KRAS/NRAS? Kafin zaɓar cetuximab ko panitumumab, dole ne a yi la'akari da maye gurbin RAS.
