Ciwon daji na launin fata yana daya daga cikin ciwace-ciwacen da aka fi sani da shi. A kasar Sin, kamuwa da cutar kansar launin fata ya kasance na 4 da na 3 a tsakanin maza da mata, bi da bi. Shiga cikin yanayin ci-gaban cuta, dabarun jiyya ga waɗannan marasa lafiya shine cikakken jiyya na tushen chemotherapy. Idan aka kwatanta da mafi kyawun maganin tallafi, zai iya tsawaita lokacin rayuwa sosai kuma ya inganta yanayin rayuwa. A cikin shekaru biyu da suka gabata, tare da zurfafa bincike na kwayoyin cutar kansa, tasirin magungunan da aka yi niyya yana samun kyau kuma yana da kyau, kuma illar da ke tattare da ita kadan ne, ta yadda likitoci da marasa lafiya su sami karin hanyoyin magani. Bari mu kalli colorectal Menene zaɓuɓɓukan magani na yanzu don ciwon daji?
Tsarin maganin cutar kansa
(1) It is recommended to detect the gene status of tumo K-ras, N-ras and BRAF before treatment, and EGFR is not recommended as a routine test item.
(2) Combined chemotherapy should be used as the first- and second-line treatment for patients with metastatic colorectal cancer that can tolerate chemotherapy. The following chemotherapy regimens are recommended: FOLFOX or FOLFIRI, or combined with cetuximab (recommended for patients with wild-type K-ras, N-ras, BRAF genes), CapeOx, FOLFOX or FOLFIRI, or combined with bevacizumab.
(3) Marasa lafiya da ke da fiye da layi na uku chemotherapy ana ba da shawarar gwada magungunan da aka yi niyya ko shiga cikin gwaji na asibiti. Ga marasa lafiya waɗanda ba sa amfani da magungunan da aka yi niyya a cikin jiyya na farko da na biyu, irinotecan haɗe tare da maganin miyagun ƙwayoyi kuma ana iya la'akari da su.
(4) Regofinil ko gwajin asibiti ana ba da shawarar ga marasa lafiya waɗanda suka kasa layin na uku kuma sama da daidaitaccen tsarin kulawa. Ga marasa lafiya waɗanda ba sa amfani da ƙwayoyi masu niyya a cikin layin farko da na biyu, irinotecan haɗe da cetuximab (ana ba da shawarar irin-daji K-ras, N-ras, kwayoyin BRAF).
(5) Ga marasa lafiya waɗanda ba za su iya jure wa haɗuwa da cutar sankara ba, an ba da shawarar makircin fluorouracil + calcium folinate ko capecitabine guda magani ko haɗin magungunan da aka yi niyya. Marasa lafiya da ke fama da cutar kansa mai saurin canza launi waɗanda ba su dace da tsarin fluorouracil + calcium leucovorin na iya yin la’akari da maganin da ake yiwa wakili ɗaya tare da raltrexone.
(6) Marasa lafiya waɗanda cutar ta daidaita bayan watanni 4 zuwa 6 na jinƙai amma har yanzu ba su da damar sakewa na R0 na iya yin la'akari da shigar da maganin kiyayewa (kamar yin amfani da ƙananan fluorouracil mai guba + calcium leucovorin, ko capecitabine guda magani haɗuwa da niyya Jiyya, ko dakatar da tsarin tsarin) don rage yawan guba da ke tattare da cutar sankara.
(7) Ga marasa lafiya tare da maye gurbin BRAF gene V600E maye gurbi, idan yanayin gabaɗaya ya fi kyau, FOLFOXIRI ko maganin layin farko haɗe da bevacizumab za'a iya yin la'akari dashi.
(8) Idan yanayin gaba ɗaya ko aikin gabobi yana da talauci a cikin marasa lafiya masu ci gaba, ana bada shawarar mafi kyawun maganin tallafi.
(9) Idan matakin metastasis ya iyakance ga hanta da / ko huhu, koma ga ƙa'idodin maganin cutar hanta da huhu.
(10) Ga marasa lafiya tare da komawa gida na ciwon daji na launi, ana ba da shawarar kima mai yawa don sanin ko suna da damar sake sakewa ko kuma rediyon rediyo. Idan kawai ya dace da ilimin chemotherapy, ana amfani da ka'idodin da ke sama na maganin miyagun ƙwayoyi ga marasa lafiya masu ci gaba.
Zaɓin chemotherapy ga marasa lafiya da ke fama da cutar kansa
Magungunan Chemotherapy a halin yanzu ana amfani dasu don magance ciwon daji mai saurin kai tsaye sun haɗa da: fluorouracil (gami da baka
Capecitabine), oxaliplatin da irinotecan.
Daya
Farjin cikin ciki
1. Tsarin magunguna uku
FOLFOXIRI [23]: irinotecan 165 mg / m2, jigon cikin jini, d1; oxaliplatin 85 mg / m2, jigon jini, d1; LV 400 mg / m2, jigilar jijiyoyin jini, d1; 5-FU 1 600 mg / (m2 · d) × 2 d ci gaba da jigilar jijiyoyin jini (duka 3 200 mg / m2, jiko na awanni 48), farawa a ranar farko. Maimaita kowane mako 2.
2. Dual tsarin mulki
(1) Shirye-shiryen tushen Oxaliplatin, irin su FOLFOX da CapeOx, duba maganin ciwon daji na hanji.
(2) Tsarin tushen Irinotecan: FOLFIRI: irinotecan 180 mg / m2, jigilar jijiyoyin ciki na awanni 2, d1; LV 400 mg / m2, jigilar jijiyoyin cikin awanni 2, d1; 5-FU 400 mg / m2, Intravenous bolus injection, d1, sannan 2 400 mg / m2, ci gaba da maganin cikin jini na 46 zuwa 48 hours. Maimaita kowane mako 2.
3. Tsarin kwaya daya
Idan mai haƙuri ba zai iya jure wa magani na farko ba, 5-FU / LV ko jiko na capecitabine (duba adjuvant far don takamaiman bayani) ko kuma irinotecan wakili ɗaya (125 mg / m2 irinotecan, intravenous infusion 30 ~ 90 minutes, d1, d8, maimaitawa kowane mako 3; ko irinotecan 300-350 mg / m2, jigilar jijiyoyin cikin minti 30-90, d1, ana maimaitawa kowane sati 3). Ko irinotecan 180 mg / m2, jigilar jijiyoyin cikin awanni 2, d1, ana maimaitawa kowane sati 2.
Bayan wannan magani na sama, idan yanayin rashin lafiyar bai inganta ba, ya kamata a ba da mafi kyawun magani na taimako.
Biyu
Kulawa da kulawa
Gwajin na OPTIMOX1 ya nuna cewa a cikin marasa lafiya masu fama da cutar sankarar hanji da ke karɓar FOLFOX a matsayin jiyya ta farko, amfani da kai tsaye na dabarar “tsayar da tafiya” ta oxaliplatin na iya rage yawan ƙwayoyin cuta amma ba ya shafar Tsira [26]. Sabili da haka, bayan watanni 3 zuwa 6 na hade-hade guda biyu hade-hade, kamar cutar CR / PR / SD, oxaliplatin ko irinotecan tare da mummunan halayen halayen za a iya dakatar da su, kuma sauran magungunan kula da shan magani a cikin tsarin suna ci gaba. Har sai ciwace-ciwacen ya ci gaba, ba za a ci gaba da rayuwa ba tare da ci gaba ba, amma fa'idar rayuwa gaba daya ba a bayyane take ba.
Three
Na biyu, na uku da zaɓuɓɓuka na chemotherapy masu zuwa
Zaɓin magani na layin na biyu ya dogara da tsarin jiyya na farko. Shirye-shiryen oxaliplatin da tushen irinotecan na iya zama layi na farko da na biyu na juna. Dangane da yanayin lafiyar mara lafiyar, zaɓi zaɓi guda ɗaya ko shirin hada magunguna.
Ana ba da shawara ga marasa lafiya da ke da sama da layi na uku don gwada ƙwayoyi masu niyya ko shiga cikin gwaji na asibiti. Ga marasa lafiyar da ba sa amfani da magungunan da aka yi niyya a cikin hanyar layin farko da ta biyu, ana iya yin la'akari da irinotecan haɗe da maganin ƙwayoyi masu niyya.
Amfani da niyya don cutar kansa
Jerin wadanda aka yi niyya da immunotherapy magunguna don ciwon sankarar hanji wanda aka amince da su a gida da waje.
1. Bevacizumab
Sunan gama gari: Wani Wei ne
Sunan Turanci: Avastin
Sunan tsarin kwayoyin: Bevacizumab
Babban alamomi: ciwan kai tsaye
Asali: Roche
Bevacizumab (Avastin®) ɗan adam ne mai sake haɗuwa da kwayar cutar monoclonal. Hukumar ta FDA ta amince da shi a ranar 26 ga Fabrairu, 2004, kuma shi ne magani na farko da aka amince da shi a Amurka don kawar da tumo angiogenesis.
Amfanin bevacizumab azaman wakili ɗaya yana da ƙasa, kuma galibi ana ba da shawarar a yi amfani da shi a haɗe tare da cutar sankara.
Haɗaɗɗen tsarin maganin sankara: IFL, FOLFIRI, FOLFOX da CapeOX; allurai da aka yi amfani da su: 5 mg / kg (tsarin sati 2) da 7.5 mg / kg (tsarin sati 3).
Haɗuwa da IFL da bevacizumab a cikin maganin babban ciwan kansa ya haɓaka OS daga watanni 15.6 zuwa watanni 20.3 (binciken AVF2107).
Bevacizumab hade da tsarin FOLFIRI a matsayin jiyya na farko, ƙimar tasiri shine 58.7%, PFS shine watanni 10.3 (nazarin FIRE3).
Bevacizumab haɗe tare da FOLFOX ko FOLFIRI azaman jiyya na farko, PFS ya kai watanni 11.3, OS ya kai watanni 31.2 (binciken CALGB80405).
2. Cetuximab
Sunan gama gari: Erbitux
Sunan Ingilishi: CETUXIMAB MAGANIN CIKI
Sunan tsarin kwayoyin halitta: Cetuximab
Babban alamomi: ciwan kai tsaye
Wurin Asali: Merkelion, Jamus
Kafin magani tare da cetuximab, dole ne a gwada kwayar RAS kafin dukkan marasa lafiya masu nau'in daji suyi amfani da cetuximab. Effectiveimar tasiri na cetuximab kusan 20% ne, kuma yawanci ana ba da shawarar a yi amfani da shi a haɗe tare da chemotherapy.
FOLFIRI da FOLFOX; sashi: 400mg / m2 250mg / m2 a kowane mako bayan sashi na farko.
A cikin marasa lafiya irin na RAS, cetuximab haɗe tare da tsarin FOLFIRI ko tsarin FOLFOX yana kawo PFS da OS mafi tsayi fiye da chemotherapy kadai.
3. Regafini
Sunan gama gari: Baivango
Sunan Turanci: regorafenib
Sunan tsarin kwayoyin: Regefenib
Babban alamomi: cututtukan daji na cikin gida
Wurin Asali: Kamfanin Bayer
Mutanen da suka dace: A watan Satumba na 2012, Regefini ya amince da FDA don kula da ciwon daji na ci gaba. A watan Mayu 2017, CFDA ta kasar Sin ta kuma amince da regorafenib don maganin fluorouracil, oxaliplatin, da irinotecan da ke da sinadarai da kuma maganin VEGF 1. Magungunan Anti-EGFR (nau'in RAS na daji) tare da cututtukan cututtukan sankara a cikin jiki (mCRC).
4. Panitumumab (panitumumab)
Sunan gama gari: Viktibi
Sunan Ingilishi: Erbitux cetuximab
Sunan tsarin kwayoyin: panitumumab
Babban alamomi: cututtukan daji na cikin gida
Wurin Asali: Amgen Amurka
Magungunan maganin ciwon daji na launi Vectibix (panitumumab) da panitumumab sune na farko da aka samar da cikakken jikin mutum guda daya wanda ke kaiwa ga mai karɓar haɓakar haɓakar epidermal (EGFR). A cikin Yuli 2005, Panituumab ya sami amincewar FDA cikin sauri. A ƙarshen 2005, Amgen da abokin aikinsa Abgenix tare sun ƙaddamar da takardar lasisi don wannan samfur ga FDA don maganin ciwon daji na ciwon daji bayan gazawar chemotherapy.
5.Ziv-aflibercept (Abercept)
Sunan Ingilishi: Zaltrap (ziv-aflibercept ga mafita ga jiko)
Sunan tsarin kwayoyin halitta: Abecip
Babban alamomi: cututtukan daji na cikin gida
Asali: Sanofi
Abe FDA ya sami amincewar hukumar ta FDA ta Amurka don maganin cutar kansa mai saurin ciwan kai a shekara ta 2012. Magungunan furotin ne na chimeric wanda ke takurawa da samar da sinadarin ƙari ta hanyar hana mutum ci gaban kwayar cutar ta VEGF, saboda haka hana yaduwar ƙari.
Aflibercept yana ɗaure don yawo da VEGF a cikin jiki kuma yana aiki kamar "tarkon VEGF". Sabili da haka, suna hana aiki na ƙananan ƙwayoyin cuta na endothelial subtypes VEGF-A da VEGF-B da haɓakar haɓakar mahaifa (PGF), bi da bi, kuma suna hana ci gaban sabbin jijiyoyin jini a cikin cysts ko ƙwayoyin cuta. Ana iya cewa cewa manufar Aflibercept ita ce “yunwa” da ƙwayar nama.
6. Ramolimumab (Cyramza)
Sunan Turanci: ramucirumab
Sunan tsarin kwayoyin: Remolumumab
Babban alamomi: ciwan kai tsaye
Asali: Eli Lilly da Kamfanin
Cyramza was approved by the US FDA in 2014 to treat gastric cancer, colorectal cancer and non-small cell lung ciwon daji.
Yayinda kasusuwan kumburin ya kara girma, zai shiga aikin angiogenesis, ma'ana, samuwar sabbin jijiyoyin jini a kusa da jikin kumburin don jigilar kayan abinci zuwa kwayoyin cutar. Sabili da haka, hana wannan aikin zai iya hana yaduwar yawancin ciwace-ciwacen ƙwayoyi.
Cyramza magani ne na kwayar cutar monoclonal, wanda yafi hana samuwar sabbin jijiyoyin jini a kusa da kumburin kuma yana hana samar da kayan abinci ga ƙwayar ta hanyar ɗaure ga mai karɓar rashi mai karɓar mahaifa (VEGFR2), don haka hana haɓakar ƙari.
7. Fruquintinib
Sunan Samfur: Aiyoute
Alamomin da suka dace: An amince da su a China a ranar 5 ga Satumba don maganin fluorouracil na baya, oxaliplatin da irinotecan chemotherapy, da kuma magani na baya ko maras dacewa tare da haɓakar haɓakar ƙwayar jijiyoyin jini (VEGF) 1. Marasa lafiya tare da CRC metastatic CRC da aka kula da maganin mai karɓar haɓakar haɓakar epidermal (EGFR) (RAS daji-nau'in).
7.opdivo
Sunan Turanci: nivolumab
Sunan tsarin kwayoyin halitta: nivolumab
Babban alamomi: ciwan kai tsaye
Wurin Asalin: Bristol-Myers Squibb
Ono da Bristol Myers Squibb (BMS) bincike da haɓaka haɗin gwiwa, a cikin Yuli 2014 ta amincewar Hukumar Kula da Magunguna da Magunguna ta Japan (PMDA), Disamba 2014 ta Hukumar Abinci da Magunguna ta Amurka (FDA) ta Amince, ta amince da Hukumar Kula da Magunguna ta Turai (Pharmaceutical and Medical Devices Agency). EMA) a watan Yuni 2015, wanda Hukumar Abinci da Magunguna ta kasar Sin (CFDA) ta amince da ita don tallatawa a watan Yuni 2018, kuma Ono Pharmaceuticals a Japan, Bristol-Myers Squibb a Amurka, ana siyar da shi a Turai da China a ƙarƙashin alamar. suna Odivo®.
Ci gaban magani na ƙarshe na ciwan kai tsaye
1) TAS-102 (Lonsurf)
TAS102 magani ne na chemotherapeutic na baka wanda ya hada da anti-tumor nucleoside analog FTD (trifluorothymidine, trifluridine) da thymidine phosphorylase inhibitor TPI.
MPFS na ƙungiyar TT-B da aka kula da TAS102 + bevacizumab ya kasance watanni 9.2, wanda ya kasance mafi girma fiye da watanni 7.8 na ƙungiyar capecitabine + bevacizumab CB da aka saba da su. Cigaba-babu rayuwa. Ana tsammanin ya zama sabon zaɓin jiyya na farko don irin waɗannan marasa lafiya.
2) Menene fa'idojin farfadowa cikin nasara a haɗakar magunguna uku?
A hade da encorafenib, binimetinib and cetuximab for BRAF mutation patients is a big change, because multiple studies have shown that the combination of BRAF inhibitors and MEK inhibitors in refractory patients, It can be seen that the reaction rate exceeds 30%, which is unheard of.
Bayanai na kwanan nan da aka gabatar a taron Majalisar Dinkin Duniya na 2018 na Ciwon Cutar Canji ya nuna cewa haɗin magungunan uku ba kawai yana da ƙimar amsa mai girma ba, amma kuma yana da dogon PFS da OS. Wannan shine dalilin da ya sa ake haɓaka gwaji a cikin layin farko. Abin sha'awa, wannan sau uku ba ya ƙunsar magungunan ƙwayoyin cytotoxic. Wannan yana nuna cewa yana iya gane ƙwayoyin cuta na ƙwayoyin cuta da hankali kuma yana haifar da tasirin asibiti ba tare da haifar da yawan guba ba.
3) Menene ci gaba na rigakafi?
Don ciwace-ciwacen MSI-H, haɗuwa da nivolumab da ipilimumab suna da damar samun magani na farko, saboda bayanan inganci suna da tabbaci sosai.
Don ciwan ciwan microsatellite, yakamata mu haɗu da rigakafin rigakafi tare da daidaitaccen cutar sankara-FOLFOX / bevacizumab a hade tare da nivolumab.
