In the past two years, with the deepening of research related to targeting and immunotherapy and genotyping, more and more drugs with good effects and fewer side effects have become new options for individualized treatment and comprehensive treatment of colorectal cancer patients. Treatment strategies have also advanced from third-line or second-line treatment of colorectal cancer to first-line treatment. The overall treatment expectation of colorectal cancer patients has been greatly improved.
- Colorectal ciwon daji must be genetically tested before use. If you can’t obtain tissue sections, you can choose blood for testing. At this time, you mainly look at the NRAS, KRAS and BRAF genes.
- Zaɓin magani don ciwan kai tsaye yawanci haɗuwa ne da ƙwayoyi da yawa da magungunan ƙera ƙwayoyi tare da ƙwayoyi masu niyya.
- Bayan daidaitaccen maganin kansar kansa, har yanzu akwai sauran ƙwayoyi masu niyya waɗanda za a iya gwada su. Ko da kuwa sakamakon jiyya bai yi kyau kamar layi na farko da na biyu ba, zai iya kawo fa'idar rayuwa.
- Bayan layin farko da na layin na biyu sun kasance masu juriya, ana ba da shawarar a sake gudanar da gwajin kwayar halitta. Idan aka gano maye gurbin MSI-H ko NTRK, za a iya zaɓar rigakafi ko larotinib.
Don haka, ta yaya ya kamata marasa lafiya da ciwon sankarar hanji su ƙayyade shirin shan magani?
Bayan bincikar cutar kansa, likitoci za su ba da shawarar cewa kowane mai haƙuri da ke fama da cutar kansa (mCRC) ya yi gwajin ƙwayoyin halitta don ƙayyade rukunin ƙananan cututtukan, saboda wannan bayanin na iya faɗi hangen nesa na jiyya. Kwayoyin halittar da ake buƙatar a gwada sune:
MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK
Magunguna da aka yi niyya da su:
MSI (H) -pembrolizumab; nivolumab
BRAF (+) - Dalafenib, Trimetinib; Verofinil
RAS (KRAS- / NRAS -) - cetuximab; panitumumab (anti-EGFR)
HER2 (+) - trastuzumab
NTRK (+) - Larotinib
Anti-angiogenesis da ke niyya magunguna
VEGF: bevacizumab, abercept
VEGFR: ramucirumab, rigofinib, fruquintinib
Chemotherapy drugs include:5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil)
Ganin nau'ikan ƙwayoyi da yawa, yadda za a zaɓa da yadda ake haɗuwa tare da kyakkyawan sakamako? Vicki zai baku cikakken kaya don ganin wanne rukuni kuke, kawai je ku sami wurin zama!
Lissafin layi na farko a cikin ciwon sankarau
Before taking the medicine, the doctor will definitely look at the results of the genetic test. If the genetic test report shows that there are no mutations in the RAS or BRAF genes, chemotherapy and anti-EGFR targeted drugs are recommended. It is generally recommended that anti-EGFR targeted drugs must be used on the first line, because the effect will be greatly reduced if used in the back line.
Idan tasirin wannan maganin ba shi da kyau, canza zuwa hadewar sankarar magani da masu hana anti-angiogenesis, ana amfani da bevacizumab sosai.
Idan mai haƙuri bai dace da magungunan anti-EGFR ba, to kai tsaye amfani da chemotherapy haɗe tare da masu hana anti-angiogenesis.
Lokacin da babu ɗayan tsarin da ke sama da ke da tasiri, za a maye gurbin wani tsarin shan magani da wani mai hana anti-angiogenesis.
Chemistry na kansar kai tsaye yawanci yana zaɓar haɗakar magunguna da yawa. Doctors haɗuwa da daidaita daidai da ainihin halin marasa lafiya. Amfani da yawa shine:
- FOLFOX (fluorouracil, calcium folinate, oxaliplatin) ko FOLFIRI (fluorouracil, calcium folinate, irinotecan), ko haɗe shi da cetuximab (wanda aka ba da shawarar ga marasa lafiya masu kwayar KRAS- / NRAS-BRAF)
- CapeOx (capecitabine, oxaliplatin), FOLFOX or FOLFIRI, or combined with bevacizumab
- FOLFIRINOX (fluorouracil, folinate calcium, irinotecan, oxaliplatin)
Jiyya ta biyu
A cikin layin layi na biyu, muna da masu hana anti-angiogenesis daban daban da za mu zaɓa daga.
A layin farko, zamuyi amfani da bevacizumab hade da chemotherapy. Idan jiyya ba ta da tasiri, za mu iya canza tsarin sanko da ci gaba da amfani da bevacizumab. Tabbas, yana kuma yiwuwa a canza wani magani da aka yi niyya a lokaci guda kamar tsarin maganin sankara, canza zuwa abercept, ko zuwa ramucirumab.
Layi na uku da layin baya
Zaɓin zaɓin magungunan layi na farko da na layi na biyu don cutar kansar kai-tsaye yawanci wasu daidaitattun ƙwayoyi ne na ilimin kimiya da magungunan da aka yi niyya.
Starting from the third-line treatment is a back-line treatment. The back-line treatment plan can use some oral chemotherapeutics that have just come out, including TAS-102, as well as S-1 (tegio), rifafine, or some immunotherapy, such as pembrolizumab (MSI-H).
TA-102
TAS-102, magani ne na maganin ƙwaƙwalwa, maganin haɗuwa ne na trifluridine (mai hana shiga cikin kwayar halitta ta nucleoside) da tipiracil (mai hana maganin thromidine phosphorylase). Maganin yana da matukar buƙata, kuma kowane mako huɗu hanya ce ta magani. Theauki magani daga Litinin zuwa Jumma'a a farkon mako da sati na biyu, dakatar da maganin a ranar Asabar da Lahadi, dakatar da maganin a mako na uku da mako na huɗu, sannan fara zagaye na gaba. A wannan lokacin, idan mai haƙuri ba shi da maye gurbin RAS, ana iya amfani da shi a haɗe tare da panitumumab. Gabatarwar wannan tsarin shine cewa mai haƙuri baiyi amfani da panitumumab a baya ba.
Tigio
S-1 (Teggio) kuma magani ne na maganin ƙwaƙwalwa, wanda yake cikin ajin haɓakar fluorouracil. Oral Teggio capsules 80 mg / m2 / day, sau 2 a rana, sau ɗaya bayan karin kumallo da kuma bayan cin abincin dare, ko da sau 14 Kwanaki, cire magani na kwanaki 7;
Regafini
Regefini magani ne na maganin anti-angiogenesis wanda ake nufi da magani. Yana da fenti mai haske mai haske ruwan hoda mai haske. Regofenib yana da kyakkyawar tasiri akan maganin kansar hanji kuma zai iya inganta rayuwar marasa lafiyar da ke fama da ciwon hanji. Shawarwarin da aka ba da shawara: Gwargwadon shawarar da aka ba da ita ita ce 160 MG (Allunan 4, kowannensu yana ɗauke da 40 mg na rifafenib), sau ɗaya a rana, a baki a cikin kwanaki 21 na farko na kowane magani, da kuma kwanaki 28 a matsayin hanyar magani.
Yin rigakafi
If the patient finds MSI-H through genetic testing, immunotherapy may be considered. You can consider pembrolizumab only if you want to use a single drug. For patients with MSI-H colorectal cancer, pembrolizumab has a 50% chance of shrinking the tumo.
Baya ga immunotherapy guda-wakili, zaku iya yin la'akari da haɗuwa da rigakafin rigakafi daban-daban, kamar amfani da Nivolumab (nivolumab) da Ipilimumab (Ipilimumab) haɗuwa, damar rage ƙwanjin shine 55%.
Pembrolizumab shi kaɗai, nivolumab haɗe tare da ipilimumab FDA ta amince da su don ci gaba da kula da masu fama da cutar sankarau da MSI-H. Bayanai sun cika girma.
Larotinib
Larotinib mai ƙarfi ne, na baka, mai zaɓaɓɓen maganin hana kumburi wanda yake aiki akan TRKB, TRKB, da kuma TRKC kinases. An amince da shi a watan Nuwamba na 2018 har zuwa cutar kansa 17, gami da Cancer na ciki, amma ana buƙatar gano maye gurbin NTRK1 / 2/3, don haka Larotinib shima zaɓi ne don magani na gaba. Manyan marasa lafiya suna shan MG 100 sau biyu a rana.
Sakamakon jiyya na layin baya yawanci ba a bayyane yake ba kamar layin farko da na layin na biyu, amma kuma yana iya tsawanta lokacin rayuwa. Sabili da haka, idan za mu iya zaɓar zaɓuɓɓukan maganin layi daban-daban, ana amfani da magunguna daban-daban a cikin juyawa, kuma ana iya tsawanta rayuwa.
Me zan yi idan ba zan jure wa maganin cutar sankara ba?
Bugu da kari, dole ne a yi la’akari da abubuwan da ake hangowa na marasa lafiya masu fama da cutar sankarau, ma'ana, yanayin da zai shafi tasirin magani. Babban dalilan sune: nisan metastasis na kwayoyin cutar kanjamau, wurin da asalin ƙwayar cuta, yanayin
s na maye gurbi, amsawa da tazarar lokaci na magungunan da suka gabata, Matsayin raunin mai haƙuri zai shafi tasirin magani da zaɓin shirin magani.
Musamman ga marasa lafiya waɗanda ke da ɗan rauni kuma ba sa iya ɗaukar sakamakon cutar shan magani, ta yaya za a zaɓi shirin shan magani?
Babban shawarwarin sune kamar haka:
①Single targeted drug therapy, if there is no RAS gene mutation, you can choose cetuximab or panitumumab
Cannot Ba za a iya amfani da masu hana maganin anti-angiogenesis shi kaɗai ba, kuma dole ne a yi amfani da su tare da chemotherapy, don haka za ku iya zaɓar haɗakar magungunan chemotherapy tare da ƙananan illoli da kuma niyya, kamar irinotecan + bevacizumab (ko cetuximab)
ImmunSamun magani guda daya, kamar MSI-H, zabi pembrolizumab
Mahimmin bayani
- Dole ne a gwada cututtukan kansa na kai tsaye kafin ayi amfani da su. Idan ba za ku iya samun sassan nama ba, za ku iya zaɓar jini don gwaji. A wannan lokacin, galibi kuna kallon kwayoyin NRAS, KRAS da BRAF.
- Zaɓin magani don ciwan kai tsaye yawanci haɗuwa ne da ƙwayoyi da yawa da magungunan ƙera ƙwayoyi tare da ƙwayoyi masu niyya.
- Bayan daidaitaccen maganin kansar kansa, har yanzu akwai sauran ƙwayoyi masu niyya waɗanda za a iya gwada su. Ko da kuwa sakamakon jiyya bai yi kyau kamar layi na farko da na biyu ba, zai iya kawo fa'idar rayuwa.
- Bayan layin farko da na layin na biyu sun kasance masu juriya, ana ba da shawarar a sake gudanar da gwajin kwayar halitta. Idan aka gano maye gurbin MSI-H ko NTRK, za a iya zaɓar rigakafi ko larotinib.
