Tsarin da aka yi niyya don cutar kansa

Menene ƙwayoyin cutar kansa da ake niyya ga magunguna?

17 years ago, the number of drugs available for advanced colorectal cancer was very limited. There were only a few chemotherapeutic drugs and almost no targeted drugs. Once diagnosed, the survival period is only between half a year and one year. But now, cancer treatment is entering the era of precision treatment, and more and more targeted and immune drugs are on the market.

In the 2017 version of the colorectal cancer treatment guidelines, the recommendations for genetic testing only involve KRAS, NRAS, dMMR, and MSI-H. In the latest treatment guidelines for 2019, new targets such as BRAF, HER2, NTRK are newly included Point, through genetic testing, to understand more molecular information about colorectal cancer, can help us find more medication options. The average patient survival rate is more than 3 years, which is a huge improvement brought by precision medicine.

Wadanne kwayoyin ne ya kamata a gwada su a cikin masu cutar kansa?

Bayan ganewar asali, likitoci dole ne su gwada kowane mai haƙuri tare da cututtukan cututtukan fata (mCRC) da wuri-wuri don sanin rukunin ƙananan cututtukan, saboda wannan bayanin na iya hango hangen nesa game da jiyya, kamar haɓakar HER2 da ke ba da shawarar anti-EGFR therapy Resistant. Dole ne a gwada wadannan kwayoyin halitta!

MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK.

Manufa da ƙwayoyi masu niyya a halin yanzu akwai don magani

VEGF: bevacizumab, aparcept

VEGFR: Ramulizumab, Regigofinil, Fruquintinib

EGFR: Cetuximab, Panitumumab

PD-1 / PDL-1: Pamumab, Navumab

CTLA-4: Ipilizumab

BRAF: Wimofenib

NTRK: Larotinib

List of colorectal cancer targeting and immunotherapy drugs that have been approved so far at home and abroad:

Alamar bevacizumab: Metastatic colorectal cancer da kuma ci-gaba, metastatic ko maimaituwa mara karamin cell huhu ciwon daji.

Alamomin trastuzumab: HER2-positive metastatic breast cancer, HER2-positive early breast cancer, and HER2-positive metastatic gastric adenocarcinoma or gastroesophageal junction adenocarcinoma.

Alamar Pertuzumab: This product is suitable for combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer with a high risk of recurrence.

Alamar Nivolumab: negative epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) negative, disease progression or intolerable locally advanced or metastatic disease after previous platinum-containing chemotherapy Adult patients with non-small cell lung cancer (NSCLC).

Alamar Regorafenib: previously treated metastatic colorectal cancer patients. Durvalumab, Tremelimumab, Ipilimumab, lapatinib are not yet available in China.

Tsarin Farfaɗɗen Maƙasudin Launi (Sabunta 2019)

1.Kras-mummunan cutar kansa wanda aka yiwa niyya

KRAS daji nau'in ciwon hanji shine daidaitaccen jiyya na layin farko don chemotherapy da aka yi niyya tare da chemotherapy. To wane irin chemotherapy aka zaba?

Yayin da ake zaɓar wani magani da aka yi niyya, ana ba da shawarar zaɓar tsarin ƙarancin magani tare da dogon OS, wato, cetuximab ya fi dacewa da FOLFOX, kuma bevacizumab ya fi dacewa da FOLFIRI. Wanne shirin zaba ya dogara da takamaiman binciken asibiti:

Idan akwai fatan samun waraka, ana fifita cetuximab haɗe da chemotherapy gabaɗaya saboda ƙimar makasudin kwanan nan na cetuximab ya fi bevacizumab girma;

Ga marasa lafiya da ke fama da cutar mai saurin warkewa, bevacizumab haɗe tare da chemotherapy za a iya amfani da layi na farko, sannan cetuximab ko panitumumab.

2.Yi maganin Kras-tabbataccen ciwan marashi

Marasa lafiya da ke fama da cutar kansa ta hanji suna buƙatar a gwada su don yanayin maye gurbi na RAS ciki har da KRAS da NRAS, kuma aƙalla matsayin KRAS exon 2 yana buƙatar bayyana.

Idan za ta yiwu, yakamata a bayyana matsayin sauran abubuwan banda KRAS Exon 2 da kuma halin maye gurbi na NRAS.

Bevacizumab haɗe tare da maganin chemotherapy biyu na iya kawo PFS (tsakanin ci gaba mara rayuwa) da fa'idodin OS (cikakken rayuwa) ga marasa lafiya tare da maye gurbin KRAS.

Ga marasa lafiya tare da maye gurbin RAS, yin amfani da cetuximab na iya samun mummunan tasiri akan ƙimar gaba ɗaya. Marasa lafiya tare da maye gurbin KRAS ko NRAS kada suyi amfani da cetuximab ko panitumumab.

3.Yi maganin cutar kansa ta BRAF

7-10% na marasa lafiya da ke fama da cutar kansa ta hanji suna ɗauke da maye gurbin BRAF V600E. BRAF V600E maye gurbi yana kunna maye gurbin BRAF kuma yana da mafi girman adadin maye gurbi na BRAF. Yana da halaye na musamman na asibiti: galibi yana bayyana a cikin madaidaicin dama; rabo dMMR yana da girma, yana kaiwa 20%; BRAF V600E maye gurbi yana da mummunan hangen nesa; abubuwan da ba su dace ba;

Nazarin ya gano cewa FOLFOXIRI + bevacizumab na iya zama mafi kyawun magani ga marasa lafiya tare da maye gurbi na BRAF. Jagoran 2019 V2 NCCN yana ba da shawarar BRAF V600E zaɓuɓɓukan magani na layin na biyu don cutar kansar hanji: verofinib + irinotecan + cetuximab / panitumumab Dabarafenib + trametinib + cetuximab / panit MAb

Encorafenib + Binimetinib + Cetux / Pan

4.HER2 fadadawa

HER2 amplification or overexpression is found in 2% to 6% of patients with advanced or metastatic colorectal cancer. Pertuzumab and trastuzumab bind to different HER2 domains to produce synergistic inhibitory effects on tumor cells. MyPathway is the first clinical study to investigate the efficacy of Pertuzumab + Trastuzumab in patients with HER2 expansion metastatic colorectal cancer (regardless of KRAS mutation status). This study shows that HER2 dual-targeted therapy, Pertuzumab + Trastuzumab, is well tolerated or could be used as a treatment option for patients with HER2 expansion metastatic colorectal cancer. Early genetic testing to identify HER2 mutations and consider early use of HER2 targeted therapy may benefit patients.

5.Yi maganin NTRK mai hadewar kansar kansa

NTRK haɗuwa yana faruwa a game da 1 zuwa 5% na marasa lafiya da ciwon daji na hanji, kuma an ba da shawarar gwajin NGS. An amince da Lorarectinib don sake fasalin NTRK a cikin marasa lafiya tare da ciwace-ciwacen ƙwayoyi, tare da ORR na 62% da 3 daga cikinsu tare da CRC. Bayyanar masu hana TRK kamar larotinib da emtricinib suna ba da sababbin dabaru na warkewa don NTRK gene fusion CRC.

Wata mace mai shekaru 75 da ke fama da cutar sankarar sankara (CRC) ta yi sa'a sosai:

Ciwon ciki na farko.

Ciwon daji na Peritoneal.

Hanyoyin hanta.

Ana amfani da 1600 mg / m 2 na emtricinib a baki sau ɗaya a mako don kwanaki huɗu a jere (watau kwanaki 4/4 kwanakin kashe) da kuma sati 3 a jere kowane kwana 3. Aft
er makonni takwas na jiyya, raunin ya ragu sosai.

Ƙarshen Magana

Idan aka shiga zamanin maganin warkewa, duk mai haƙuri da ke da cutar sankarau ya kamata ya wuce gwajin MSI, RAS da BRAF na maye gurbi, kuma su yi aikin fadada HER2 gwargwadon iko, gano kwayoyin halitta kamar NTRK, da gwajin kwayar halitta (NGS) za a saka su cikin manyan sharuɗɗan binciken farko don yawancin marasa lafiya.

Don ƙarin bayani kira +91 96 1588 1588 ko rubuta zuwa cancerfax@gmail.com.