How do patients with liver cancer choose genetic testing to truly achieve precise treatment?

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The occurrence of cancer is ultimately due to genetic abnormalities, which makes the growth of mutant cells into an uncontrolled state, and cancer cells begin to divide and increase in value endlessly. In other words, cancer is a genetic disease. However, external factors such as high life pressure, low immunity, smoking and drinking, and irregular work and rest are the causes of gene errors.

Factors related to cancer are:

  • age
  • alcohol
  • Carcinogen (aflatoxin)
  • Chronic inflammation
  • Eating habits
  • hormone
  • Immunosuppressive
  • Infectious pathogens (hepatitis B virus, Helicobacter pylori)
  • obesity
  • radiation
  • illumination
  • tobacco

After more than ten years of development, cancer genetic testing has become the immediate need of a large number of cancer patients. The test report guidance provided by tumor genetic testing perfectly fits the development concept of precision medicine, and has penetrated into all aspects of the diagnosis and treatment of cancer patients, so that patients can choose targeted drugs for precise treatment, avoid detours, and avoid unnecessary side effects bitter.

Current status of targeted therapy for liver cancer

Only by classifying the essential characteristics of liver cancer from the molecular level can early diagnosis and prognosis judgment of the tumor be more reasonable and accurate, and molecular targeted drugs can be used to personalize and accurately treat patients. The approved liver cancer targeted drugs are as follows:

1.Sorafenib ( Sorafenib, Dorjemi )

Sorafenib is a targeted drug with two effects. One is to prevent the new blood vessels needed for tumor growth, and it can also target proteins that promote the growth of cancer cells. The main targets are VEGFR-1 / 2/3, RET , FLT3 , BRAF and so on.

Sorafenib can directly inhibit the proliferation of tumor cells, and can also act on VEGFR and PDGFR to inhibit the formation of new blood vessels and cut off the nutritional supply of tumor cells, thereby curbing tumor growth. Sorafenib is suitable for the first-line treatment of advanced liver cancer that cannot be operated or metastasized.

Sorafenib is an oral medicine, twice a day. The most common side effects of this medication include fatigue of the palms or soles, rash, loss of appetite, diarrhea, high blood pressure, redness, pain, swelling or blisters. Serious side effects (uncommon) include problems with blood flow to the heart and perforation of the stomach or intestines.

2.regorafenib ( Regofenib, Baivango )

Regefenib can block tumor angiogenesis, and can also target several proteins on the surface of cancer cells to prevent the growth of cancer cells. It is an oral multi-target kinase inhibitor that can inhibit VEGFR-1, 2 , 3 , TIE-2 , BRAF , KIT , RET , PDGFR and FGFR , and its structure is similar to sorafenib.

On December 12 , 2017, the State Food and Drug Administration ( CFDA ) approved the oral polykinase inhibitor regorafenib for patients with hepatocellular carcinoma ( HCC ) who had previously received sorafenib treatment. Take it orally once a day for 3 consecutive weeks, then rest for a week, and then continue to the next cycle.

Common side effects include fatigue, loss of appetite, hand-foot syndrome (redness and irritation of hands and feet), high blood pressure, fever, infection, weight loss, diarrhea and abdominal pain. Serious side effects (uncommon) may include severe liver damage, severe bleeding, heart blood flow problems, and perforation of the stomach or intestines.

3.lenvatinib (Levatinib, Le Weima )

Lenvatinib is a multi-targeted drug. The main targets of levatinib include vascular endothelial growth factor receptor VEGFR1-3 , fibroblast growth factor receptor FGFR1-4 , platelet-derived growth factor receptor PDGFR- α, cKit , Ret et al. Work by preventing tumors from forming new blood vessels that need to grow.

In August this year, Eisai ( Eisai ) and Merck ( MSD ) of lovastinib were approved by the US FDA for marketing. Leweima was included in the first-line treatment of non-surgical advanced liver cancer by CSCO liver cancer guideline ( 2018 version), the most authoritative tumor diagnosis and treatment guideline in China.

Lenvatinib is administered orally once daily. The most common side effects of this medication are palmar-footed redness syndrome, rash, loss of appetite, diarrhea, high blood pressure, joint or muscle pain, weight loss, abdominal pain or blisters. Serious side effects (uncommon) may include bleeding problems and loss of protein in the urine.

4. Cabozantinib (Cabozantinib)

Cabozantinib (Cabozantinib) is a small molecule multi-target inhibitor developed by Exelixis of the United States, which can target VEGFR , MET , NTRK , RET , AXL and KIT . XL184 ” .

On May 29 , 2018, FDA approved Carbotinib for second-line treatment of advanced liver cancer. Approval is based on the Phase III clinical trial CELESTIAL . Patients with advanced hepatocellular carcinoma who have progressed after treatment with sorafenib have significantly improved overall survival compared with placebo. Progression-free survival and objective response rate have also improved significantly.

5.nivolumab ( Navumab , Opdivo®)

Opdivo helps the body’s immune system attack cancer cells by targeting the PD-1 / PD-L1 cell signaling pathway ( PD-1 and PD-L1 are proteins present in the body’s immune cells and certain cancer cells). In layman’s terms: By blocking the binding of PD-L1 protein to cancer cells, the camouflage of cancer cells is prevented, and the body’s own immune cells can recognize and eliminate cancer cells.

On September 23 , 2017, according to the Checkmate-040 clinical trial, the US FDA approved Opdivo for patients with advanced liver cancer after treatment failure of sorafenib ( dojime ): effective rate 20% , disease control rate 64% .

6. larotrectinib (Larotinib, trade name Vitrakvi)

Larotrectinib (the more familiar name may be LOXO-101) was approved by the FDA on November 27 , 2018 for the treatment of adult and pediatric patients with locally advanced or metastatic solid tumors with NTRK gene fusion. This targeted drug is not only effective, but also a broad-spectrum anti-cancer drug, effective for many different tumors! As long as you have undergone genetic testing and there is NTRK1 , NTRK2, or NTRK3 gene fusion, you can choose this spectral anti-cancer drug that does not distinguish tumor types.

How to choose genetic testing for liver cancer patients?

Experts from the Global Oncologist Network clearly told their friends that cancer genetic testing and clinical treatment analysis are a systematic project that requires strong laboratory support, high standard testing quality control and a high level of data analysis team. A good genetic test analysis can save the lives of cancer patients, and a patchwork analysis report will make patients lose the chance of treatment. At present, there are dozens of genetic testing institutions on the market, and patients must carefully select genetic testing companies to ensure the accuracy of the test results.

The following editors will introduce two precise genetic testing technologies in the United States!

1. Keris multi-platform molecular analysis technology

The multi-platform molecular analysis technology of Careris Cancer Precision Therapy of Careris Life Sciences in the United States is an optimal choice for cancer patient genetic testing, because it includes not only DNA-level genetic testing but also RNA and protein-related mo
lecular testing. All other genetic testing companies do not have. Due to the variety of analysis techniques, multi-platform molecular analysis technology can analyze the patient’s tumor variation more comprehensively and comprehensively, and the drug guidance given is more authoritative.

According to the official data of Keruis, a large solid tumor study of 1180 patients enrolled , after being guided by Keruis multi-platform molecular analysis, patients prolonged survival by 422 days . The average number of medications for patients under instruction is 3.2 , and the number of medications for patients without guidance is 4.2 . More medications means that patients may need to suffer more side effects and unnecessary economic losses. What patients ca n’t imagine is that, in addition to guiding the selection of targeted drugs, Kerrys can also analyze which chemotherapeutic drugs are suitable for patients. In fact, the selection of chemotherapeutic drugs also needs guidance, and can not be copied according to the treatment guidelines . Keris multi-platform molecular analysis is such a comprehensive comprehensive analysis technology to provide patients with the most accurate and suitable treatment options.

Careers multi-platform molecular analysis guides precise treatment to cover almost all cancer types

The most common targets of Keruis molecular analysis such as EGFR, ALK , ROS1 , MET , mTOR , BRAF , HER2 and so on, as well as immunotherapy targets PD-L1 , TMB and MSI-H , the test report can guide patients to choose targets Precise treatment of medicines helps patients avoid detours and avoid unnecessary side effects. Even if there is no mutation target and no opportunity to choose targeted drugs, Keruis can also guide the use of chemotherapy drugs and hormone drugs based on the analysis results, and also provide the opportunity to participate in the latest clinical trials in the United States.

2. FoundationOne®CDx

FoundationOne®CDx was approved by the FDA as the first pan-tumor type companion diagnostic product. As a research tool, it assisted the discovery of countless scientific research results, and accumulated a large amount of data during this period. The current test coverage includes 324 genes and two molecular markers ( MSI / TMB ) that can predict the efficacy of immune checkpoint inhibitors. It can cover all solid tumors (except sarcoma) and can directly correspond to 17 targeted therapies approved by the FDA !

In clinical evaluation of cancer genes, commonly used techniques include Sanger sequencing, mass spectrometry genotyping, fluorescence in situ hybridization ( FISH ) and immunohistochemical analysis ( IHC ). “Standard single marker detection” such as FISH , IHC and multi-gene hotspot detection ( hotspot panel ) can only find one or two types of clinically significant genetic abnormalities (such as only base substitutions). Studies have shown that the latest comprehensive next-generation sequencing technology for cancer comprehensive genetic testing can detect all four types of genetic abnormalities (base replacement; insertion and deletion; copy number variation and rearrangement), and is more accurate than traditional, standard tests.

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