Teret karcinoma jetre
Liver cancer is a common malignant tumor accounting for more than half of the global liver cancer. The onset of hepatocellular carcinoma (HCC) is hidden, and early symptoms are not obvious. Most people have lost the opportunity for surgery at the time of treatment. Whether it is surgery, interventional therapy or chemotherapy, the treatment effect on liver cancer is still not very satisfactory. The survival rate is still very low.
With the development of science and technology, liver cancer targeted drugs have made great progress, and a variety of targeted drugs and imunoterapija lijekovi su odobreni, donoseći novu nadu u dugoročno preživljavanje pacijenata s rakom jetre!
Kemoterapija raka jetre
Kemoterapija je liječenje lijekovima za uništavanje stanica karcinoma. Sustavna kemoterapija koristi lijekove protiv raka koji se ubrizgavaju intravenozno ili oralno. Ti lijekovi ulaze u krvotok i dopiru do svih dijelova tijela, čineći ovaj tretman potencijalno korisnim za karcinome koji su se proširili na udaljene organe.
Međutim, rak jetre is resistant to most chemotherapy drugs. The most effective drugs for systemic chemotherapy in liver cancer are doxorubicin (doxorubicin), 5-fluorouracil and cisplatin. But even these drugs will only shrink a small part of the tumor, and the response usually does not last long. Even with a combination of drugs, in most studies, systemic chemotherapy did not help patients live longer.
Transcatheter hepatic artery infusion chemotherapy due to poor response to systemic chemotherapy, doctors study placing chemotherapy drugs directly into the hepatic artery for treatment. This technique is called transcatheter hepatic artery infusion chemotherapy, and continuous infusion of anticancer drugs is suitable for hepatic artery intubation For the treatment of liver cancer patients who can not be resected or undergo palliative resection, because the blood supply of liver cancer mainly comes from the arteries, this method can make the drug directly act on the tumor tissue, increase the local drug concentration, reduce the systemic response, and achieve the treatment of the tumor and relieve the symptoms And the purpose of prolonging life.
U usporedbi sa sistemskom kemoterapijom, transkateterska kemoterapija infuzije jetrenih arterija učinkovitija je, ali ne povećava nuspojave. Najčešće korišteni lijekovi uključuju fluorouracil, cisplatin, mitomicin C i doksorubicin.
Lijekovi odobreni za ciljanu terapiju karcinoma jetre
Sorafenib (Sorafenib, Dorjemi),
Sorafenib je ciljani lijek s dva učinka. Jedna je prevencija novih krvnih žila potrebnih za rast tumora, a može ciljati i na proteine koji potiču rast stanica raka. Glavni ciljevi su VEGFR-1 / 2/3, RET, FLT3, BRAF i tako dalje.
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 je oralni lijek, dva puta dnevno. Najčešće nuspojave ovog lijeka uključuju umor dlanova ili tabana, osip, gubitak apetita, proljev, povišeni krvni tlak, crvenilo, bol, otekline ili mjehurići. Ozbiljne nuspojave (neuobičajene) uključuju probleme s protokom krvi u srce i perforacijom želuca ili crijeva.
regorafenib (Regofenib, Baivango),
Regefenib može blokirati angiogenezu tumora, a također može ciljati nekoliko proteina na površini stanica karcinoma kako bi spriječio rast stanica karcinoma. To je oralni višeciljni inhibitor kinaze koji može inhibirati VEGFR-1, 2, 3, TIE-2, BRAF, KIT, RET, PDGFR i FGFR, a njegova je struktura slična sorafenibu.
12. prosinca 2017. Državna uprava za hranu i lijekove (CFDA) odobrila je oralni inhibitor multi-kinaze regorafenib za pacijente s hepatocelularnim karcinomom (HCC) koji su prethodno liječeni sorafenibom. Uzimajte ga oralno jednom dnevno tijekom 3 uzastopna tjedna, zatim odmarajte tjedan dana, a zatim nastavite na sljedeći ciklus.
Česte nuspojave kemoterapije
Uobičajene nuspojave uključuju umor, gubitak apetita, sindrom šaka i stopala (crvenilo i nadraženost ruku i stopala), povišeni krvni tlak, vrućicu, infekciju, gubitak kilograma, proljev i bolove u trbuhu (trbuhu). Ozbiljne nuspojave (neuobičajene) mogu uključivati ozbiljna oštećenja jetre, ozbiljna krvarenja, probleme sa protokom srca i perforaciju želuca ili crijeva.
lenvatinib (levatinib, levira)
Lenvatinib je višeciljni lijek. Glavni ciljevi levatiniba uključuju vaskularni receptor za endotelni faktor rasta VEGFR1-3, receptor za faktor rasta fibroblasta FGFR1-4, receptor za faktor rasta rasta izveden iz trombocita PDGFR-α, cKit, Ret et al. Djelujte sprečavajući tumore da stvaraju nove krvne žile koje trebaju rasti.
In August this year, Eisai (Eisai) and Merck (MSD) lovastinib were approved by the US FDA for marketing. Leweima was included in the first-line treatment of non-surgical advanced liver cancer by the CSCO liver cancer guideline (2018 version), China’s most authoritative tumor diagnosis and treatment guideline.
Lenvatinib se daje oralno jednom dnevno. Najčešće nuspojave ovog lijeka su sindrom crvenila dlanonogih nogu, osip na koži, gubitak apetita, proljev, povišeni krvni tlak, bolovi u zglobovima ili mišićima, gubitak težine, bolovi u trbuhu ili mjehurići. Ozbiljne nuspojave (neuobičajene) mogu uključivati probleme s krvarenjem i gubitak proteina u mokraći.
Kabozantinib
Kabozantinib (kabozantinib) je višeciljni inhibitor male molekule koji je razvio Exelixis iz Sjedinjenih Država i koji može ciljati VEGFR, MET, NTRK, RET, AXL i KIT. Ima ime koje je većini pacijenata poznato, „XL184“.
FDA je 29. svibnja 2018. odobrila karbotinib za liječenje druge linije uznapredovalog karcinoma jetre. Odobrenje se temelji na kliničkom ispitivanju faze III CELESTIAL. Pacijenti s uznapredovalim hepatocelularnim karcinomom koji su napredovali nakon liječenja sorafenibom značajno su poboljšali ukupno preživljenje u usporedbi s placebom. Preživljavanje bez napredovanja i objektivna stopa odgovora također su se značajno poboljšali.
Larotinib, lijek širokog spektra protiv raka
On November 26, 2018, the legendary anticancer drug larotrectinib (Vitrakvi, Larotinib, LOXO-101) was finally approved by the FDA for the treatment of adult and pediatric patients with locally advanced or metastatic solid tumors with NTRK gene fusion . Regardless of the type of cancer, as long as it is a solid tumor positive for genetic testing for NTRK fusion, this broad-spectrum targeted drug can be used!
In some rare cancers, NTRK fusion often occurs. These include infantile fibrosarcoma, secretory rak dojke, etc. These rare cancers usually find NTRK fusion, and these patients may benefit from drugs such as larotrectinib. This targeted drug is not only effective, but also a broad-spectrum anti-cancer drug, effective for many different tumors! This is why this medicine is so eye-catching.
In the experiment, these patient tumor types included 10 different soft tissue sarcomas, salivary adenocarcinoma, infantile fibrosarcoma, thyroid cancer, lung cancer, melanoma, colorectal cancer, gastrointestinalni stromalni tumor (GIST), breast cancer, osteosarcoma , Cholangiocarcinoma, primary unknown cancer, congenital mesoderm kidney cancer, appendix and pancreatic cancer.
Uz to, pacijenti s naprednim karcinomom koji su prošli testiranje genoma raka mogu otkriti da njihovi tumori imaju fuziju NTRK, jer se fuzija gena NTRK može pojaviti u različitim tkivima karcinoma, uključujući karcinom jetre.
Opći pregled fuzijskih gena zahtijeva upotrebu tehnologije genetičkog ispitivanja druge generacije. I mora se napomenuti da mutacija fuzije gena NTRK s drugim genima, a ne slučajna mutacija mutacije.
Vrhunske svjetske kompanije za genetsko testiranje Kerris i Foundation Medicine također se nedavno razvijaju
otvorio Foundation One CDx za ispitivanje fuzije NTRK. Pacijenti koji žele znati mogu nazvati Medicinski odjel Globalne onkološke mreže radi savjetovanja (400-626-9916).
Lijekovi za rak jetre u istraživanju
① Everolimus
Selektivni je inhibitor mTOR. MTOR je ključna serin-treonin kinaza. Everolimus se može kombinirati s unutarstaničnim proteinom FKBP12 da bi stvorio inhibicijski kompleks mTORC1. Može proizvesti antitumorske svrhe ometajući stanični ciklus i angiogenezu. .
However, the results of the current clinical trials suggest that Everolimus is not effective in the treatment of patients with advanced HCC, and its clinical value as a second-line drug therapy still needs to be further discussed.
EBevacizumab
It is the first anti-angiogenic drug approved by the FDA for clinical use. It is a recombinant human IgG-1 monoclonal antibody against VEGF. It can prevent VEGF from binding to VEGFR by binding to VEGF and inhibit the proliferation and activation of vascular endothelial cells. , Thereby exerting anti-angiogenesis and anti-tumor effects. Current research shows that bevacizumab alone or combined chemotherapy or other targeted drugs are effective in the treatment of liver cancer.
PatApatinib
Apatinib is the world’s first small molecule anti-angiogenesis targeted drug that has been proven to be safe and effective in advanced gastric cancer. It is also a single drug that significantly prolongs survival after standard chemotherapy for advanced gastric cancer fails. It is also a self-developed anti-cancer targeted drug in China, which has achieved certain effects in liver cancer, gastric cancer, karcinom pluća nedrobnih stanica and breast cancer, and has been included in medical insurance.
Aitan (Apatinib) is through highly selective competition for intracellular VEGFR-2 ATP binding site, blocking downstream signal transduction, thereby potently anti-tumor tissue angiogenesis, and ultimately achieve the goal of combating tumors in all directions.
Lijekovi odobreni za imunoterapiju raka jetre
Immunotherapy drugs help 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 that are 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.
Pembrolizumab (Pembrolizumab, Keytruda) and Nivolumab (Nivolumab, Opdivo) are drugs targeting PD-1. By blocking PD-1, these drugs can enhance the immune response to cancer cells. This can shrink some tumors or slow their growth. These drugs can be used in patients with liver cancer who have previously undergone treatment with the targeted drug sorafenib (dojime).
Pembrolizumab (Pembrolizumab, Keytruda)
