Dingindira re2019 NCCN Annual Meeting nderokuwedzera biomarker bvunzo kutungamira kurapwa chaiko kwegomarara, pamwe neshanduko nyowani kune colorectal cancer (CRC) nhungamiro. Makore mashanu ekupona kwegomarara remukati ingori 5%, uye chirongwa chakagadziridzwa chekurapa cheNCCN nhungamiro yekurapa inotarisirwa kuvandudza kupona.
Currently, the FDA has approved a variety of drugs to treat colorectal cancer, of which only four are related to genetic mutations, and biomarkers need to be tested. The 2019 update of NCCN treatment guidelines for kenza yakajeka adds treatment methods based on detection of biomarkers, including EGFR, MSI-H / dMMR, BRAF + MEK, and NTRK fusion targets.
Ngatitarisei pane chaiwo akakosha ekuvandudza uye data rinorema:
mFOLFXIRI + EGFR
Based on the phase II phase VOLFI trial, mFOLFOXIRI (fluorouracil + leucovorin + oxaliplatin + irinotecan) plus panitumumab for the EGFR inhibitor, for patients with unresectable metastatic colorectal cancer, these The patient’s genetic test must be: KRAS / NRAS / BRAF wild type and only the left tumarara iripo.
Muchiedza cheVOLFI, 96 varwere vane RAS yemusango-mhando metastatic colorectal cancer yaiwanzopihwa mFOLFOXIRI inosanganiswa nepanitumumab (n = 63) kana chete mFOLFOXIRI (n = 33) mune 2: 1 chiyero. Iri rakabatanidzwa panitumumab boka raive nezinga rinoshanda re85.7%, nepo mFOLFOXIRI yega yaive 54.5%.
WDC / MMR
Kunyangwe microsatellite instability (MSI) uye mismatch repair (MMR) kazhinji isiri nhaka, izvi hazvisanganise mapundu anokonzerwa neLynch syndrome, inowanikwa mu1% yeBRAF V600E colorectal cancers Embodied. Kana uine nhoroondo yemhuri yakasimba, unofanirwa kuitisa genetic test.
Iyi yazvino nhungamiro inoratidza kushandiswa kweiyo immunohistochemistry kuona izvo zvina mutant majini aripo muLynch syndrome: MLH1, MSH2, MSH6 uye PMS2.
MuNCCN yepamusoro kana metastatic colorectal cancer kurapwa nhungamiro, yekutanga-mutsara immunotherapy options for patients with MSI-H and dMMR are nivolumab (nivolumab, Opdivo) or pembrolizumab (pembrolizumab, Keytruda), or nivolumab and ipilimumab (Iraq Combined therapy with Pitimab, Yervoy). These recommendations are category 2B recommendations and apply to patients who are not suitable for a combination cytotoxic chemotherapy regimen. These immunotherapy drug options are also listed in the guidelines as second- and third-line treatment recommendations for dMMR / MSI-H patients.
ZveNTRK
Larotrectinib (Larotinib, Vitrakvi) ikozvino ndiyo yechipiri-mutsara wekurapa sarudzo yevarwere vane metastatic colorectal cancer. Iyo yemurwere genetiki bvunzo inoda kuona yakanaka NTRK gene fusion. Iyo kiriniki yekutsvaga data yemushonga yakaburitswa mu2018 New England Journal yeMishonga.
Naizvozvo, munaNovember 2018, iyo FDA yakabvumidza kushandiswa kweLototinib yekurapa kwevakuru uye kwevarwere varwere vane kuzvimba kwakasimba mamota. Chero bedzi murwere aine iyo NTRK gene fusion uye pasina chinozivikanwa chinowanikwa kushorwa kwekuchinja, chirwere ichi chakasimbisa uye kuvhiya resection kunogona kukonzera Kuipa kwakanyanya kwekufa, hapana imwe nzira inogutsa yekurapa kana kufambira mberi kwakaitika mushure mekurapwa.
Mune ino yakazara yekenza kliniki kuyedzwa, 4 varwere vane metastatic colorectal cancer vakanyoreswa, uye 1 murwere akapindura zvakanaka.
Yezve BRAF neMEK
Mune ino gadziriso yeNCCN nhungamiro, maviri echipiri-mutsara musanganiswa marapirwo eiyi biomarker akawedzerwa, anoti:
(1) dabrafenib (dalafinib, Tafinlar; BRAF) + trametinib (trametinib, Mekinist; MEK), inosanganiswa necetuximab kana panitumumab (EGFR monoclonal antibody);
(2) Encorafenib (Braftovi; BRAF) plus binimetinib (Mektovi; MEK) plus cetuximab or panitumumab.
The encorafenib / binimetinib and EGFR inhibitor treatment regimens are supported by data from the introduction of phase III BEACON trials. In 30 patients with metastatic colorectal cancer with BRAF V600E mutation, combined treatment with encorafenib / binimetinib plus cetuximab was followed up for 18.2 months, with an estimated overall survival of 15.3 months. According to local evaluation results, the combined The effective rate of treatment was 48%, and 3 patients achieved complete remission.
Iyi inogadziridzwa yeNCCN nhungamiro yegomarara remukati zvakare inosimbisa basa rakakosha rekuongorora genetic mukurapa cancer. Neimwezve nzira yekurapa, kune tariro yakawanda! Shamwari dzegomarara dzinofanira kurega kukahadzika mamiriro ekuongororwa kwemajini. Nhau dzakanaka ndedzekuti kune akawanda akatenderwa akanangana nemishonga yecolorectal cancer. Ndapota koshesa zviri mumaoko ako.
