Nyaya isati yatanga, kutarisa kwekutanga kwesainzi.
Kunzwisisa kweMSI-H, MSS, MSI-L
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MSS (MicroSatellite kugadzikana), microsatellite kugadzikana, zvichienzaniswa neMSI, hapana MSI iri pachena.
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MSI-H (MicroSatellite Kusagadzikana-Yakakwira, yakanyanya-frequency microsatellite kusagadzikana), ndiko kuti, kuwanda kwekusagadzikana kwemicrosatellite kwakakwirira, kazhinji kwakakwirira kupfuura 30%;
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MSI-L (MicroSatellite Kusagadzikana-Yakadzika, yakaderera frequency microsatellite kusagadzikana), ndiko kuti, kuwanda kwemicrosatellite kusagadzikana kuri pasi, kazhinji kuri pasi pe30%.
Friends who are concerned about the latest progress in cancer treatment know that the broad-spectrum anticancer drugs pembrolizumab and nivolumab have been approved for the treatment of all solid tumor patients with MSI-H (high microsatellite instability). Especially for colorectal patients, the detection rate of MSI-H is relatively high, so some cancer patients benefit from this type of treatment to prolong survival.
In the NCCN advanced or metastatic colorectal cancer treatment guidelines, the first-line 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.
Kune varwere vane unresectable munharaunda yemhando yepamusoro kana metastatic colorectal cancer avo vakagadzira chirwere kana vari vangangopokana nemaviri apfuura systemic chemotherapy regimens, 95% yavo vanogona kuona MSS pachinzvimbo cheMSI-H. Saka, sei kusarudza MSS colorectal cancer varwere?
Recently, the IMblaze370 trial was published as a phase III open-label trial, and 363 patients with metastatic colorectal cancer whose genetic test results were MSS were randomly assigned to atezolizumab (atezolizumab) in combination with cobimetinib (cobititib) at 2: 1: 1 Ni, MEK targeted drug) group, attuzumab monotherapy group, regorafenib (regorafenib, multi-target kinase inhibitor) group. Patients with MSS colorectal cancer have historically not responded to immunotherapy.
Mhedzisiro yeichi chidzidzo inosimbisa zvakare zvakare: MSS colorectal cancer varwere havapindure zvakanaka kune immunotherapy (PD-L1) drug atuzumab. Kurarama kwepakati nepakati kweatezumab kwakasanganiswa neboka recobtinib raive mwedzi 8.87, zvichienzaniswa nemwedzi 7.10 muboka reatezumab roga uye nemwedzi 8.51 muboka regofenib, zvisinei nekuti iyo immunotherapy yoga kana yakasanganiswa Hapana chakakosha kupona kubatsirwa.
Kune yekupfuurira kwepakati- kusununguka, iwo matatu mapoka ekurapa aive 1.91 mwedzi, 1.94 mwedzi, uye 2.00 mwedzi, pasina mutsauko. Chiyero chegiredhi 3/4 zviitiko zvakashata zvaive 61% muboka rerapi rekubatanidza, 31% muboka reatuzumab monotherapy, uye 58% muboka regofenib.
"Mhedzisiro iyi inoratidza kusimba kwakasiyana kwehupenyu pakati peMSS neMSI-H, uye ichisimbisa zvakasiyana marapirwo anodikanwa pakati pemhando mbiri idzi dzezvirwere," akadaro Dr. Cathy Eng, muongorori paUniversity yeTexas Anderson Cancer Center.
That is to say, the colorectal cancer patients whose MSS is found by genetic testing do not recommend the choice of immunotherapy, and use other methods instead. At present, the targets and targeted drugs that can be achieved by patients with colorectal cancer are:
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VEGF: Bevacizumab, Apsip
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VEGFR: ramucirumab, rigofinib, fruquintinib
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EGFR: cetuximab, panitumumab
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PD-1 / PDL-1: pembrolizumab, nivolumab
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CTLA-4: Ipilimumab
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BRAF: Velofini
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NTRK: Larotinib
Kana zvimwe zvinowirirana zvinochinja mutserendende zvikaonekwa, inoenderana yakanangwa mishonga yekurapa inogona kusarudzwa.
Kune colorectal kenza varwere, iwe unogona kusarudza yakajairwa seti yekemotherapy-FOLFOXIRI (fluorouracil + leucovorin + oxaliplatin + irinotecan), iri mubatanidzwa weboka recytotoxic chemotherapeutic agents, akakodzera vanhu vese.
After drug resistance, the genetic test result is not MSI-H. You can also choose multi-target kinase inhibitors regorafenib (regorafenib, Stivarga) and TAS-102 (trifluridine / tipiracil; Lonsurf).
Cetuximab is also a star drug often selected by colorectal patients, which is a drug that often appears in individualized treatment plans. Evaluation methods include: Is the tumor on the left or right? Does it contain KRAS / NRAS mutations? Before selecting cetuximab or panitumumab, the RAS gene mutation must be considered.
