In the past two years, with the deepening of research related to targeting and immunotherapy and genotyping, more and more drugs with good effects and fewer side effects have become new options for individualized treatment and comprehensive treatment of colorectal cancer patients. Treatment strategies have also advanced from third-line or second-line treatment of colorectal cancer to first-line treatment. The overall treatment expectation of colorectal cancer patients has been greatly improved.
- Colorectal cancer must be genetically tested before use. If you can’t obtain tissue sections, you can choose blood for testing. At this time, you mainly look at the NRAS, KRAS and BRAF genes.
- Sarudzo yemishonga yekenza yakajeka kenza inowanzo kuve musanganiswa wemishonga yakawanda uye chemotherapy mishonga inosanganiswa nemishonga yakanangwa.
- Mushure mekurapwa kwakajairika kwekenza yakajeka, kuchine akawanda akanangwa mishonga inogona kuyedzwa. Kunyangwe iyo yekurapa maitiro isiri yakanaka senge yekutanga-tambo uye yechipiri-mutsara, inogona kuunza kupona mabhenefiti.
- Mushure mekutanga-mutsara uye wechipiri-mutsara marapirwo ari kusagadzikana, zvinokurudzirwa kuitisa genetiki kuyedza zvakare. Kana MSI-H kana NTRK fusion shanduko ikaonekwa, immunotherapy kana larotinib inogona kusarudzwa.
Saka, varwere vane gomarara remudumbu vanofanirwa sei kuronga chirongwa chemushonga?
Mushure mekuongororwa kwekenza yakajeka, vanachiremba vachakurudzira kuti murwere wega wega ane metastatic colorectal cancer (mCRC) aongororwe magene kuti aone chikamu chechirwere ichi, nekuti ruzivo urwu runofanotaura fungidziro yekurapa. Majini anoda kuongororwa ndeaya:
MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK
Inoenderana yakanangwa zvinodhaka:
MSI (H) -pembrolizumab; nivolumab
BRAF (+) - Dalafenib, Trimetinib; Verofinil
RAS (KRAS- / NRAS -) - cetuximab; panitumumab (anti-EGFR)
HER2 (+) - trastuzumab
NTRK (+) - Larotinib
Anti-angiogenesis inotarisa zvinodhaka
VEGF: bevacizumab, gamuchira
VEGFR: ramucirumab, rigofinib, fruquintinib
Chemotherapy drugs include:5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil)
Kuona akawanda marudzi emishonga, sei kusarudza uye maitiro ekubatanidza neyakanakisa mhedzisiro? Vicki anokupa yakadzama hesera kuti uone kuti ndewe chikamu chipi, ingo enda unotora chigaro!
Kutanga-mutsara kurapwa mukenza yakajeka
Before taking the medicine, the doctor will definitely look at the results of the genetic test. If the genetic test report shows that there are no mutations in the RAS or BRAF genes, chemotherapy and anti-EGFR targeted drugs are recommended. It is generally recommended that anti-EGFR targeted drugs must be used on the first line, because the effect will be greatly reduced if used in the back line.
Kana zvinoitwa nemushonga uyu zvisina kunaka, chinja musanganiswa wemakemikari uye anti-angiogenesis inhibitors, bevacizumab inowanzo shandiswa.
Kana murwere asina kukodzera anti-EGFR inotarisirwa madhiragi, saka shandisa zvakananga chemotherapy inosanganiswa neanti-angiogenesis inhibitors.
Kana pasina mamwe marongero ari pamusoro ari kushanda, imwe chemotherapy regimen uye imwe anti-angiogenesis inhibitor inozotsiviwa.
Iyo kemesitiri yekenza yakajeka kenza inowanzo sarudza yakawanda-mishonga musanganiswa. Vanachiremba vanobatana uye vanowirirana zvinoenderana nemamiriro chaiwo evarwere. Inowanzo shandiswa ndeiyi:
- FOLFOX (fluorouracil, calcium folinate, oxaliplatin) kana FOLFIRI (fluorouracil, calcium folinate, irinotecan), kana kusanganiswa necetuximab (yakakurudzirwa kune varwere vane mhando yemusango KRAS- / NRAS-BRAF gene)
- CapeOx (capecitabine, oxaliplatin), FOLFOX or FOLFIRI, or combined with bevacizumab
- FOLFIRINOX (fluorouracil, calcium folinate, irinotecan, oxaliplatin)
Yechipiri-mutsara kurapwa
Muchikamu chechipiri-kurapwa, isu tine akasiyana anti-angiogenesis inhibitors kusarudza kubva.
Mutsara wekutanga, isu tinoshandisa bevacizumab inosanganiswa nekemotherapy. Kana kurapwa kusiri kushanda, tinogona kuchinja chemotherapy regimen uye kuramba tichishandisa bevacizumab. Ehezve, zvakare zvinokwanisika kushandura imwe yakanangwa mushonga panguva imwechete seye chemotherapy regimen, kushandukira kuabercept, kana ramucirumab.
Yechitatu-mutsara uye kumashure-mutsara kurapwa
Sarudzo yemutsara-wekutanga uye wechipiri-mutsara mutsara sarudzo dzekenza yakajeka kenza inowanzo kuve yakajairwa chemotherapy mishonga uye yakanangwa zvinodhaka.
Starting from the third-line treatment is a back-line treatment. The back-line treatment plan can use some oral chemotherapeutics that have just come out, including TAS-102, as well as S-1 (tegio), rifafine, or some immunotherapy, such as pembrolizumab (MSI-H).
TAS-102
TAS-102, an oral chemotherapeutic drug, chinhu chinobatanidzwa che trifluridine (a nucleoside metabolism inhibitor) uye tipiracil (a thymidine phosphorylase inhibitor). Mushonga uyu unonetsa kwazvo, uye vhiki dzese ina nzira yekurapa. Tora mushonga kubva Muvhuro kusvika Chishanu muvhiki yekutanga uye wechipiri vhiki, mira mushonga Mugovera neSvondo, misa mushonga muvhiki rechitatu nevhiki rechina, wobva watanga iyo inotevera kutenderera. Munguva iyi, kana murwere asina RAS mutation, inogona kushandiswa musanganiswa nepanitumumab. Pfungwa yeiyi regimen ndeyekuti murwere haana kumboshandisa panitumumab zvisati zvaitika.
Tigio
S-1 (Teggio) zvakare iri yemumuromo chemotherapeutic mushonga, iri yekirasi fluorouracil rinobva. Oral Teggio capsules 80 mg / m2 / zuva, kaviri pazuva, kamwe mushure mekudya kwemangwanani uye mushure mekudya kwemanheru, kunyangwe gumi nemana Mazuva, bvisa mushonga kwemazuva manomwe;
Regafini
Regefini ndeyemuromo anti-angiogenesis yakanangwa zvinodhaka. Iyo yakajeka pink oval ovhiri-yakavharwa piritsi. Regofenib ine maitiro akanaka pakurapa gomarara remudumbu uye inogona kuwedzera zvakanyanya kupona kwevarwere vane gomarara remuura. Yakakurudzirwa dosi: Iyo yakakurudzirwa dosi ndeye 160 mg (mahwendefa mana, imwe neimwe iine 4 mg ye rifafenib), kamwe pazuva, nemuromo pamazuva makumi maviri nemaviri ekutanga ehurongwa hwekurapa, uye mazuva makumi maviri nemasere senzira yekurapa.
Kurapa kwekudzivirira
If the patient finds MSI-H through genetic testing, immunotherapy may be considered. You can consider pembrolizumab only if you want to use a single drug. For patients with MSI-H colorectal cancer, pembrolizumab has a 50% chance of shrinking the tumarara.
Pamusoro peyechete-mumiririri immunotherapy, iwe unogona zvakare kufunga nezvekusanganisa akasiyana immunotherapy, senge kushandiswa kweNivolumab (nivolumab) uye Ipilimumab (Ipilimumab) mubatanidzwa, mukana wekudzora bundu iri 55%.
Pembrolizumab yoga, nivolumab inosanganiswa neipilimumab yakagamuchirwa neDFA yekurapa kwekutevera kwevanorwara nekenza yemakonzo vane MSI-H. Iyo data yakawedzera kukura.
Larotinib
Larotinib ine simba, muromo, inosarudza tropomyosin kinase inhibitor iyo inoshanda paTrKB, TRKB, uye TRKC kinases. Yakagamuchirwa munaNovember 2018 kune anosvika gumi nemanomwe cancer, kusanganisira colorectal Cancer, asi iyo fusion mutation yeNTRK17 / 1/2 geni inoda kuongororwa, saka Larotinib iri zvakare sarudzo yekurapa inotevera. Varwere vakuru vanotora 3 mg nemuromo kaviri pazuva.
Mhedzisiro yekurapa yeiyo yekumashure-mutsetse kazhinji haina kujeka sekutanga-mutsara uye wechipiri-mutsara kurapwa, asi inogona zvakare kuwedzera nguva yekurarama. Naizvozvo, kana isu tikakwanisa kusarudza nzira dzakasiyana dzekurapa-kumashure, dzakasiyana mishonga inoshandiswa mukutenderera, uye hupenyu hunogona kuwedzerwa.
Chii chandinofanira kuita kana ndikasashivirira chemotherapy?
Uye zvakare, izvo zvekufungidzira zvevarwere vane colorectal kenza inofanirwa kutariswa, ndiko kuti, mamiriro anozokanganisa maitiro ekurapa. Zvinonyanya kukosha ndezvekuti: metastasis iri kure yekenza maseru, iko iko kwepamoyo yekutanga, hunhu
s ekuchinja kwemajini, mhinduro uye nguva yenguva yemishonga yapfuura, Iyo degree yekushaya simba kwemurwere ichakanganisa maitiro ekurapa uye nesarudzo yechirongwa chemushonga.
Kunyanya kune varwere vasina kusimba uye vasingakwanise kutakura mhedzisiro yemakemikari, kuti ungasarudza sei chirongwa chemushonga?
Izvo zvinowanzo kurudzirwa zvinotevera:
①Single targeted drug therapy, if there is no RAS gene mutation, you can choose cetuximab or panitumumab
NtAnti-angiogenesis inhibitors haigone kushandiswa yoga, uye inofanira kushandiswa pamwechete nekemotherapy, saka unogona kusarudza mubatanidzwa wemakemikari madhiragi ane madiki mhedzisiro uye kurapwa kwakanangwa, senge irinotecan + bevacizumab (kana cetuximab)
IngSingle drug immunotherapy, yakadai seMSI-H, sarudza pembrolizumab
Ongororo yakakosha
- Colorectal cancer inofanirwa kuongororwa genetiki isati yashandiswa. Kana iwe usingakwanise kuwana matissue zvikamu, unogona kusarudza ropa rekuyedzwa. Panguva ino, iwe unonyanya kutarisa iyo NRAS, KRAS uye BRAF magene.
- Sarudzo yemishonga yekenza yakajeka kenza inowanzo kuve musanganiswa wemishonga yakawanda uye chemotherapy mishonga inosanganiswa nemishonga yakanangwa.
- Mushure mekurapwa kwakajairika kwekenza yakajeka, kuchine akawanda akanangwa mishonga inogona kuyedzwa. Kunyangwe iyo yekurapa maitiro isiri yakanaka senge yekutanga-tambo uye yechipiri-mutsara, inogona kuunza kupona mabhenefiti.
- Mushure mekutanga-mutsara uye wechipiri-mutsara marapirwo ari kusagadzikana, zvinokurudzirwa kuitisa genetiki kuyedza zvakare. Kana MSI-H kana NTRK fusion shanduko ikaonekwa, immunotherapy kana larotinib inogona kusarudzwa.
