Kurapa kenza yechiropa, chirongwa chegomarara rekurapa gomarara, nzira yekurapa gomarara rechiropa, nzira yekurapa gomarara rechiropa, mushonga wekurapa gomarara rechiropa.
Chirwere chechiropa chekutanga
Chirwere chepuraimari chepuraimari ndechimwe chezvinhu zvinowanzoitika zvinokonzeresa mamota uye kufa kwemamota munyika dzichiri kusimukira, izvo zvinotyisidzira zvakanyanya hupenyu hwevanhu uye hutano. Kusimudza kuongororwa uye kurapwa kwechirwere chegomarara kwakakosha zvakanyanya kugadzirisa kuongororwa uye kurapwa kwevarwere vegomarara rechiropa uye nekuvandudza hupenyu hwevarwere.
There are many treatment options for gomarara rechiropa, including surgery, radiotherapy, radiofrequency ablation, venous embolization, and drug treatment. Among them, the chemotherapy effect of liver cancer is not good, because most liver cancer cells are not sensitive to chemotherapeutic drugs, even if the benefit of using chemotherapeutic drugs may be smaller than the side effects. Therefore, the proportion of patients with liver cancer treated with chemotherapy is not large.
Kubva 2007, kuuya kwe sorafenib, yekutanga yakanangwa mushonga wekenza yechiropa, yakaputsa mamiriro ekuti hapana mushonga unowanikwa wekenza yechiropa, asi yakaenderera kweanopfuura makore gumi. Chete sorafenib ndiyo inogona kushandiswa sekutanga-kurapwa kurapwa kwechirwere chisinga gadzirike chegomarara rechiropa. Mushure mekuramba kwemishonga, hauzive nzira yekusarudza?
However, through unremitting efforts, scientists broke through obstacles. In 2018, the second targeted drug that could replace sorafenib was successfully launched, that is, lovatinib! Both sorafenib and lovatinib It is a targeted drug used for first-line treatment of liver cancer. Later, a variety of second-line treatment drugs have also come out one after another!
Since 2017, many new high-level evidences in line with the principles of evidence-based medicine have emerged in the diagnosis, staging and treatment of liver cancer at home and abroad, especially research results adapted to China’s national conditions. This article focuses on the drug treatment plan and sequence in the latest edition of the “Specifications for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)”, giving a clear guide for liver cancer friends.
Mirayiridzo yekurapa kenza yechiropa neDFA
yekenza yechiropa shamwari.
| zuva | FDA inobvumira kenza yechiropa yakanangwa nemushonga | Chiratidzo | Kubvumidzwa mudzimba |
| 2007-11 | Sorafenib (Sorafenib, Nexavar) | Nekurapa kusingachinjiki hepatocellular carcinoma kana gomarara rechiropa | Dzimba dzakanyorwa uye dzakafukidzwa neinishuwarenzi yekurapa |
| 2018-8 | Lenvatinib (Levatinib, Lenvima) | Kwekutanga-mutsara kurapwa kweusingadzoreke hepatocellular carcinoma | Zvemumba zvinyorwa |
| 2017-4 | Regorafenib (Sigvarga) | Yechipiri-mutsara kurapa kwechirwere chesirafenib-inodzivirira chiropa | Musika wepamba |
| 2017-9 | Nivolumab (navumab, Opdivo) | Yechipiri-mutsara kurapa kwechirwere chesirafenib-inodzivirira chiropa | Musika wepamba |
Sarudzo yemutsara wekutanga kurapwa kwecancer yechiropa
(1) Sorafenib
Tsvakurudzo dzinoverengeka dzekiriniki dzakaratidza kuti Sorafenib ine zvimwe zvikomborero zvekupona kune varwere vane kenza yepamusoro yechiropa munyika dzakasiyana-siyana uye mamiriro ezvinhu ane zvirwere zvakasiyana-siyana zvechiropa (chiyero cheuchapupu 1).
Iko kunowanzo kurudzirwa kushandiswa ndeye 400 mg nemuromo, kaviri pazuva. Inogona kushandiswa kuMwana-Pugh Kirasi A kana B varwere vane chiropa chinoshanda. Zvichienzaniswa neChidiki-Pugh B chiropa chinoshanda, Mwana-Pugh Kubatsirwa kwevarwere kuri pachena.
Inoda kutarisisa kune zvinokanganisa HBV uye chiropa mashandiro, uye kusimudzira manejimendi echiropa chechiropa chirwere panguva yese iyi. Mhedzisiro yakajairika ndeyemanyoka, kuonda, ruoko uye tsoka tsoka, mapundu, myocardial ischemia, uye neBP, izvo zvinowanzoitika mukati memavhiki maviri kusvika matanhatu mushure mekutanga kwekurapwa.
(2) Lemvatinib
Lenvatinib inokodzera varwere vasingachinjike vane danho IIb, IIIa, IIIb, chiropa chinoshanda Mwana-Pugh Kenza yechiropa, uye kurapwa kwaro kwekutanga hakusi kwakaderera kune sorafenib. Kenza yechiropa inoenderana neHBV ine zvirinani Kupona kwekubatsirwa [185] (huwandu hweuchapupu 1).
Lenvatinib yakagamuchirwa kuti ishandiswe muChild-Pugh A varwere vegomarara rechiropa vane gomarara repamusoro reropa. Kushandisa: 12mg, muromo, kamwe chete zuva nezuva kwehuremu hwemuviri ≥60kg; 8mg, muromo, kamwe chete zuva nezuva kwehuremu hwemuviri <60kg. Zvinowanzoitika nenjodzi hypertension, manyoka, kushomeka kwekuda kudya, kuneta, ruoko-tsoka syndrome, proteinuria, kuda kurutsa, uye hypothyroidism.
(3) Yakagadziriswa chemotherapy
Iyo FOLFOX4 (fluorouracil, calcium folinate, oxaliplatin) protocol inotenderwa mukati. China yekurapa kwenzvimbo yepamusoro uye metastatic chiropa kenza isingakodzeri kuvhiyiwa kuvhiyiwa kana kurapwa kwenzvimbo (chikamu cheuchapupu 1).
Akawanda echikamu chechipiri zvidzidzo zvakataura kuti systemic chemotherapy ne oxaliplatin yakasanganiswa ne sorafenib inogona kugadzirisa zvinangwa zvekupindura, kuwedzera kufambira mberi-kusununguka kwehupenyu uye kupona kwese, uye nekupa chengetedzo yakanaka (padanho reuchapupu 3).
Kune varwere vane yakanaka chiropa mashandiro uye chimiro chemuviri, iyi yekubatanidza kurapa inogona kutariswa, asi kiriniki randomized inodzorwa zvidzidzo zvichiri kudikanwa kuti vape hukuru-hwepamusoro humbowo-hwakavakirwa humbowo hwekurapa. Uye zvakare, arsenic trioxide ine imwe palliative yekurapa maitiro pane yakakwira kenza yechiropa (chikamu cheuchapupu 3). Mukushandisa kwemakiriniki, kutarisirwa kunofanirwa kutorwa kuongorora uye kudzivirira huturu hwechiropa neitsvo.
Yechipiri-mutsara kurapa kenza yechiropa
(1) Regofini
Regorafenib inogamuchirwa kuti ishandiswe mune varwere vane nhanho IIb, IIIa, uye IIIb CNLC gomarara rechiropa avo vakamborapwa ne sorafenib (humbowo nhanho 1). Iko kushandiswa i160mg kamwe zuva nezuva kwemavhiki matatu uye kumiswa kwe3 vhiki.
MuChina, iyo yekutanga dosi inogona kuve 80mg kana 120mg kamwe, kamwe pazuva, uye zvishoma nezvishoma ichiwedzera zvinoenderana nekushivirira kwemurwere. Zviitiko zvakajairika zvinowedzerwa neBP, ruoko-tsoka tsoka ganda, kuneta, uye manyoka.
(2) Navumab uye Paimumab
IU.S. FDA yakabvumira kushandiswa kweNavulinu monoclonal antibodies (Nivolumab) uye Pabrolizumab monoclonal antibodies (Pembrolizumab) kune varwere vane kenza yechiropa vakafambira mberi kana vasingakwanisi kushivirira sorafenib mushure mekurapa kwesorafenib yapfuura (chiyero cheuchapupu 2).
Parizvino, immunological checkpoint inhibitors zvakazvimiririra zvakagadzirwa nemakambani eChina, akadai seCarellidizum monoclonal antibodies, Treplepril monoclonal antibodies, uye Xindili monoclonal antibodies, ari kuongorora kiriniki. Iko kusanganiswa kwe immunotherapy and targeted drugs, chemotherapeutic drugs, and topical treatments is also constantly being explored.
Mamwe ma immunomodulators (akadai se interferon α, thymosin α1, nezvimwewo), cellular immunotherapy (yakadai se chimeric antigen receptor T cell therapy, CAR-T, uye cytokine-induced killer cell therapy, CIK) zvese zvine mamwe antitumor mhedzisiro. Zvisinei, ichiri kuzosimbiswa nezvidzidzo zvekiriniki zvakakura.
