Ndeapi macolorectal cancer anotarisana nemishonga?
Makore 17 apfuura, huwandu hwemishonga iripo yekenza yegomarara repamusoro yaive shoma. Kwaingova nemishonga mishoma yemakemikari uye inenge isina mishonga yakanangwa. Kana ukangoonekwa, nguva yekurarama inongova pakati pehafu yegore negore. Asi ikozvino, kurapwa kwegomarara kuri kupinda munguva yekurapa chaiko, uye zvakanyanya kunangwa uye mishonga yekudzivirira muviri iri pamusika.
Mune 2017 vhezheni yeiyo colorectal cancer kurapwa nhungamiro, kurudziro yekuongorora genetic inongosanganisira KRAS, NRAS, dMMR, uye MSI-H. Mumirayiridzo yemazuva ano yekurapa ye2019, zvinangwa zvitsva zvakaita seBRAF, HER2, NTRK zvichangobva kusanganisirwa Point, kuburikidza nekuongororwa kwemajini, kuti tinzwisise mamwe mamorekuru nezve cancer cancer, inogona kutibatsira kuwana mamwe maitiro emishonga. Huwandu hwekupona kwemurwere hunopfuura makore matatu, inova shanduko huru yakaunzwa nemushonga chaiwo.
Ndeapi magene anofanirwa kuyedzwa mucolorectal cancer varwere?
Mushure mekuongororwa, vanachiremba vanofanirwa kuyedza murwere wega wega nekenza yemastastatic colorectal (mCRC) nekukurumidza sezvinobvira kuona chikamu chehosha iyi, sezvo ruzivo urwu rungangofungidzira kurapwa kwechirwere, senge HER2 kukwidziridzwa kunoratidza kurwisa-EGFR kurapwa Resistant. Aya majeni anotevera anofanira kuongororwa!
MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK.
Zvinangwa uye zvakanangwa zvinodhaka zviripo zvekurapa
VEGF: bevacizumab, aparcept
VEGFR: Ramulizumab, Regigofinil, Fruquintinib
EGFR: Cetuximab, Panitumumab
PD-1 / PDL-1: Pamumab, Navumab
CTLA-4: Ipilizumab
BRAF: Wimofenib
NTRK: Larotinib
Rondedzero ye colorectal cancer yakanangana uye immunotherapy mishonga yakatenderwa kusvika zvino kumba nekune dzimwe nyika:
| R & D kambani | Chinodhaka chinodhaka | Zita remushonga wakananga | Nguva yekutengesa | |
| Her1 (EGFR / ErbB1) | Cetuximab (Cetuximab) Erbitux | 2006 | ||
| Her1 (EGFR / ErbB1) | Panitumumab | 2005 | ||
| KIT / PDGFRβ / RAF / RET / VEGFR1 / 2/3 | Regorfenib | 2012 | ||
| Hutchison whampoa | VEGFR1 / 2/3 | Fruquintinib | 2018 | |
| Sanofi | VEGFA / B | Ziv-aflibercept, abbiscop | 2012 | |
| Eli Lilly | VEGFR2 | Ramucirumab | 2014 | |
| Gene Tektronix | VEGFR | Bevacizumab | 2004 | |
| Bristol-Myers Squibb | PD-1 | Nivolumab | 2015 | |
| Bristol-Myers Squibb | CTLA-4 | Ipilimumab | 2011 |
Zviratidzo zvebevacizumab: metastatic colorectal cancer uye yepamusoro, metastatic kana inodzokororwa isiri-diki cell kenza yemapapu.
Zviratidzo zvetastuzumab: HER2-positive metastatic cancer cancer, HER2-positive kenza yemazamu yekutanga, uye HER2-positive metastatic gastric adenocarcinoma kana gastroesophageal junction adenocarcinoma.
Zviratidzo zvePertuzumab: Ichi chigadzirwa chakakodzera kusanganiswa netrastuzumab uye chemotherapy seadjuvant kurapa kune varwere vane HER2-positive kenza yemazamu yekutanga ine njodzi huru yekudzokazve.
Zviratidzo zvaNivolumab: negative epidermal growth factor receptor (EGFR) gene mutation uye anaplastic lymphoma kinase (ALK) yakaipa, kufambira mberi kwechirwere kana kusashivirira munharaunda yepamusoro kana metastatic chirwere mushure mekare platinum-ine chemotherapy Varwere vakuru vane isiri-diki cell kenza yemapapu (NSCLC).
Zviratidzo zvaRegorafenib: yakamborapwa metastatic colorectal cancer varwere. Durvalumab, Tremelimumab, Ipilimumab, lapatinib haisati yave kuwanikwa kuChina.
Colorectal Targeted Therapy (Gadziridza 2019)
1.Kras-negative colorectal cancer yakanangwa kurapwa
KRAS yemusango-rudzi rwegomarara remusango ndiyo yakajairwa mutsara wekurapa wakanangwa chemotherapy pamwe chete nechemotherapy. Saka rudzii rwechemotherapy inosarudzwa?
Paunenge uchisarudza chakanangwa chinodhaka, zvinokurudzirwa kusarudza chemotherapy regimen ine OS yakareba, ndokuti, cetuximab inonyanya kukodzera FOLFOX, uye bevacizumab inonyanya kukodzera FOLFIRI. Ndeipi chirongwa chekusarudza chinoenderana nechero kuongororwa kwechipatara:
Kana paine tariro yekurapa, cetuximab inosanganisirwa nekemotherapy inowanzo sarudzwa nekuti ichangoburwa chinangwa checetuximab chakakwirira kupfuura bevacizumab;
Kune varwere vane chirwere chemberi chisingarapike, bevacizumab inosanganiswa nekemotherapy inogona kushandiswa yekutanga-mutsara, ichiteverwa necetuximab kana panitumumab.
2.Kurapwa kweKras-yakanaka kenza yakajeka kenza
Varwere vane metastatic cancer cancer vanofanirwa kuyerwa neRAS mutation chinzvimbo kusanganisira KRAS neNRAS, uye zvirinani iro chimiro cheKRAS exon 2 inoda kujekeswa.
Kana zvichikwanisika, chinzvimbo chemamwe maexons kunze kweKRAS Exon 2 uye NRAS chinzvimbo chinoshandurwa chinofanira kujekeswa.
Bevacizumab yakasanganiswa neaviri-zvinodhaka chemotherapy inogona kuunza PFS (yepakati kufambira mberi-isina kupona) uye OS (kupona kwese) mabhenefiti kune varwere vane KRAS shanduko.
Kune varwere vane RAS shanduko, kushandiswa kwecetuximab kunogona kukanganisa maitiro ese ehutano. Varwere vane KRAS kana NRAS shanduko havafanire kushandisa cetuximab kana panitumumab.
3. Kurapa kweBRAF mutant colorectal cancer
7-10% yevarwere vane cancer yekoloni vanotakura iyo BRAF V600E mutation. Iyo BRAF V600E shanduko ndeye BRAF-yakagadziriswa mutserendende uye ine yakanyanya chikamu chikamu cheBRAF shanduko. Iine yakasarudzika makiriniki maitiro: anonyanya kuoneka mune chaiyo hemicolon; dMMR ratio yakakwira, inosvika 20%; BRAF V600E shanduko ine fungidziro yakaipa; atypical metastatic mapatani;
Zvidzidzo zvakawana kuti FOLFOXIRI + bevacizumab inogona kunge iri yekurapa kwakanyanya kune varwere vane BRAF shanduko. 2019 V2 NCCN nhungamiro inokurudzira BRAF V600E yechipiri-mutsara kurapa sarudzo yekenza metastatic colorectal: verofinib + irinotecan + cetuximab / panitumumab Dabarafenib + trametinib + cetuximab / panit MAb
Encorafenib + Binimetinib + Cetux / Pan
4.HER2 kuwedzera
HER2 amplification kana overexpression inowanikwa mu2% kusvika 6% yevarwere vane advanced or metastatic colorectal cancer. Pertuzumab uye trastuzumab inosunga kune akasiyana HER2 madomasi kuti abudise synergistic inhibitory mhedzisiro pa tumor cell. MyPathway ndiyo yekutanga kiriniki yekudzidza kuongorora kushanda kwePertuzumab + Trastuzumab muvarwere vane HER2 yekuwedzera metastatic colorectal cancer (zvisinei neKRAS mutation mamiriro). Chidzidzo ichi chinoratidza kuti HER2 dual-targeted therapy, Pertuzumab + Trastuzumab, inobvumirwa zvakanaka kana kuti inogona kushandiswa senzira yekurapa varwere vane HER2 yekuwedzera metastatic colorectal cancer. Kuongororwa kwemajini ekutanga kuona HER2 kuchinja uye kufunga kushandiswa kweHER2 kwakanangwa kurapwa kunogona kubatsira varwere.
5.Kurapa kweNTRK fusion colorectal cancer
Fungidziro yeNTRK inoitika munenge 1 kusvika ku5% yevarwere vane gomarara rekoloni, uye kuongororwa kweNGS kunokurudzirwa Lorarectinib yakatenderwa kugadziriswazve kweNTRK kune varwere vane mamota akasimba, iine ORR ye62% uye 3 yavo iine CRC. Kubuda kweTrK inhibitors senge larotinib uye emtricinib inopa mazano matsva ekurapa yeNTRK gene fusion CRC.
Mukadzi ane makore makumi manomwe nemashanu ane metastatic colorectal cancer (CRC) ane rombo rakanaka:
Primary colon tumarara.
Kenza yePeritoneal.
Chiropa metastases.
1600 mg / m 2 yeemtricinib inoitwa nemuromo kamwe pavhiki kwemazuva mana akateedzana (kureva, mazuva mana / mazuva matatu abviswa) uye masvondo matatu akateedzana mazuva ese makumi maviri nemasere. Aft
Mavhiki masere ekurapwa, maronda akanyanya kuderedzwa.
Mashoko Okupedzisa
Kupinda panguva yekurapa kwakanangwa, murwere wese ane gomarara rakasarudzika anofanira kupasa kuongororwa kweMSI, RAS uye BRAF shanduko yekuchinja, uye kuita HER2 kukwidziridzwa zvakanyanya sezvinobvira, kuonekwa kwemajini senge NTRK, uye kuongororwa kwemajini (NGS) kuchasanganisirwa hombe Initial bvunzo nzira dzevarwere vazhinji.
