The theme of the 2019 NCCN Annual Meeting is to expand biomarker testing to guide the precise treatment of cancer, as well as new changes to colorectal cancer (CRC) guidelines. The 5-year survival rate of colorectal cancer is only 11%, and the updated treatment plan of the NCCN treatment guidelines is expected to improve survival.
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 kansarka mindhicirka adds treatment methods based on detection of biomarkers, including EGFR, MSI-H / dMMR, BRAF + MEK, and NTRK fusion targets.
Aynu eegno cusbooneysiinta gaarka ah ee muhiimka ah iyo xogta culus:
mFOLFOXIRI + 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 buro waa joogtaa.
Tijaabinta VOLFI, 96 bukaan ah oo qaba RAS nooca duurjoogta ah ee loo yaqaan 'metastatic colorectal cancer' ayaa si aan kala sooc lahayn loogu qoondeeyay mFOLFOXIRI oo lagu daray panitumumab (n = 63) ama kaliya mFOLFOXIRI (n = 33) ee saamiga 2: 1. Isku darka panitumumab group wuxuu lahaa heer wax ku ool ah oo ah 85.7%, halka mFOLFOXIRI kaliya ay ahayd 54.5%.
MSI / MMR
Although microsatellite instability (MSI) and mismatch repair (MMR) are usually not hereditary, this does not exclude tumors induced by Lynch syndrome, which is found in 1% of BRAF V600E colorectal cancers Embodied. If you have a strong family history, you must conduct genetic testing.
Tilmaamaha ugu dambeeyay waxay muujinayaan isticmaalka immunohistochemistry si loo ogaado afarta hidde-wadaha ee ku jira cudurka Lynch: MLH1, MSH2, MSH6 iyo PMS2.
NCCN horumarsan ama habraaca daawaynta kansarka mindhicirka, safka kowaad 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.
Wixii NTRK
Larotrectinib (Larotinib, Vitrakvi) ayaa hadda ah ikhtiyaar daaweyn labaad ah oo loogu talagalay bukaannada qaba kansarka mindhicirka weyn. Tijaabada hidda-socodka bukaanku waxay u baahan tahay inay ogaato isku-darka hidda-wadaha NTRK oo wanaagsan. Xogta baaritaanka daaweynta ee daawada waxaa lagu daabacay 2018 New England Journal of Medicine.
Sidaa darteed, Bishii Nofeembar 2018, FDA waxay oggolaatay isticmaalka larotinib ee daaweynta dadka waaweyn iyo bukaanka carruurta leh burooyin adag oo bararsan. Ilaa iyo inta bukaanku leeyahay isugeynta hidde-wadaha NTRK oo uusan jirin wax isbeddel ah oo la ogsoon yahay oo laga helay, cudurku wuxuu metastasized iyo qalliinka qalliinka ayaa laga yaabaa inay keento Khatar aad u daran oo dhimasho ah, ma jiro qorshe daaweyn kale oo lagu qanco ama horumarka ayaa dhacay daaweynta ka dib.
Tijaabadan tijaabada ah ee kansarka buuxa, 4 bukaan oo qaba kansarka mindhicirka mindhicirka ayaa la qoray, bukaanki 1 sifiican buu uga jawaabey.
Wixii BRAF iyo MEK
Cusboonaysiinta tilmaamaha NCCN, laba daaweyn oo isku-dhafan oo isku-dhafan oo loogu talagalay biomarker-ka ayaa lagu daray, kuwaas oo ah:
(1) dabrafenib (dalafinib, Tafinlar; BRAF) + trametinib (trametinib, Mekinist; MEK), oo lagu daro cetuximab ama 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.
This update of the NCCN guidelines for colorectal cancer once again confirms the important role of genetic testing in the treatment of cancer. With one more treatment option, there is more hope! Cancer friends should stop doubting the status of genetic testing. The good news is that there are so many approved targeted drugs for colorectal cancer. Please cherish what is in your own hands.
