Kansarka mindhicirka waa mid ka mid ah burooyinka halista ah ee ugu caansan. Shiinaha, dhacdooyinka kansarka mindhicirka ayaa ka galay kaalinta 4aad iyo 3aad ee ragga iyo dumarka, siday u kala horreeyaan. Gelitaanka xaalad cudur horumarsan, istaraatijiyadda daawaynta ee bukaannadani waa daawaynta dhammaystiran ee kiimoterabiga ku salaysan. Marka la barbardhigo daaweynta ugu fiican ee taageerada, waxay si weyn u dheereyn kartaa muddada badbaadada waxayna hagaajin kartaa tayada nolosha. Labadii sano ee la soo dhaafay, iyada oo qoto-dheeraanta molecular-ka kansarka ee cilmi-baarista, waxtarka daawooyinka la beegsado ayaa soo fiicnaanaya oo soo fiicnaanaya, waxyeellooyinkuna waa yar yihiin, si ay dhakhaatiirta iyo bukaanku u helaan ikhtiyaaro daaweyn oo badan. Aan eegno mindhicirka waa maxay daawoyinka hadda jira ee kansarka?
Qorshaha daaweynta kansarka malawadka
(1) It is recommended to detect the gene status of buro K-ras, N-ras and BRAF before treatment, and EGFR is not recommended as a routine test item.
(2) Isku darka kemotherabi waa in loo isticmaalo daawaynta safka kowaad iyo labaad ee bukaanada qaba kansarka mindhicirka dheef-shiid kiimikaadka oo u dulqaadan kara kiimoterabiga. Dawooyinka kiimikaad ee soo socda ayaa lagula talinayaa: FOLFOX ama FOLFIRI, ama lagu daro cetuximab (waxaa lagu talinayaa bukaanada qaba nooca K-ras, N-ras, BRAF), CapeOx, FOLFOX ama FOLFIRI, ama lagu daro bevacizumab.
(3) Bukaanka qaba kiimoterabi ka badan safka saddexaad ayaa lagula talinayaa inay isku dayaan daawooyinka la beegsaday ama ka qaybqaataan tijaabooyinka caafimaad. Bukaannada aan isticmaalin dawooyinka la beegsanayo ee daawaynta safka koowaad iyo labaad, irinotecan oo lagu daray daawaynta mukhaadaraadka ayaa sidoo kale la tixgelin karaa.
(4) Regofinil ama tijaabooyinka bukaan socodka waxaa lagula talinayaa bukaanada ku fashilmay khadka seddexaad iyo nidaamka ka sarreeya. Bukaannada aan u isticmaalin daawooyinka la bartilmaameedsaday ee daaweynta koowaad iyo labaadba, irinotecan oo lagu daray cetuximab (oo lagula taliyay nooca duurjoogta ah ee K-ras, N-ras, gen BRAF) ayaa sidoo kale la tixgelin karaa
(5) Bukaannada aan u dulqaadan karin iskudhafka kiimoteraabiga, nidaamka fluorouracil + kalsiyum folinate ama dawada capecitabine ee hal daawo ah ama isku darka daawooyinka ayaa lagula talinayaa. Bukaannada qaba kansarka mindhicirka sare ee aan ku habboonayn nidaamka fluorouracil + kalsiyum leucovorin ayaa laga yaabaa inay tixgeliyaan daaweynta hal wakiil oo lagu daaweynayo raltrexone.
(6) Bukaannada cudurkoodu xasilloon yahay 4 ilaa 6 bilood oo daaweyn ah kadib laakiin aan wali fursad u helin dib u soo kabashada R0 waxay ka fiirsan karaan inay galaan daaweynta dayactirka (sida isticmaalka sunta yar ee fluorouracil + calcium leucovorin, ama capecitabine hal daroogada oo isku dhafan oo lagu beegsanayo Daaweynta, ama laalo nidaamka daaweynta nidaamka) si loo yareeyo sunta sunta isku darka kiimoteraabiga.
(7) Bukaannada qaba hiddo-wadaha 'BRAF gene V600E mutation', haddii xaaladda guud ay ka wanaagsan tahay, FOLFOXIRI ama daaweynta-safka koowaad ee lagu daro bevacizumab waa la tixgelin karaa.
(8) Haddii xaaladda guud ama shaqada xubnuhu ay aad ugu liidato bukaannada horumarsan, daaweynta ugu fiican ee taageerada ah ayaa lagula talinayaa.
(9) Haddii metastasisku uu ku egyahay beerka iyo / ama sambabada, tixraac mabaadi'da daaweynta ee beerka metastasis iyo sanbabada metastasis.
(10) Bukaanka qaba kansarka mindhicirka ee ku soo noqnoqda, qiimaynta culuumta badan ayaa lagula talinayaa si loo go'aamiyo inay fursad u haystaan in mar kale dib loo soo celiyo ama radiotherapy. Haddii ay ku habboon tahay kaliya daaweynta kemotherabi, mabaadi'da kor ku xusan ee daaweynta daroogada ee bukaannada sare ayaa la qaataa.
Xulashada daaweynta kiimiko ee bukaanka qaba kansarka mindhicirka malawadka
Daawooyinka kiimikada ee loo isticmaalo daaweynta kansarka mindhicirka ee horumarsan waxaa ka mid ah: fluorouracil (oo ay ku jiraan afka
Capecitabine), oxaliplatin iyo irinotecan.
waa maxay taasi
Dawaynta qalitaanka
1. Qorshe saddex daawo ah
FOLFOXIRI [23]: irinotecan 165 mg / m2, faleebo xididka, d1; oxaliplatin 85 mg / m2, faleebo faleebo, d1; LV 400 mg / m2, faleebada faleebada, d1; 5-FU 1 600 mg / (m2 · d) × 2 d faleebada faleebada oo joogto ah (wadar ahaan 3 200 mg / m2, faleebo 48 saacadood), laga bilaabo maalinta ugu horeysa. Ku celi 2dii toddobaadba mar.
2. Labada nooc ee daroogada
(1) Barnaamijyada ku saleysan Oxaliplatin, sida FOLFOX iyo CapeOx, eeg daawada loo yaqaan 'adjuvant treatment of colon cancer'.
(2) Nidaamka ku saleysan Irinotecan: FOLFIRI: irinotecan 180 mg / m2, faleebada xididka ee 2 saacadood, d1; LV 400 mg / m2, faleebada xididka ee 2 saacadood, d1; 5-FU 400 mg / m2, Intravenous bolus duray, d1, ka dibna 2 400 mg / m2, faleebo faleebo joogto ah 46 ilaa 48 saacadood. Ku celi 2dii toddobaadba mar.
3. Nidaamka daroogada ee keli ah
Haddii bukaanku u dulqaadan karin daaweynta bilowga ah ee adag, 5-FU / LV ama faleebada capecitabine (fiiri daaweynta dheeraadka ah ee faahfaahinta qaaska ah) ama hal-wakiil irinotecan (125 mg / m2 irinotecan, faleebo xididada 30 ~ 90 daqiiqo, d1, d8, soo noqnoqday 3dii usbuucba mar; ama irinotecan 300-350 mg / m2, faleebada xididka 30-90 daqiiqo, d1, oo lagu celiyo 3dii asbuucba). Ama irinotecan 180 mg / m2, faleebada faleebada 2 saacadood, d1, oo lagu celiyo 2dii usbuucba.
Daaweynta kor ku xusan ka dib, haddii xaalada guud ee bukaanku aysan soo hagaagin, daaweynta ugu fiican ee taageerada ah waa in la siiyaa.
Laba
Daaweynta dayactirka
Tijaabada OPTIMOX1 waxay muujisay in bukaanada qaba kansarka mindhicirka weyn ee qaata FOLFOX sida daaweynta safka hore, isticmaalka joogtada ah ee istiraatiijiyadda "jooji oo tag" ee oxaliplatin waxay yareyn kartaa neerfaha laakiin ma saameynayso Badbaadada [26]. Sidaa darteed, ka dib 3 illaa 6 bilood oo ah isku-darka kiimiko isku-darka labada wakiil ah, sida cudurka CR / PR / SD, oxaliplatin ama irinotecan oo leh fal-celinno daran ayaa la joojin karaa, iyo daaweynta kale ee dayactirka daroogada ee nidaamka ayaa sii socota. Ilaa iyo inta ay buradu sii socoto, sii socoshada ka-madax-bannaan waa la dheereyn karaa, laakiin faa'iidada guud ee badbaadada ma muuqato.
Saddex
Fursadaha labaad, saddexaad iyo kan xiga
Xulashada daaweynta kiimiko ee safka labaad waxay kuxirantahay qorshaha daaweynta safka koowaad. Barnaamijyada ku saleysan oxaliplatin iyo irinotecan waxay noqon karaan safka koowaad iyo kan labaad ee midba midka kale. Marka loo eego xaalada jireed ee bukaanka, dooro hal dawo ama qorshaha isku dhafka daaweynta.
Bukaannada qaba wax ka badan kiimikaad daweynta seddexaad ayaa lagula talinayaa inay tijaabiyaan daroogooyinka la bartilmaameedsado ama ay kaqaybqaataan tijaabooyinka caafimaad. Bukaannada aan u isticmaalin daawooyinka la bartilmaameedsaday ee daaweynta koowaad iyo labaadba, irinotecan oo ay weheliso daaweynta daroogada ee la bartilmaameedsaday ayaa sidoo kale loo tixgelin karaa.
Daaweynta loogu talagalay kansarka mindhicirka mindhicirka
Liiska bartilmaameedka iyo immunotherapy daawooyinka loogu talagalay kansarka mindhicirka mindhicirka oo ilaa hadda laga oggolaaday gudaha iyo dibaddaba.
1. Bevacizumab
Magaca guud: Wei Ting
Magaca Ingiriisiga: Avastin
Magaca qaab dhismeedka Molecular: Bevacizumab
Tilmaamaha ugu muhiimsan: kansarka mindhicirka
Asal ahaan: Roche
Bevacizumab (Avastin®) waa antibiyootiko monoclonal bini'aadan ah oo dib-u-dhisme ah. Waxaa ansixiyay FDA bishii Febraayo 26, 2004, waana daawadii ugu horreysay ee laga oggolaado Mareykanka si loo xakameeyo burooyinka angiogenesis.
Waxtarka bevacizumab oo ah hal wakiil kaliya ayaa hooseeya, waxaana guud ahaan lagu talinayaa in loo isticmaalo iskudarka daaweynta kiimikada.
Nidaamka iskudhafan ee daaweynta kiimikada: IFL, FOLFIRI, FOLFOX iyo CapeOX; Qiyaasaha la isticmaalay: 5 mg / kg (2-usbuuc regimen) iyo 7.5 mg / kg (3-usbuuc regimen).
Isku darka IFL iyo bevacizumab ee daaweynta kansarka mindhicirka ee horumarsan ayaa kordhiyay OS laga bilaabo bilaha 15.6 ilaa bilaha 20.3 (daraasadda AVF2107).
Bevacizumab oo lagu daray nidaamka FOLFIRI oo ah daawaynta safka koowaad, heerka wax ku oolka ahi wuxuu ahaa 58.7%, PFS waxay ahayd 10.3 bilood (daraasad FIRE3).
Bevacizumab oo ay weheliso FOLFOX ama FOLFIRI oo ah daweynta koowaad, PFS waxay gaadhay 11.3 bilood, OS waxay gaadhay 31.2 bilood (CALGB80405 study).
2. Cetuximab
Magaca guud: Erbitux
Magaca Ingiriisiga: CETUXIMAB XALKA FASHILKA
Magaca qaab dhismeedka Molecular: Cetuximab
Tilmaamaha ugu muhiimsan: kansarka mindhicirka
Goobta Asalka: Merkelion, Jarmalka
Kahor daaweynta cetuximab, hidda-wadaha RAS waa in la tijaabiyaa kahor inta bukaannada nooca duurjoogta oo dhan aysan isticmaali karin cetuximab. Qiyaasta waxtarka leh ee 'cetuximab' waa kaliya 20%, waxaana badanaa lagu taliyaa in loo isticmaalo isku-darka daaweynta kiimikada.
FOLFIRI iyo FOLFOX; qiyaasta: 400mg / m2 250mg / m2 asbuucii kadib qiyaasta koowaad.
Bukaannada nooca RAS-duurka ah, cetuximab oo ay weheliso nidaamka FOLFIRI ama nidaamka FOLFOX waxay si aad ah uga dheer tahay PFS iyo OS marka loo eego daaweynta kiimikada oo keliya.
3. Regafini
Magaca guud: Baivango
Magaca Ingiriisiga: regorafenib
Magaca qaab dhismeedka Molecular: Regefenib
Tilmaamaha ugu muhiimsan: kansarka mindhicirka mindhicirka
Goobta Asalka: Shirkadda Bayer
Dadka ay khuseyso: Bishii Sebtember 2012, Regefini waxaa ansixisay FDA si loo daweeyo kansarka ku dhaca mindhicirka weyn. Bishii Meey 2017, CFDA-da Shiinaha ayaa sidoo kale ansixisay regorafenib daaweynta fluorouracil, oxaliplatin, iyo daaweynta kiimiko ah ee daaweynta iyo daawada VEGF ee 1. Anti-EGFR therapy (RAS wild-type) bukaanada qaba kansarka mindhicirka weyn (mCRC).
4. Panitumumab (panitumumab)
Magaca guud: Viktibi
Magaca Ingiriisiga: Erbitux cetuximab
Magaca qaab dhismeedka kulka: panitumumab
Tilmaamaha ugu muhiimsan: kansarka mindhicirka mindhicirka
Goobta Asalka: Amgen Mareykan ah
Daawooyinka daawaynta kansarka mindhicirka Vectibix (panitumumab) iyo pantumumab waa unugyada difaaca jirka ee ugu horreeya ee si buuxda u bini'aadantinimo kuwaas oo bar-tilmaameedsada receptor factor factor koritaanka epidermal (EGFR). Bishii Luulyo 2005, Panituumab waxay heshay oggolaanshaha degdegga ah ee FDA. Dhammaadkii 2005, Amgen iyo la-hawlgalayaasheeda Abgenix waxay si wadajir ah u gudbiyeen arjiga shatiga alaabtan FDA si loogu daweeyo kansarka mindhicirka ee metastatic ka dib markii kiimoterabiga uu ku guuldareystay.
5.Ziv-aflibercept (Abercept)
Magaca Ingiriisiga: Zaltrap (ziv-aflibercept for solution for faleebo)
Magaca qaab dhismeedka kulka: Abecip
Tilmaamaha ugu muhiimsan: kansarka mindhicirka mindhicirka
Asal ahaan: Sanofi
Abecip waxaa ansixiyay US FDA si loogu daaweeyo kansarka mindhicirka sare ee sanada 2012. Waa daawo borotiin chimeric ah oo xaddidaya bixinta nafaqooyinka burooyinka iyadoo la joojinayo cunsuriyada koritaanka xididada jirka ee VEGF, taas oo ka hortageysa faafitaanka burooyinka
Aflibercept waxay ku xidhan tahay wareegga VEGF ee jirka waxayna u dhaqantaa sida "dabin VEGF" Sidaa darteed, waxay xakameynayaan waxqabadka noocyada koritaanka xididdada xididdada VEGF-A iyo VEGF-B iyo cunsurka kobaca mandheerta (PGF), siday u kala horreeyaan, waxayna horjoogsanayaan koritaanka xididdada dhiigga ee cusub ee qanjidhada chorionic ama burooyinka. Waa la dhihi karaa ujeedka Aflibercept waa inuu "gaajoodo" unugyada burooyinka.
6. Ramolimumab (Cyramza)
Magaca Ingiriisiga: ramucirumab
Magaca qaab dhismeedka kulka: Remolumumab
Tilmaamaha ugu muhiimsan: kansarka mindhicirka
Asal ahaan: Eli Lilly iyo Shirkad
Cyramza waxaa ansixiyay US FDA sanadii 2014 si loogu daweeyo kansarka caloosha, kansarka malawadka iyo kansarka sanbabada ee unugyada yar.
Maaddaama unugyada buroodu sii weynaanayaan, waxay mari doontaa habka loo yaqaan 'angiogenesis', taas oo ah, sameynta marinno dhiig oo cusub oo ku wareegsan unugyada burooyinka si loogu qaado nafaqooyinka unugyada burooyinka. Sidaa darteed, ka hortagga nidaamkan ayaa horjoogsan kara badashada burooyinka badankood.
Cyramza waa daroogada monoclonal antibody, taas oo inta badan xakameysa sameynta xididdada dhiigga ee cusub ee hareeraha burada waxayna hor istaagtaa bixinta nafaqooyinka burooyinka iyadoo ku xirmeysa soo dhaweynta xididdada koritaanka xididdada dhiigga ee xididdada (VEGFR2), taas oo ka hortageysa faafidda burooyinka.
7. Fruquintinib
Magaca Magaca: Aiyoute
Calaamadaha lagu dabaqi karo: Waxaa lagu ansixiyay Shiinaha 5-tii Sebtember si loogu daaweeyo dawada hore ee fluorouracil, oxaliplatin iyo kemoterapi-ku salaysan, iyo sidoo kale daaweyn hore ama mid aan ku habboonayn oo la socota cunsuriyadda koritaanka jirka ee ka hortagga xididdada dhiigga (VEGF) Daawada cuncunka epidermal factor receptor (EGFR) (nooca RAS duurjoogta ah).
7.opdivo
Magaca Ingiriisiga: nivolumab
Magaca qaab dhismeedka kulka: nivolumab
Tilmaamaha ugu muhiimsan: kansarka mindhicirka
Meesha Asal ahaan: Bristol-Myers Squibb
Ono iyo Bristol Myers Squibb (BMS) cilmi-baaris wadajir ah iyo horumarin, bishii Luulyo 2014 ee ay oggolaatay Wakaaladda Dawooyinka iyo Qalabka Caafimaadka ee Japan (PMDA), Disembar 2014 Maamulka Cuntada iyo Dawooyinka ee Mareykanka (FDA) La ansixiyay, waxaa ansixiyay Wakaaladda Daawooyinka Yurub EMA) bishii Juun 2015, oo ay ansixisay Maamulka Cuntada iyo Dawooyinka ee Shiinaha (CFDA) suuq geynta Juun 2018, oo ay iibiso Ono Pharmaceuticals ee Japan, Bristol-Myers Squibb ee Mareykanka, Waxaa lagu iibiyaa Yurub iyo Shiinaha hoos yimaada astaanta. Magaca Odivo®.
Horumarkii ugu dambeeyay ee daaweynta kansarka malawadka
1) TAS-102 (Lonsurf)
TAS102 waa daawada kiimikaad afka laga qaato oo ka kooban anti-tumor nucleoside analog FTD (trifluorothymidine, trifluridine) iyo thymidine fosforylase inhibitor TPI.
The mPFS ee kooxda TT-B ee lagu daaweeyay TAS102 + bevacizumab wuxuu ahaa bilaha 9.2, taas oo si aad ah uga sareysay 7.8 bilood ee capecitabine + bevacizumab CB koox ahaan dhaqan ahaan loola dhaqmo. Badbaadinta horumarka-la'aan. Waxaa la filayaa inay u noqoto ikhtiyaar daaweynta cusub ee safka koowaad ee bukaannada noocaas ah.
2) Waa maxay faa iidooyinka daaweynta ku-meel-gaadhka ah ee isku-darka saddexda daroogo?
Isku darka loo yaqaan 'umerafenib', 'binimetinib' iyo 'cetuximab' ee bukaanlayda 'BRAF mutation' waa isbedel weyn, sababtoo ah daraasado badan oo la sameeyay ayaa muujiyay in isku darka ka hortagayaasha 'BRAF inhibitors' iyo 'MEK inhibitors' ee bukaanka diidan, Waxaa la arki karaa in heerka falcelintu uu ka badan yahay 30%, taas oo aan hore loo maqal ee.
Xogta ugu dambeysay ee lagu soo gudbiyay 2018 World Congress ee Kansarka Cudurka Kansarka waxay muujineysaa in isku darka daroogada saddexda ah kaliya aysan laheyn jawaab celin sare, laakiin sidoo kale waxay leedahay PFS dheer iyo OS. Tani waa sababta tijaabooyinka loogu horumarinayo daweynta koowaad. Waxaa xiiso leh, seddexdan gabdhood kuma jiraan daawooyinka la bartilmaameedsado ee cytotoxic. Tani waxay muujineysaa inay si caqligal ah u aqoonsan karto maaddooyinka burooyinka waxayna soo saari kartaa saameyn caafimaad oo muhiim ah iyada oo aan la soo saarin sun badan.
3) Waa maxay horumarka tallaalku?
Burooyinka MSI-H, isku darka nivolumab iyo ipilimumab waxay leeyihiin fursad ay ku helaan daweynta koowaad, maxaa yeelay xogta waxtarka waxay umuuqataa mid lagu qanco.
Burooyinka microsatelite-ka ee xasilloon, waa inaan isku darnaa difaaca jirka iyo daaweynta kiimiko ee caadiga ah-FOLFOX / bevacizumab oo lagu daray nivolumab.
