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.
- kansarka mindhicirka 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.
- Xulashada daaweynta kansarka mindhicirka malawadka badanaa waa isku darka daawooyin badan iyo daawooyinka kiimiko ah oo lagu daro daawooyinka la bartilmaameedsaday.
- Kadib daaweynta caadiga ah ee kansarka mindhicirka, waxaa weli jira dawooyin badan oo la bartilmaameedsaday oo la isku dayi karo. Xitaa haddii saameynta daaweynta aysan u fiicnayn sida safka koowaad iyo kan labaad, waxay wali keeni kartaa faa'iidooyinka badbaadada.
- Ka dib daaweynta-safka koowaad iyo tan-labaad daaweyn iska caabin ah, waxaa lagu talinayaa in markale la sameeyo baaritaanka hidda-socodka Haddii isbeddelada isugeynta MSI-H ama NTRK la ogaado, difaaca jirka ama larotinib waa la dooran karaa.
Marka, sidee bukaanleyda qaba kansarka mindhicirka ay u go'aamiyaan qorshaha daaweynta?
Ka dib ogaanshaha kansarka mindhicirka mindhicirka, dhakhaatiirtu waxay ku talin doonaan in bukaan kasta oo qaba kansarka mindhicirka weyn (mCRC) uu maro baaritaanka hidda-socodka si loo go'aamiyo koox-hoosaadka cudurka, maxaa yeelay macluumaadkan wuxuu saadaalin karaa saadaasha daaweynta. Hidda-wadaha u baahan in la baaro waa:
MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK
Daawooyinka lala beegsado
MSI (H) -pembrolizumab; nivolumab
BRAF (+) - Dalafenib, Trimetinib; Verofinil
RAS (KRAS- / NRAS -) - cetuximab; panitumumab (anti-EGFR)
HER2 (+) - trastuzumab
NTRK (+) - Larotinib
Anti-angiogenesis bartilmaameedka daroogada
VEGF: bevacizumab, abercept
VEGFR: ramucirumab, rigofinib, fruquintinib
Chemotherapy drugs include:5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil)
Markaad aragto noocyo badan oo daroogo ah, sida loo doorto iyo sida la isugu daro saamaynta ugu fiican? Vicki waxay ku siin doontaa liis garayn faahfaahsan si loo arko qaybta aad ka tirsan tahay, tag oo hel kursi!
Daaweynta-koowaad ee kansarka malawadka
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.
Haddii saameynta daaweyntan aysan fiicneyn, u beddel isku-darka daaweynta kiimikada iyo anti-angiogenesis inhibitors, bevacizumab ayaa badanaa la isticmaalaa.
Haddii bukaanku uusan ku habboonayn daawooyinka la bartilmaameedsado ee EGFR, ka dibna si toos ah u isticmaal kiimoterapi oo ay weheliso kuwa ka hortagga anti-angiogenesis.
Marka midkoodna nidaamyada kor ku xusan aysan waxtar lahayn, nidaam kale oo kiimiko ah iyo antibiyootiko kale oo lidka ku ah ayaa la beddeli doonaa.
Kiimikada kansarka mindhicirka malawadka badanaa waxay doortaa isku darka daroogada badan. Dhakhaatiirtu waxay isku daraan oo u dhigmaan sida ay tahay xaaladda dhabta ah ee bukaanka. Caadi ahaan la isticmaalo waa:
- FOLFOX (fluorouracil, calcium folinate, oxaliplatin) ama FOLFIRI (fluorouracil, calcium folinate, irinotecan), ama lagu daro cetuximab (oo lagula taliyay bukaanada qaba nooca duurjoogta ah ee KRAS- / NRAS-BRAF)
- CapeOx (capecitabine, oxaliplatin), FOLFOX or FOLFIRI, or combined with bevacizumab
- FOLFIRINOX (fluorouracil, folinate calcium, irinotecan, oxaliplatin)
Daaweynta khadka labaad
Daaweynta laynka labaad, waxaan leenahay kahortagayaal anti-angiogenesis ah oo aan kala dooran karno.
Sadarka koowaad, waxaan u isticmaali doonnaa bevacizumab oo ay weheliso kiimiko ku daaweynta. Haddii daaweyntu aysan waxtar lahayn, waan beddeli karnaa nidaamka daaweynta kiimikada oo waxaan sii wadeynaa isticmaalka bevacizumab. Dabcan, sidoo kale waa suurtagal in la beddelo daroogo kale oo bartilmaameed ah isla waqtigaas sida daaweynta kemotherabi, loo beddelo abercept, ama ramucirumab.
Daaweynta sadarka iyo sadarka dambe
Xulashada xulashada daawada-safka-koowaad iyo kan-labaad ee kansarka mindhicirka malawadka badanaa waa xoogaa heer qiyaas ah oo daawooyinka kiimiko ah iyo daawooyinka la bartilmaameedsado.
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, oo ah daawo kiimiko ku daweyn, waa shey isku dhafan oo ah trifluridine (a nucleoside metabolism inhibitor) iyo tipiracil (a thymidine phosphorylase inhibitor). Daawada waa mid aad u baahan, afartii toddobaadba mar waa daaweyn daaweyn ah. Daawada qaado Isniinta ilaa Jimcaha todobaadka koowaad iyo usbuuca labaad, daawada jooji Sabtida iyo Axada, jooji daawada usbuuca saddexaad iyo kan afraad, ka dibna bilow wareegga xiga. Inta lagu jiro muddadan, haddii bukaanku uusan lahayn isbeddel RAS ah, waxaa loo isticmaali karaa isku dhafka panitumumab. Ujeeddada nidaamkan ayaa ah in bukaanku uusan horay u isticmaalin panitumumab.
Tigio
S-1 (Teggio) sidoo kale waa daawo afka laga qaato oo kiimiko ah, oo ka tirsan fasalka ka soo baxa fluorouracil. Afka Teggio kaabsal 80 mg / m2 / maalin, 2 jeer maalintii, hal jeer quraac kadib iyo casho kadib, xitaa 14 jeer Maalmo, daawo kala bax 7 maalmood;
Regafini
Regefini waa daawo afka looga qaato anti-angiogenesis. Waa kiniin khafiif ah oo casaan ah oo oval-daboolan. Regofenib wuxuu saameyn wanaagsan ku leeyahay daaweynta kansarka mindhicirka wuxuuna si weyn u dheereyn karaa guud ahaan badbaadada bukaanka qaba kansarka mindhicirka. Qiyaasta lagu taliyey: Qaddarka lagu taliyey waa 160 mg (4 kiniin, mid kasta oo ka kooban 40 mg oo rifafenib ah), hal mar maalintii, hadal ahaan 21ka maalmood ee ugu horreeya koorso kasta oo daaweyn ah, iyo 28 maalmood oo ah daaweyn ahaan.
Daaweynta difaaca jirka
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 buro.
Marka lagu daro hal-tallaalka tallaalka, waxaad sidoo kale tixgelin kartaa isku-darka tallaalka difaaca jirka ee kala duwan, sida isticmaalka isku-darka Nivolumab (nivolumab) iyo Ipilimumab (Ipilimumab), fursadda yareynta buro waa 55%.
Pembrolizumab oo keli ah, nivolumab oo lagu daray ipilimumab ayaa laga ansixiyay FDA si loogu dabagalo daaweynta bukaanjiifka kansarka mindhicirka ee qaba MSI-H Xogtu wey bislaatay.
Larotinib
Larotinib waa awood, hadal, xulasho tropomyosin kinase inhibitor ah oo ku shaqeeya TRKB, TRKB, iyo kinaseyaasha TRKC. Waxaa loo ansixiyay Nofeembar 2018 illaa 17 kansar, oo ay ku jiraan kansarka malawadka, laakiin isbeddelka isku dhafka hiddo-wadaha NTRK1 / 2/3 ayaa loo baahan yahay in la ogaado, sidaa darteed Larotinib sidoo kale waa ikhtiyaar daaweyn xigta. Bukaannada qaangaarka ah waxay qaataan 100 mg afka ah laba jeer maalintii.
Saameynta daaweynta ee qadka dambe caadi ahaan uma muuqato sida daaweynta safka hore iyo kan labaad, laakiin sidoo kale waxay sii dheereyn kartaa muddada badbaadada. Sidaa darteed, haddii aan dooran karno kala-doorashooyin daaweyn oo kala duwan, daawooyin kala duwan ayaa loo isticmaalaa wareegga, sidoo kale nolosha waa la dheereyn karaa.
Maxaan sameeyaa haddii aanan u dulqaadanayn daaweynta kemotherabi?
Intaa waxaa dheer, sababaha saadaalinta bukaanka qaba kansarka mindhicirka waa in la tixgeliyaa, taasi waa, xaaladaha saameynaya saameynta daaweynta. Waxyaabaha ugu waaweyn waa: metastasis fog ee unugyada kansarka, meesha burooyinka aasaasiga ah, astaamaha
s ee isbeddelada hiddo-wadaha, jawaabta iyo muddada u dhexeysa daawooyinka hore, Heerka tabar-darrada bukaanku waxay saameyn ku yeelan doontaa saameynta daaweynta iyo doorashada qorshaha daroogada.
Gaar ahaan bukaanleyda daciifka ah ee aan qaadi karin dhibaatooyinka soo raaca kiimoteraabiga, sida loo doorto qorshaha daawada?
Talooyinka guud waa sida soo socota:
①Single targeted drug therapy, if there is no RAS gene mutation, you can choose cetuximab or panitumumab
Itors Kahortagayaasha anti-angiogenesis kaligood lama isticmaali karo, waana in lala isticmaalaa kemotherabi, sidaa darteed waxaad dooran kartaa iskudhafka daawooyinka kemotherabi ee leh waxyeelooyin yar yar iyo daweyn lala beegsado, sida irinotecan + bevacizumab (ama cetuximab)
Immun Daawada iskudhafka ah ee daweynta, sida MSI-H, dooro pembrolizumab
Dib u eegis muhiim ah
- Kansarka mindhicirka malawadka waa in hiddo ahaan loo baaraa kahor isticmaalka. Haddii aadan heli karin qaybaha unugyada, waxaad dooran kartaa dhiig si loo baaro. Waqtigaan, waxaad inta badan fiirisaa hiddo-wadaha NRAS, KRAS iyo BRAF.
- Xulashada daaweynta kansarka mindhicirka malawadka badanaa waa isku darka daawooyin badan iyo daawooyinka kiimiko ah oo lagu daro daawooyinka la bartilmaameedsaday.
- Kadib daaweynta caadiga ah ee kansarka mindhicirka, waxaa weli jira dawooyin badan oo la bartilmaameedsaday oo la isku dayi karo. Xitaa haddii saameynta daaweynta aysan u fiicnayn sida safka koowaad iyo kan labaad, waxay wali keeni kartaa faa'iidooyinka badbaadada.
- Ka dib daaweynta-safka koowaad iyo tan-labaad daaweyn iska caabin ah, waxaa lagu talinayaa in markale la sameeyo baaritaanka hidda-socodka Haddii isbeddelada isugeynta MSI-H ama NTRK la ogaado, difaaca jirka ama larotinib waa la dooran karaa.
