Daaweynta loogu talagalay kansarka mindhicirka

Waa maxay dawooyinka kansarka mindhicirka mindhicirku?

17 sano ka hor, tirada dawooyinka loo heli karo kansarka mindhicirka ee horumaray aad bay u koobnaayeen. Waxa jiray dhawr dawo oo kiimiko ah oo ku dhawaad ​​ma jirin dawooyin la beegsaday. Marka la ogaado, muddada badbaadadu waa inta u dhaxaysa nus sano iyo hal sano oo keliya. Laakiin hadda, daawaynta kansarku waxay gelaysaa xilligii daawaynta saxda ah, iyo in badan oo la beegsaday iyo dawooyinka difaaca ayaa suuqa yaal.

Nooca 2017 ee tilmaamaha daawaynta kansarka mindhicirka, talooyinka baadhista hidde-sidaha waxa ku lug leh KRAS, NRAS, dMMR, iyo MSI-H. Tilmaamaha daawaynta ee ugu dambeeyay ee 2019, bartilmaameedyada cusub sida BRAF, HER2, NTRK ayaa dhawaan lagu daray Point, iyada oo loo marayo baaritaanka hidda-socodka, si loo fahmo macluumaad badan oo unugyo ah oo ku saabsan kansarka mindhicirka, waxay naga caawin kartaa inaan helno ikhtiyaaro daawo oo badan. Celceliska heerka badbaadada bukaanku waa in ka badan 3 sano, taas oo ah horumar aad u weyn oo ay keentay dawo sax ah.

Noocee noocee ah ayaa lagu baaraa bukaanka kansarka mindhicirka?

Baadhista kadib, dhakhaatiirtu waa inay hiddo ahaan u tijaabiyaan bukaan kasta oo qaba kansarka mindhicirka weyn (mCRC) sida ugu dhaqsaha badan si loo go'aamiyo koox hoosaadka cudurka, maadaama macluumaadkani uu saadaalin karo saadaasha daaweynta, sida kordhinta HER2 ee soo jeedinaysa anti-EGFR therapy Resistant Hidda-wadayaasha soo socda waa in la baaro!

MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK.

Bartilmaameedyada iyo daroogada la bartilmaameedsaday ee hada loo heli karo daaweyn

VEGF: bevacizumab, aragti la'aan

VEGFR: Ramulizumab, Regigofinil, Fruquintinib

EGFR: Cetuximab, Panitumumab

PD-1 / PDL-1: Pamumab, Navumab

CTLA-4: Ipilizumab

BRAF: Wimofenib

NTRK: Larotinib

Liistada bartilmaameedka kansarka mindhicirka iyo dawooyinka difaaca jirka ee laga ansixiyey gudaha iyo dibadda:

Tilmaamaha bevacizumab: kansarka mindhicirka dheef-shiid kiimikaadka iyo sare, metastatic ama kansarka sanbabada unug yar oo soo noqnoqda.

Tilmaamaha trastuzumab: HER2-horta kansarka naasaha metastatic, HER2-positive kansarka naasaha hore, iyo HER2-positive metastatic gastric adenocarcinoma ama isgoysyada gastroesophageal adenocarcinoma.

Tilmaamaha Pertuzumab: Alaabtani waxay ku habboon tahay isku-darka trastuzumab iyo kiimoterabiga sida daaweynta adjuvant ee bukaannada qaba HER2-positive kansarka naasaha hore ee khatarta sare leh ee soo noqoshada.

Tilmaamaha Nivolumab: Neefsashada hidda-wadaha kobaca epidermal-ka xun (EGFR) iyo anaplastic lymphoma kinase (ALK) taban, horumarka cudurka ama aan loo dulqaadan karin gudaha deegaanka horumaray ama cudur metastatic ka dib kiimiko daaweynta hore ee platinum-ku-jirta bukaanada qaangaarka ah ee qaba kansarka sanbabada unugyada yaryar (NSCLC).

Tilmaamaha Regorafenib: bukaannada kansarka mindhicirka ee hore loo daweeyay. Durvalumab, Tremelimumab, Ipilimumab, lapatinib ayaan wali laga helin Shiinaha.

Daaweynta Bartilmaameedka Midabaysan (Cusbooneysiinta 2019)

1.Kras-negative kansarka mindhicirka mindhicirka

Kansarka mindhicirka ee nooca duurjoogta ah ee KRAS waa daawaynta safka koowaad ee caadiga ah ee daaweynta kemotherabi ee la beegsaday marka lagu daro kiimoterabi. Hadaba waa maxay nooca kemotherabi ee la doortay?

Markaad xulaneyso daroogada la bartilmaameedsaday, waxaa lagugula talinayaa inaad doorato nidaamka daaweynta kiimikada ee leh OS dheeri ah, taas oo ah, cetuximab ayaa ku habboon FOLFOX, bevacizumabna waxay ku habboon tahay FOLFIRI. Qorshe noocee ah in la doorto waxay kuxirantahay falanqaynta caafimaad ee gaarka ah:

Haddii ay jirto rajo daawo, cetuximab oo ay weheliso kemotherabi guud ahaan waa la door bidaa maxaa yeelay waxtarka hadafka dhow ee cetuximab ayaa ka sareeya bevacizumab;

Bukaannada qaba cudurrada aan la daaweyn karin, bevacizumab oo ay weheliso kemotherabi ayaa loo isticmaali karaa safka koowaad, waxaana ku xigi kara cetuximab ama panitumumab.

Daaweynta kansarka mindhicirka weyn ee Kras-positive

Bukaannada qaba kansarka mindhicirka weyn waxay u baahan yihiin in laga baaro xaaladda isbeddelka RAS oo ay ku jiraan KRAS iyo NRAS, iyo ugu yaraan heerka KRAS exon 2 waa inuu ahaadaa mid cad.

Haddii ay suurtagal tahay, xaaladda exons-yada kale marka laga reebo KRAS Exon 2 iyo xaaladda isbadalka NRAS waa in la caddeeyaa.

Bevacizumab oo lagu daray laba-daawada kiimoterabi waxay u keeni kartaa PFS (badbaadada horu-kaca dhexdhexaadka ah) iyo OS (badbaadinta guud) faa'iidooyinka bukaannada leh isbeddellada KRAS.

Bukaannada qaba isbeddelada RAS, isticmaalka cetuximab wuxuu saameyn xun ku yeelan karaa guud ahaan waxtarka. Bukaannada qaba isbeddellada KRAS ama NRAS waa inaysan isticmaalin cetuximab ama panitumumab.

3.Daaweynta cudurka BRAF kansarka mindhicirka mindhicirka

7-10% bukaanada qaba kansarka mindhicirka weyn waxay wataan isbedelka 'BRAF V600E'. Isbeddelka BRAF V600E waa isbeddel ku shaqeeya BRAF oo leh saamiga ugu sarreeya ee isbeddelada BRAF. Waxay leedahay astaamo caafimaad oo gaar ah: inta badan waxay ka muuqataa hemicolon midig; saamiga dMMR ayaa sareeya, oo gaaraya 20%; Isbedelka BRAF V600E wuxuu leeyahay saadaal xumo; qaabab metastatic atypical;

Daraasado ayaa lagu ogaaday in FOLFOXIRI + bevacizumab ay noqon karto daaweynta ugu fiican ee loogu talagalay bukaanada qaba isbeddelada BRAF. Tilmaamaha 2019 V2 NCCN wuxuu kugula talinayaa BRAF V600E xulashada daaweynta labaad ee daaweynta kansarka mindhicirka: verofinib + irinotecan + cetuximab / panitumumab Dabarafenib + trametinib + cetuximab / panit MAb

Encorafenib + Binimetinib + Cetux / Pan

4.HER2 kordhinta

Kordhinta HER2 ama muujinta xad-dhaafka ah waxaa laga helaa 2% ilaa 6% bukaannada qaba kansarka mindhicirka ee sare ama metastatic. Pertuzumab iyo trastuzumab waxay ku xidhan yihiin xayndaabyo kala duwan oo HER2 ah si ay u soo saaraan saamaynta is-hortaagga ah ee unugyada burooyinka. MyPathway waa daraasaddii ugu horreysay ee caafimaad si loo baaro waxtarka Pertuzumab + Trastuzumab ee bukaannada qaba HER2 ballaarinta kansarka mindhicirka metastatic (iyadoon loo eegin heerka isbeddelka KRAS). Daraasadani waxay muujinaysaa in HER2 daawaynta laba-geesoodka ah, Pertuzumab + Trastuzumab, si wanaagsan loo dulqaatay ama loo isticmaali karo ikhtiyaar daawaynta bukaanada qaba HER2 balaadhinta kansarka mindhicirka metastatic. Tijaabada hore ee hidde-sidaha si loo aqoonsado isbeddellada HER2 oo loo tixgeliyo isticmaalka hore ee daawaynta la beegsanayo ee HER2 waxay faa'iido u yeelan kartaa bukaannada.

Daaweynta NTRK kansarka mindhicirka mindhicirka

Isugeynta NTRK waxay ku dhacdaa qiyaastii 1 ilaa 5% bukaannada qaba kansarka mindhicirka weyn, iyo baaritaanka NGS ayaa lagula talinayaa. Lorarectinib waxaa loo oggolaaday dib-u-habeynta NTRK ee bukaannada qaba burooyinka adag, oo leh ORR 62% iyo 3 ka mid ah oo leh CRC. Soo bixitaanka TRK xannibaadaha sida larotinib iyo emtricinib waxay bixisaa fikrado daaweyn oo cusub oo loogu talagalay NTRK hiddo-wadaha CRC.

Haweeney 75 jir ah oo qabta kansarka mindhicirka weyn (CRC) aad ayey u nasiib badan tahay:

Burooyinka aasaasiga ah ee xiidanka.

Kansarka xiidmaha

Beerka metastases.

1600 mg / m 2 ee emtricinib waxaa afka lagu qaataa hal mar usbuucii 4 maalmood oo isku xigta (yacni, 4 maalmood / 3 maalmood oo nasasho ah) iyo 3 usbuuc oo isku xigta 28 maalmood oo kasta. Aft
er siddeed toddobaad oo daaweyn ah, nabarrada ayaa si weyn hoos ugu dhacay.

Gabagabaynta Hadalka

Gelitaanka xilliga daaweynta la bartilmaameedsaday, bukaan kasta oo qaba kansarka mindhicirka mindhicirka waa inuu ka gudbaa baaritaanka MSI, falanqaynta isbeddelka RAS iyo BRAF, oo samee ballaadhinta HER2 sida ugu macquulsan, ogaanshaha hiddo-wadaha sida NTRK, iyo baaritaanka hidda-wadaha (NGS) ayaa lagu dari doonaa shuruudaha baaritaanka bilowga ah ee bukaan socodka badankood.

Wixii macluumaad dheeri ah wac +91 96 1588 1588 ama wax u qor cancerfax@gmail.com.