Téma Rapat Taunan NCCN 2019 nyaéta pikeun ngalegaan tés biomarker pikeun panduan pengobatan kanker anu tepat, ogé parobihan énggal kana pedoman kanker kolorektal (CRC). Laju kasalametan 5 taun kanker kolorektal ngan ukur 11%, sareng rencana perawatan anu diropéa tina pedoman perawatan NCCN diperkirakeun ningkatkeun kasalametan.
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 kangker colorectal adds treatment methods based on detection of biomarkers, including EGFR, MSI-H / dMMR, BRAF + MEK, and NTRK fusion targets.
Hayu urang tingali pembaruan penting khusus sareng data beurat:
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 tumor aya ayeuna.
Dina sidang VOLFI, 96 pasién kanker tipe colorastal metastatic RAS sacara acak ditugaskeun pikeun mFOLFOXIRI digabungkeun sareng panitumumab (n = 63) atanapi ngan mFOLFOXIRI (n = 33) dina rasio 2: 1. Kelompok panitumumab gabungan ngagaduhan tingkat épéktip 85.7%, sedengkeun mFOLFOXIRI nyalira nyaéta 54.5%.
MSI / MMR
Sanajan instability microsatelit (MSI) jeung perbaikan mismatch (MMR) biasana teu turunan, ieu teu ngaluarkeun tumor ngainduksi ku sindrom Lynch, nu kapanggih dina 1% tina BRAF V600E kangker colorectal Embodied. Upami anjeun gaduh riwayat kulawarga anu kuat, anjeun kedah ngalaksanakeun tés genetik.
Pitunjuk panganyarna nunjukkeun panggunaan imunohistokimia pikeun ngadeteksi opat gén mutant anu aya dina sindrom Lynch: MLH1, MSH2, MSH6 sareng PMS2.
Dina tungtunan pangobatan kanker kolorektal maju atanapi metastatik NCCN, garis kahiji 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.
Pikeun NTRK
Larotrectinib (Larotinib, Vitrakvi) ayeuna mangrupikeun pilihan pangobatan kadua pikeun penderita kanker kolorektal metastatik. Tés genetik pasién kedah ngadeteksi fusi gén NTRK positip. Data panalungtikan klinis ubar ieu diterbitkeun dina 2018 New England Journal of Medicine.
Ku alatan éta, dina bulan Nopémber 2018, FDA nyatujuan panggunaan larotinib pikeun pengobatan penderita sawawa sareng murangkalih kalayan tumor padet anu ngabareuhan. Salami pasién ngagaduhan fusi gén NTRK sareng teu aya mutasi résistansi anu dipikaterang dipikaterang, panyakit parantos metastasisikeun sareng reseksi bedah tiasa nyababkeun résiko parah maot, teu aya rencana pangobatan alternatif anu nyugemakeun atanapi kamajuan parantos kajantenan saatos dirawat.
Dina uji klinis kanker pinuh ieu, 4 pasién sareng kanker kolorektal metastatik didaptarkeun, sareng 1 pasién diréspon ogé.
Pikeun BRAF sareng MEK
Dina pembaruan ieu pedoman NCCN, dua terapi kombinasi garis kadua pikeun biomarker ieu parantos ditambihan, nyaéta:
(1) dabrafenib (dalafinib, Tafinlar; BRAF) + trametinib (trametinib, Mekinist; MEK), digabungkeun sareng cetuximab atanapi panitumumab (EGFR monoclonal antibody);
(2) Encorafenib (Braftovi; BRAF) plus binimetinib (Mektovi; MEK) plus cetuximab or panitumumab.
nu 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.
Pembaruan ieu pedoman NCCN pikeun kanker kolorektal sakali deui negeskeun peran penting tés genetik dina pengobatan kanker. Kalayan hiji deui pilihan perawatan, aya deui harepan! Babaturan kanker kedah ngeureunkeun ragu kana status tés genetik. Warta anu saé nyaéta yén aya seueur obat anu disatujuan pikeun kanker kolorektal. Mangga hargai naon anu aya dina panangan anjeun sorangan.
