Kanker payudara & kémoterapi
Among the many cancers, breast cancer is probably the most difficult to decide whether to undergo chemotherapy after surgery. Similar to other cancers, the factors that determine breast cancer chemotherapy are (age, tumor size, metastasis of lymph nodes and other organs (so-called TNM, staging), ER, PR, CerbB-2, Ki-67, P53, etc.). If the results of the analysis are obviously sideways, it is easier to make a decision about whether to administer chemotherapy. But in many cases, the result of the analysis is exactly in the middle “gray zone” (I don’t exaggerate, there are many examples of middle zone), which will cause the situation of uncertainty. We often say: Second opinion (listen to the opinions of several doctors), but have you ever thought about it, even if you ask 10 doctors, the answer you get is likely to be: 5 say chemotherapy, 5 say no ( Still two opinions), isn’t it annoying.
Saatos Anjeun gaduh kanker payudara, it’s important to make a decision about whether to get chemotherapy. If patients who do not need chemotherapy receive unnecessary chemotherapy, it will not only waste time and money, but also endure the various side effects of chemotherapy (nausea, vomiting, hair loss, bone marrow suppression, infection, bleeding, etc.). Patients who originally needed chemotherapy miss the chance of chemotherapy, which increases the risk of recurrence.
Naon anu kedah dilakukeun ?
Hiji tés parantos disarankeun ku Amérika ASCO (American Clinical Oncology Association). Disebut oncotype DX. Tés ieu ngagunakeun métode biologi molekular basajan pikeun nganalisis faktor-faktor anu disebatkeun di luhur dina bagian patologis kanker payudara pasién, teras masihan "Skor Recurrent" (RS). Penderita RS tinggi perlu kémoterapi, sarta maranéhanana kalayan RS low teu kedah kémoterapi. RS di tengah merlukeun analisis salajengna (sanajan lolobana pasien kalayan RS di zone tengah teu nguntungkeun teuing tina kémoterapi).
Di Amérika Serikat, tés ieu umum pisan pikeun pengobatan kanker payudara, sabab kaputusan naha peryogi kémoterapi langsung aya hubunganana sareng pangaruh perlakuan anjeun. Diperkirakeun 225,000 kasus kanker payudara anyar lumangsung unggal taun di Amérika Serikat, sareng 94,500 reséptor éstrogén positip sareng dianggap calon kémoterapi. Biaya kémoterapi per pasien sakitar $ 15,000, sareng biaya tés DX oncotype tunggal $ 4,000. Ku alatan éta, lamun sakabeh penderita kalawan skor resiko low teu narima kémoterapi, AS bakal ngahemat 300 juta taunan $ 30.8 juta.
Dr Joseph Ragaz of the University of British Columbia in Vancouver and colleagues analyzed tumor samples from 196,967 estrogen receptor-positive breast cancer patients from the database of Genomic Health, the parent company that developed the test, and found that oncotype DX The proportion of patients with positive axillary lymph nodes (59%) with a 10-year recurrence risk score below 18 was greater than that of patients with negative lymph nodes (54%).
These data indicate that oncotype DX testing should be performed on all estrogen receptor-positive breast cancer patients, ethically and economically, regardless of their axillary lymph node status. However, this test can only be applied for testing in hospitals in the United States, Japan and other regions. For details, please visit the Global Oncologist Network.
NCCN nyarankeun tés genetik pikeun kanker payudara: ncotype DX
Konférénsi Taunan National Comprehensive Cancer Network (NCCN) ka-20 dilaksanakeun ti 12 nepi ka 14 Maret 2015 di Hollywood, Florida, AS. Numutkeun warta anu dikaluarkeun dina rapat éta, NCCN ngan ukur nandatanganan tés génom pikeun kanker payudara awal. Yimaitong dilaporkeun ieu.
Amy Cyr tina Pusat Kanker Siteman di Universitas Washington, nyarios dina konperénsi éta, nyarios yén oncotype DX, anu dikembangkeun ku Génomic Health, meunang ngahargaan ieu.
Tés ieu ngagaduhan dua fungsi. Salian nyadiakeun informasi prognostic, sidang ogé boga épék duga on hasil perlakuan; eta sabenerna bisa ngaduga respon penderita 'to kémoterapi.
Pondokna, Oncotype DX mangrupikeun alat ganda pikeun prognosis sareng prediksi.
Amy Cyr nyarios yén kamampuanna pikeun ngaduga réspon perawatan nyaéta "hal anu parantos ngajantenkeun dugi ka ayeuna." Anjeunna nambahan yén tés molekular séjén pikeun kanker payudara, kalebet MammaPrint, Prosigna, EndoPredict, sareng Indéks Kanker, henteu nunjukkeun bukti kamampuan duanana.
o ncotype DX cocog pikeun reséptor hormon awéwé postmenopausal positip sareng kanker payudara (ogé cocog pikeun HER2 négatip, pT1, PT2, atanapi pT3 sareng pN0 atanapi pN1).
Dr Cyr nyatakeun yén pasar tés ngembang nalika langkung seueur awéwé didiagnosis kanker payudara awal, indikasi pikeun produkna, ku saringan payudara.
Dr Cyr ngomong yén profil ekspresi molekular "salah sahiji prestasi paling seru" dina onkologi médis, sarta sababaraha tés pikeun kanker payudara geus mawa leuwih data.
"Nguji Oncotype DX mangrupikeun alat anu mangpaat," saur Michael Stone di Klinik Glealey di Universitas Colorado dina konperénsi éta, anu ngaramalkeun résiko kambuh lokal atanapi métastatik. "Seueur pasien kuring bungah yén aranjeunna henteu peryogi kémoterapi."
Dr Stone ngécéskeun yén kémoterapi umumna henteu dianjurkeun pikeun penderita skor kambuh low, tapi dianjurkeun pikeun penderita kalawan skor kambuh tinggi. Sanajan kitu, skor kambuh nyaéta wewengkon abu. Cenah anjeunna nyarankeun kémoterapi dumasar kana umur sareng kaséhatan pasien. Kémoterapi umumna dianjurkeun pikeun ngora, pasén ménopausal cageur kalayan skor kambuh panengah. Dr Cyr ngaku yén hese terang naha awéwé kalayan skor kambuh panengah kedah nampi kémoterapi.
Cyr negeskeun yén sanaos oncotype DX ngan ukur cocog pikeun penderita négatif titik limfa, éta ogé sigana mangpaat pikeun pasien anu positip titik limfa.
Manehna dicutat ulikan TransATAC, nu sasaran awéwé jeung kanker payudara postmenopausal dirawat kalayan anastrozole atanapi tamoxifen (J Clin Oncol. 2010; 28: 1829-1834). Oncotype DX dipaké pikeun nganalisis jaringan tumor pasien, sarta recurrences titik limfa négatip sarta titik limfa positif penderita diitung mungguh.
Dr Cyr ngomong yén "skor kambuh bisa dipaké salaku prediktor hasil jangka panjang dina duanana grup pasien". Eta sia noting yén éta boga nilai prediksi sarua pikeun penderita 3 atawa kurang titik limfa positif sarta 4 atawa leuwih titik limfa positif.
