First immunotherapy has been approved for esophageal cancer treatment. Esophageal cancer is a common malignant tumor. The International Center for Cancer Research of the World Health Organization points out that esophageal cancer has now become the 6th highest incidence cancer in the world. China is also one of the regions with the highest incidence of kanker esophageal in the world. Some are squamous cell carcinoma.
The main treatments for esophageal cancer include surgery, radiotherapy, and chemotherapy. Squamous cell carcinoma is moderately sensitive to chemotherapy. Traditional chemotherapeutic drugs and radiation therapy have a high status in the treatment of esophageal squamous cell carcinoma. However, the prognosis of patients with advanced esophageal cancer after first-line chemotherapy is poor, and treatment options are limited. Taxane and irinotecan have been used after first-line treatment, but no overall survival benefit was seen in the Phase 3 study of chemotherapy.
In recent years, there have been many new attempts in the treatment of esophageal squamous cell carcinoma-molecular targeted drugs and immunotherapy, and great progress has been made.
Recently Merck announced:
The U.S. Food and Drug Administration (FDA) has approved PD-1 tumor immunotherapy Keytruda (creta, common name: pembrolizumab, pabolizumab) as a single drug therapy for PD-L1 (combined positive score [CPS] ≥ 10) and treatment of patients with recurrent locally advanced or metastatic esophageal squamous cell carcinoma (ESCC) who have progressed after one or more systemic therapies.”
Imunoterapi munggaran pikeun kanker esofagus
Persetujuan dumasar kana hasil kode tés anu dingaranan KEYNOTE-181 (NCT02564263).
KEYNOTE-181 mangrupikeun multicenter, acak, open-label, uji coba anu dikontrol aktip. Pasien 628 anu kanker lokal tiasa bulak balik atanapi metastatis esophageal dilebetkeun. Pasien anu maju ieu maju sateuacan sareng saatos perlakuan sistemik garis kahiji.
Pasién sacara acak ditugaskeun nampi palmumab 200 mg sakali unggal tilu minggu, atanapi regimen intravena kémoterapi handap: paclitaxel, docetaxel per, atanapi irinotecan.
Hasilna nunjukkeun yén dibandingkeun sareng kelompok kémoterapi, penderita tumor sareng PD-L1 CPS ≥ 10 nunjukkeun paningkatan dina OS di pasién anu sacara acak dirawat kalayan Keytruda. Tingkat réspon keseluruhan pembrolizumab ogé langkung luhur tibatan kémoterapi. Data ieu nunjukkeun yén pembrolizumab kedah dianggap standar perawatan anu anyar dina pasién anu gaduh PD-L1 CPS 10 atanapi langkung luhur dina pengobatan garis kadua.
Efek samping anu mungkin: radang paru-paru, colitis, hépatitis, endocrine disease, nephritis and renal dysfunction, severe skin reactions, solid organ transplant rejection and complications of allogeneic hematopoietic stem cell transplantation (HSCT). Depending on the severity of the adverse reaction, pembrolizumab should be discontinued or discontinued, and corticosteroid therapy should be given when appropriate.
Pilihan pangobatan sanésna pikeun kanker esofagus
Kémoterapi dina kanker esofagus
Pikeun pengobatan kanker esofagus, kémoterapi tiasa dianggo dina waktos anu sanés.
Kémoterapi Adjuvant: kémoterapi saatos dioperasi. Tujuanana nyaéta pikeun maéhan sél kanker naon waé anu tiasa ditingalkeun dina prosedur, sabab éta leutik teuing pikeun ditingali ku panon taranjang, janten teu tiasa dipiceun ku operasi. Éta ogé dimungkinkeun pikeun sél kanker kabur tina tumor utama sareng nyandak akar di bagian sanés awak.
Kémoterapi neoadjuvan: Kanggo kangker tangtu, kémoterapi (biasana digabungkeun sareng terapi radiasi) dirumuskeun sateuacan operasi pikeun nyusut tumor sareng ngajantenkeun operasi langkung gampang dibersihkeun.
Kémoterapi pikeun kanker maju: Kanggo kangker esophageal anu sumebar ka organ-organ sanés, sapertos ati, kémoterapi ogé tiasa dianggo pikeun ngaleutikan tumor sareng ngagentos gejala. Sanaos henteu gampang ngubaran kanker, éta sering tiasa ngabantosan jalma hirup langkung lami.
Obat-obatan umum anu dianggo dina pangubaran kanker esofagus
- Carboplatin sareng paclitaxel (tiasa dianggo dina kombinasi sareng radioterapi)
- Cisplatin sareng 5-fluorouracil (5-FU) (biasana digabungkeun sareng terapi radiasi)
- ECF: epirubicin, cisplatin, sareng 5-FU (khususna tumor dina simpang gastroesophagus)
- DCF: docetaxel, cisplatin, sareng 5-FU
- Cisplatin sareng capecitabine
- oxaliplatin sareng 5-FU atanapi capecitabine
- irinotecan
Terapi sasaran dina kanker esofagus
Ramucirumab (Cyramza)
Rumizumab is a humanized monoclonal antibody that specifically blocks vascular endothelial growth factor receptor 2 (VEGFR2) and downstream angiogenesis-related pathways. The currently approved indication is monotherapy or in combination with paclitaxel for advanced gastric cancer / gastroesophageal junction adénokarsinoma that progresses during or after chemotherapy with or without fluorouracil or platinum. In addition, it has been approved for the treatment of kanker paru sél non-leutik and metastatic colorectal cancer.
Trastuzumab (Trastuzumab, Herceptin)
Trastuzumab, antibodi monoclonal ngalawan Her2, nyegah faktor pertumbuhan épidermal manusa tina ngalampirkeun ka Her2 ku cara ngantelkeun dirina ka Her2, sahingga ngahambat pertumbuhan sél kanker. Herceptin ogé tiasa ngarangsang sél imun awak nyalira pikeun ngancurkeun sél kanker.
Karsinoma sél skuamosa ésofagus, salaku organ anu unik pisan dina tumor saluran pencernaan urang luhur, langsung mangaruhan tuang. Salaku tambahan, karsinoma sél skuamosa langkung invasif sareng gampang résiko halangan, kabocoran sareng perdarahan. Kusabab kitu, dina prosés pangobatan karsinoma sél skuamosa, sanaos kami bakal nganggo sababaraha metode pangobatan narkoba tradisional sareng tumut kana sababaraha usaha anyar, urang kedah ngalaksanakeun konsép manajemén kursus-kursus salami prosés pangobatan. Kalayan kamajuan ubar, bakal aya langkung seueur téknologi pikeun merangan kanker esofagus, sapertos radioterapi proton, imunoterapi sélulér, jst. Sadayana kedah yakin.
