In recent years, the incidence of gynecological tumors has increased year by year, making the terms cervical cancer and ovarian cancer no longer unfamiliar to us. Cervical cancer is the most common gynecological malignant tumor. In addition, it is also the three major gynecological malignant tumors along with ovarian cancer and endometrial cancer. Gynecological tumor are harmful to women. Early detection and early diagnosis can often help treatment and improve the survival time of patients.
Kamajuan gancang tina targét sasaran sareng immunotherapy parantos ningkat pisan kaayaan pasién kanker gynecological. Redaktorna bakal ningali tumerap gynecological disatujuan ubar terapi sareng ubar imunoterapi kanggo anjeun.
Terapi sasaran kanker gynecologic
kanker indung Terapi sasaran
Inhibitor ②PARP
Olaparib (Olapani, Lynparza), rucaparib (Rucapa, Rubraca) sareng niraparib (Nilapani, Zejula)
kanker cervical obat terapi sasaran
Bevacizumab (Bevacizumab, Avastin)
Terapi sasaran kanker endometrial
Anggo hormon atanapi ubar pamblokiran hormon pikeun merangan kanker. Obat pangobatan diantarana:
Ø Progesteron: medroxyprogesterone asétat sareng megestrol asétat
Ø Tamoxifen
Ø Luteinizing hormon-ngaleupaskeun agonists hormon: Goserelin (Norred®) sareng Leuprolide (Leuprolide®). Obat ieu disuntik unggal 1-3 bulan
Inhibitor Ø Aromatase: letrozole (Fronon®), anastrozole (Reninide®), exemestane (Anoxin®)
Rahim sarkoma Terapi sasaran
Ø Panzopinab (Votrient) mangrupikeun terapi anu ditujukeun anu tiasa dianggo pikeun ngubaran leiomyosarcoma anu sumebar atanapi kambuh saatos dirawat.
Ø Olaratumab (Lartruvo) combined with the chemotherapy drug doxorubicin to treat soft tissue sarcoma. It can be used to treat uterine sarcoma that does not respond to other treatments.
Imunoterapi tumor gynecological
Immunotherapy is a relatively new concept, not widely used like surgery, chemotherapy and radiotherapy. However, it has made great progress in improving the survival of patients with advanced lung cancer, melanoma, kidney cancer, Limfoma Hodgkin and so on. Only one drug is approved for gynecological tumor immunotherapy! But for two different situations, the star drug is pembrolizumab (Pembrolizumab, Keytruda).
Pembrolizumab (Keytruda) targets PD-1, which is a protein on T cells and usually helps prevent these cells from attacking other cells in the body. By blocking PD-1, these drugs can enhance the immune response to cancer cells, causing some tumors to shrink or slow their growth.
Onkologi Gynecologic MSI-H
On May 24, 2017, the US FDA approved the PD-1 inhibitor pembrolizumab (Pembrolizumab, Keytruda) to treat solid tumor patients with microsatellite highly unstable (MSI-H) / mismatch repair defects (dMMR) The tumor types cover 15 different malignant tumors including liver cancer, kangker colorectal, lung cancer and cervical cancer, including various gynecological tumors. (Note: If MSI-H is detected, it does not matter whether it is early or late, you can benefit)
Kangker serviks positip PD-L1
Dina Juni taun ieu, Amérika Serikat FDA ngagancangan persetujuan pembrolizumab (Keytruda) kanggo pangobatan penderita kanker serviks PD-L1-positip anu maju anu panyakitna maju nalika atanapi saatos kémoterapi. Persetujuan nangtoskeun PD-L1 positip salaku kanker serviks kalayan skor positip gabungan (CPS) ≥1 anu ngalirkeun hasil tés anu disatujuan ku FDA. Peryogi disebatkeun yén, dugi ka ayeuna, Keytruda ogé terapi anti PD-1 anu munggaran sareng ngan ukur disatujuan pikeun kanker serviks maju.
Obat imunoterapi dipasihkeun unggal 3 minggu sareng dipasihkeun ku infus intravena (IV). Ayeuna didaptarkeun di Cina sareng lebet asuransi médis. Pasien domestik tiasa angkat ka rumah sakit lokal pikeun konsultasi, atanapi nyauran Jaringan Onkologi Global (400-626-9916) pikeun inpormasi lengkep ngeunaan pangobatan pembrolizumab kanker serviks.
Persetujuan ieu dumasar kana data ti 98 pasién kangker serviks kambuh atanapi metastatik dina uji coba Phase II KEYNOTE-158. Panilitian global, terbuka, non-acak, sababaraha, sareng multicenter ieu ngaevaluasi pembrolizumab dina pengobatan pasién anu gaduh sababaraha jinis tumor padet anu maju, sareng pasien ieu parantos maju dina protokol pangobatan standar.
Waktos tindak lanjut median nyaéta 11.7 bulan (kisaran 0.6-22.7). Tingkat épéktip total (ORR) tina 77 pasien positip PD-L1 (CPS ≥ 1) nyaéta 14.3%. Pasién ieu sadayana pasién panyakit metastatik anu nampi line 1 garis kémoterapi. ORR ngagaduhan tingkat réspon lengkep 2.6% sareng tingkat réspon parsial 11.7%. Durasi réspon médi henteu ngahontal (kisaran 4.1 bulan ka 18.6 + bulan), sareng 91% réspondén ngagaduhan durasi réspon 6 bulan atanapi langkung.
Pikeun penderita éksprési PD-L1 CPS <1, teu aya réspon anu dilaporkeun.
"Sanaos parantos aya seueur kamajuan dina kanker gynecological, penderita anu diubaran sateuacana sareng kanker serviks anu maju masih kakurangan pilihan pangobatan anyar," saur Bradley Monk, ahli onkologi Arizona, diréktur médis Program onkologi Panilitian Gynecology Amérika sareng profésor péstopetrik sareng gynecology. Dina hiji pernyataan,
"Persetujuan Keytruda dina indikasi ieu penting warta-salaku ahli onkologi, pikaresepeun ningali pilihan anu diperyogikeun pikeun pasién ieu," tambah Monk.
The histological classification of 77 patients with treatment response were: 92% squamous cell carcinoma, 6% adénokarsinoma, and 1% adenosquamous carcinoma. 95% of patients have metastases, and 20% are relapsed. The PD-L1 IHC 22C3 pharmDx kit was used to determine the PD-L1 status.
Pasén nampi 200 mg pembrolizumab unggal 3 minggu dugi ka 24 bulan atanapi mundur tina pangobatan sacara spontan, atanapi konfirmasi radiologis tina kamajuan panyakit, atanapi karacunan anu henteu tiasa ditampi atanapi dumasar kana kaputusan panyidik. Pasien anu stabil sacara klinis kalayan perkembangan radiologis tiasa neraskeun pangubaran dugi ka kamajuan dikonfirmasi ku Imaging salajengna. Kamajuan Tumor dievaluasi unggal 9 minggu dina taun kahiji, sareng unggal 12 minggu saatosna.
Anu paling umum (-10% pasien) ngalaporkeun kajadian ngarugikeun (AEs) dina sadaya tingkatan kalebet kacapean (43%), nyeri (22%), muriang (19%), edema periferal (15%), sareng nyeri musculoskeletal (27 %)), Diare / colitis (23%), nyeri beuteung (22%), lieur (19%), utah (19%), kabebeng (14%), turun napsu (21%), perdarahan (19%), UTI (18%), inféksi (16%), baruntus (17%), hypothyroidism (11%), nyeri sirah (11%) sareng dispnea (10%).
Kelas anu paling umum 3/4 AEs kalebet UTI (6%), perdarahan (5%), nyeri musculoskeletal (5%), kacapean (5%), inféksi (4.1%), nyeri beuteung (3.1%), nyeri (2 )%), Edema periferal (2%), baruntus (2%), nyeri sirah (2%), diare / colitis (2%), utah (1%), dispnea (1%) sareng muriang (1%)).
Henteu panerapan pangobatan anu aya hubunganana sareng AE lumangsung dina 8% pasién. AEs parna lumangsung dina 39% pasien, anu paling umum nyaéta anémia (7%), fistula (4.1%), perdarahan (4.1%), sareng inféksi (kacuali UTI; 4.1%).
The approval of gynecological tumor immunotherapy will undoubtedly add one life-saving straw, one more treatment option, and one more hope for survival for patients who are resistant to chemotherapy, hormone therapy, and targeted therapy. From the above, we see that gynecological tumor immunotherapy is not suitable for all patients. Before treatment, two tumor markers must be tested: one is MSI and the other is PD-L1. Patients who meet the standards are more suitable.
Although pembrolizumab is already marketed in China, some patients may feel that the price of this drug is relatively expensive. If you want to save the cost of genetic testing, blindly test pembrolizumab. This method is also not bad, but it is usually If this is not recommended, pembrolizumab treatment itself will cause some side effects and may have some negative effects on the patient’s treatment.
Upami manpaatna henteu tiasa dijamin, éta tiasa langkung beurat sareng mangaruhan kondisina.
For cancer friends whose survival period is not optimistic, the doctor ‘s estimate may be less than 6 months, and the economic conditions are not good. In this case, if you take half a month to wait for an uncertain result, it seems too risky, so It is better to conduct a blind test directly, use the money on the blade, and select the most probable one to try, commonly known as “Chuangyun”.
Of course, the blind test also has its own shortcomings. Before there is no genetic test, the medication basically depends on “guessing”, and the effect is basically relying on “praying”.
