The occurrence of cancer is ultimately due to genetic abnormalities, which makes the growth of mutant cells into an uncontrolled state, and cancer cells begin to divide and increase in value endlessly. In other words, cancer is a genetic disease. However, external factors such as high life pressure, low immunity, smoking and drinking, and irregular work and rest are the causes of gene errors.
Saraton bilan bog'liq omillar:
- yosh
- spirt
- Kanserogen (aflatoksin)
- Surunkali yallig'lanish
- Ovqatlanish odatlari
- gormon
- Immunosupressiv
- Infectious pathogens (hepatitis B virus, Helicobacter pylori)
- semizlik
- radiatsiya
- yoritish
- tamaki
After more than ten years of development, cancer genetic testing has become the immediate need of a large number of cancer patients. The test report guidance provided by tumor genetic testing perfectly fits the development concept of precision medicine, and has penetrated into all aspects of the diagnosis and treatment of cancer patients, so that patients can choose targeted drugs for precise treatment, avoid detours, and avoid unnecessary side effects bitter.
Jigar saratoni uchun mo'ljallangan terapiyaning hozirgi holati
Faqatgina jigar saratonining asosiy xususiyatlarini molekulyar darajada tasniflash orqali o'simtaning erta tashxisi va prognozi yanada oqilona va aniqroq bo'lishi mumkin va molekulyar maqsadli dorilar bemorlarni shaxsiylashtirish va to'g'ri davolash uchun ishlatilishi mumkin. Tasdiqlangan jigar saratoniga qarshi dorilar quyidagilardir:
1. Sorafenib (Sorafenib, Dorjemi)
Sorafenib - bu ikki ta'sirga ega bo'lgan maqsadli dori. Ulardan biri o'smaning o'sishi uchun zarur bo'lgan yangi qon tomirlarining oldini olish, shuningdek, saraton hujayralarining o'sishiga yordam beradigan oqsillarni yo'naltirishi mumkin. Asosiy maqsadlar VEGFR-1 / 2/3, RET, FLT3, BRAF va boshqalar.
Sorafenib can directly inhibit the proliferation of tumor cells, and can also act on VEGFR and PDGFR to inhibit the formation of new blood vessels and cut off the nutritional supply of tumor cells, thereby curbing tumor growth. Sorafenib is suitable for the first-line treatment of advanced liver cancer that cannot be operated or metastasized.
Sorafenib - kuniga ikki marta og'iz orqali qabul qilinadigan dori. Ushbu dori-darmonlarning eng ko'p uchraydigan yon ta'siriga palmalar yoki oyoqlarning charchashi, toshmalar, ishtahaning pasayishi, diareya, qon bosimi, qizarish, og'riq, shishish yoki pufakchalar kiradi. Jiddiy yon ta'sirlarga (kam uchraydigan) yurakka qon oqimi va oshqozon yoki ichak teshilishi bilan bog'liq muammolar kiradi.
2. regorafenib (Regofenib, Bayvango)
Regefenib o'simta angiogenezini to'sib qo'yishi mumkin, shuningdek saraton hujayralarining o'sishini oldini olish uchun saraton hujayralari yuzasida bir nechta oqsillarni yo'naltirishi mumkin. Bu VEGFR-1, 2, 3, TIE-2, BRAF, KIT, RET, PDGFR va FGFR ni inhibe qila oladigan og'zaki ko'p maqsadli kinaz inhibitori va uning tuzilishi sorafenibga o'xshaydi.
12 yil 2017 dekabrda Davlat oziq-ovqat va farmatsevtika idorasi (CFDA) ilgari sorafenib davolashini olgan gepatotsellulyar karsinoma (HCC) bo'lgan bemorlar uchun og'iz orqali qabul qilingan polikinaz inhibitori regorafenibni ma'qulladi. Uni ketma-ket 3 hafta davomida kuniga bir marta og'iz orqali oling, so'ngra bir hafta dam oling va keyin keyingi tsiklga o'ting.
Tez-tez uchraydigan nojo'ya ta'sirlarga charchoq, ishtahani yo'qotish, qo'l-oyoq sindromi (qo'l va oyoqlarning qizarishi va tirnash xususiyati), yuqori qon bosimi, isitma, infektsiya, vazn yo'qotish, diareya va qorin og'rig'i kiradi. Jiddiy yon ta'sirlar (kam uchraydigan) og'ir jigar shikastlanishi, og'ir qon ketish, yurak qon oqimi muammolari va oshqozon yoki ichakning teshilishini o'z ichiga olishi mumkin.
3. lenvatinib (Levatinib, Le Veyma)
Lenvatinib ko'p maqsadli dori. Levatinibning asosiy maqsadlari qon tomirlari endotelial o'sish retseptorlari VEGFR1-3, fibroblast o'sish faktor retseptorlari FGFR1-4, trombotsitlardan kelib chiqqan o'sish omillari retseptorlari PDGFR- a, cKit, Ret va boshq. Shishlarning o'sishi kerak bo'lgan yangi qon tomirlari paydo bo'lishining oldini olish bilan ishlang.
Shu yilning avgust oyida AQShning FDA tomonidan marketing uchun Eisai (Eisai) va Merck (MSD) lovastinib tomonidan tasdiqlangan. Leweima Xitoyda eng nufuzli o'simta diagnostikasi va davolash bo'yicha ko'rsatma bo'lgan CSCO jigar saratoni yo'riqnomasi (2018 versiyasi) tomonidan jarrohlik bo'lmagan rivojlangan jigar saratonini davolashning birinchi qatoriga kiritilgan.
Lenvatinib kuniga bir marta og'iz orqali yuboriladi. Ushbu dorilarning eng keng tarqalgan yon ta'siri palma oyoqli qizarish sindromi, toshma, ishtahani pasayishi, diareya, qon bosimi, qo'shma yoki mushak og'rig'i, vazn yo'qotish, qorin og'rig'i yoki pufakchalardir. Jiddiy yon ta'sirlarga (kamdan-kam hollarda) qon ketishi va siydikdagi oqsil yo'qotilishi kiradi.
4. Kabozantinib (Kabozantinib)
Cabozantinib (Cabozantinib) VEGFR, MET, NTRK, RET, AXL va KIT-ni nishonga oladigan AQShning Exelixis kompaniyasi tomonidan ishlab chiqilgan kichik molekulali ko'p maqsadli inhibitordir. XL184 ”.
29 yil 2018-mayda FDA Carbotinib-ni rivojlangan jigar saratonini ikkinchi darajali davolash uchun tasdiqladi. Tasdiqlash CELESTIAL III bosqich sinovlari asosida amalga oshiriladi. Sorafenib bilan davolashdan keyin rivojlangan gepatotsellulyar karsinomali bemorlar platsebo bilan taqqoslaganda umumiy omon qolish darajasini sezilarli darajada yaxshilashdi. Progressiyasiz omon qolish va ob'ektiv javob darajasi ham sezilarli darajada yaxshilandi.
5. nivolumab (Navumab, Opdivo®)
Opdivo helps the body’s immune system attack cancer cells by targeting the PD-1 / PD-L1 cell signaling pathway ( PD-1 and PD-L1 are proteins present in the body’s immune cells and certain cancer cells). In layman’s terms: By blocking the binding of PD-L1 protein to cancer cells, the camouflage of cancer cells is prevented, and the body’s own immune cells can recognize and eliminate cancer cells.
23 yil 2017 sentyabrda, Checkmate-040 klinik tadkikotiga ko'ra, AQSh FDA sorafenib (dojime) ni davolashda muvaffaqiyatsizlikka uchraganidan keyin jigar saratoni rivojlangan bemorlar uchun Opdivo-ni tasdiqladi: samaradorlik darajasi 20%, kasalliklarga qarshi kurash darajasi 64%.
6. larotrektinib (Larotinib, savdo nomi Vitrakvi)
Larotrektinib (tanish nomi LOXO-101 bo'lishi mumkin) FTR tomonidan 27 yil 2018 noyabrda NTRK gen termoyadroviy bilan mahalliy rivojlangan yoki metastatik qattiq o'smalari bo'lgan kattalar va pediatrik bemorlarni davolash uchun tasdiqlangan. Ushbu maqsadli dori nafaqat samarali, balki ko'plab turli xil o'smalar uchun samarali bo'lgan keng spektrli saratonga qarshi vositadir! Agar siz genetik tekshiruvdan o'tgan bo'lsangiz va NTRK1, NTRK2 yoki NTRK3 genlarining birlashishi mavjud bo'lsa, siz ushbu spektral saratonga qarshi preparatni tanlashingiz mumkin, bu esa o'sma turlarini ajratmaydi.
Jigar saratoni bilan kasallanganlar uchun genetik tekshiruvni qanday tanlash mumkin?
Experts from the Global Oncologist Network clearly told their friends that cancer genetic testing and clinical treatment analysis are a systematic project that requires strong laboratory support, high standard testing quality control and a high level of data analysis team. A good genetic test analysis can save the lives of cancer patients, and a patchwork analysis report will make patients lose the chance of treatment. At present, there are dozens of genetic testing institutions on the market, and patients must carefully select genetic testing companies to ensure the accuracy of the test results.
Quyidagi muharrirlar Qo'shma Shtatlarda ikkita aniq genetik tekshiruv texnologiyalarini joriy qiladilar!
1. Keris ko'p platformali molekulyar tahlil texnologiyasi
Qo'shma Shtatlardagi Careris Life Sciences kompaniyasining Careris Cancer Precision Therapy-ning ko'p platformali molekulyar tahlil texnologiyasi saraton kasallarini genetik tekshiruvi uchun maqbul tanlovdir, chunki u nafaqat DNK darajasidagi genetik tekshirishni, balki RNK va oqsil bilan bog'liq mo
lecular test. Boshqa barcha genetik tekshiruv kompaniyalari mavjud emas. Tahlil qilish texnikasi turlicha bo'lganligi sababli, ko'p platformali molekulyar tahlil texnologiyasi bemorning o'simta o'zgarishini yanada kengroq va har tomonlama tahlil qilishi mumkin va berilgan dori-darmonlarga oid ko'rsatmalar ko'proq vakolatli hisoblanadi.
Keruisning rasmiy ma'lumotlariga ko'ra, 1180 bemorni qamrab olgan katta qattiq o'sma tekshiruvi o'tkazildi, Keruis ko'p platformali molekulyar tahlilidan so'ng, bemorlar uzoq umr ko'rishdi 422 kun . Ko'rsatma ostida bo'lgan bemorlar uchun o'rtacha dori-darmonlarning soni - 3.2, yo'riqsiz bemorlar uchun dori-darmonlarning soni - 4.2. Ko'proq dori-darmonlar bemorlar ko'proq yon ta'sirga va keraksiz iqtisodiy yo'qotishlarga duchor bo'lishlari kerakligini anglatadi. Bemorlarning tasavvurida bo'lmagan narsa, maqsadli dori-darmonlarni tanlashga rahbarlik qilishdan tashqari, Kerrys shuningdek, qaysi kimyoviy terapevtik preparatlar bemorlarga mos kelishini tahlil qilishi mumkin. Darhaqiqat, ximioterapevtik dori-darmonlarni tanlash bo'yicha ko'rsatmalarga ehtiyoj bor va ularni davolash ko'rsatmalariga binoan nusxalash mumkin emas. Keris ko'p platformali molekulyar tahlillari bemorlarga eng to'g'ri va mos davolash usullarini taqdim etish uchun shunday keng qamrovli tahlil texnologiyasidir.
Ko'p platformali molekulyar tahlil mansablari deyarli barcha saraton turlarini qamrab olish uchun aniq davolashni ko'rsatmoqda
The most common targets of Keruis molecular analysis such as EGFR, ALK , ROS1 , MET , mTOR , BRAF , HER2 and so on, as well as immunotherapy targets PD-L1 , TMB and MSI-H , the test report can guide patients to choose targets Precise treatment of medicines helps patients avoid detours and avoid unnecessary side effects. Even if there is no mutation target and no opportunity to choose targeted drugs, Keruis can also guide the use of chemotherapy drugs and hormone drugs based on the analysis results, and also provide the opportunity to participate in the latest clinical trials in the United States.
2. FoundationOne®CDx
FoundationOne®CDx FDA tomonidan pan-tumor tipidagi birinchi yordamchi diagnostika mahsuloti sifatida tasdiqlangan. Tadqiqot vositasi sifatida u son-sanoqsiz ilmiy tadqiqot natijalarini ochishga yordam berdi va bu davrda katta hajmdagi ma'lumotlarni to'pladi. Joriy sinov qamrovi 324 gen va ikkita molekulyar markerni (MSI / TMB) o'z ichiga oladi, ular immun nazorat nuqtasi inhibitörlerinin samaradorligini bashorat qila oladi. U barcha qattiq o'smalarni (sarkomadan tashqari) qamrab oladi va FDA tomonidan tasdiqlangan 17 maqsadli terapiyaga to'g'ridan-to'g'ri mos kelishi mumkin!
In clinical evaluation of cancer genes, commonly used techniques include Sanger sequencing, mass spectrometry genotyping, fluorescence in situ hybridization ( FISH ) and immunohistochemical analysis ( IHC ). “Standard single marker detection” such as FISH , IHC and multi-gene hotspot detection ( hotspot panel ) can only find one or two types of clinically significant genetic abnormalities (such as only base substitutions). Studies have shown that the latest comprehensive next-generation sequencing technology for cancer comprehensive genetic testing can detect all four types of genetic abnormalities (base replacement; insertion and deletion; copy number variation and rearrangement), and is more accurate than traditional, standard tests.
