Itimu yoMhlangano Wonyaka ka-2019 we-NCCN uwukwandisa ukuhlolwa kwe-biomarker ukuze kuqondiswe ukwelashwa okunembile komdlavuza, kanye nezinguquko ezintsha kuzinkombandlela zomdlavuza we-colorectal (CRC). Izinga lokusinda leminyaka engu-5 lomdlavuza we-colorectal liyi-11% kuphela, futhi uhlelo olubuyekeziwe lokwelapha lwezinkombandlela zokwelashwa ze-NCCN kulindeleke ukuthi luthuthukise ukusinda.
Njengamanje, i-FDA igunyaze izinhlobonhlobo zemithi yokwelapha umdlavuza we-colorectal, ezine kuphela ezihlobene nokuguqulwa kofuzo, futhi ama-biomarker adinga ukuhlolwa. Ukubuyekezwa kuka-2019 kwemihlahlandlela yokwelapha ye-NCCN ye umdlavuza colorectal yengeza izindlela zokwelapha ezisuselwe ekutholweni kwama-biomarker, okuhlanganisa i-EGFR, i-MSI-H / dMMR, i-BRAF + MEK, kanye nezinhloso zokuhlanganisa ze-NTRK.
Ake sibheke izibuyekezo ezithile ezibalulekile nedatha esindayo:
mFOLFXIRI + EGFR
Ngokusekelwe esivivinyweni sesigaba sesi-II se-VOLFI, i-mFOLFOXIRI (i-fluorouracil + leucovorin + oxaliplatin + irinotecan) kanye ne-panitumumab ye-EGFR inhibitor, ezigulini ezinomdlavuza we-metastatic colorectal onganqandeki, lezi Ukuhlolwa kofuzo kwesiguli kufanele kube: KRAS / NRAS uhlobo lwasendle / BR kwesokunxele kuphela isisu ukhona.
Esivivinyweni se-VOLFI, iziguli ezingama-96 ezinomdlavuza we-RAS wasendle we-metastatic colorectal zabiwa ngokungahleliwe ku-mFOLFOXIRI kuhlanganiswe ne-panitumumab (n = 63) noma i-mFOLFOXIRI kuphela (n = 33) ku-2: 1 ratio. Iqembu elihlanganisiwe le-panitumumab lalinezinga elisebenzayo le-85.7%, kanti i-mFOLFOXIRI iyodwa yayingu-54.5%.
I-MSI / MMR
Nakuba ukungasebenzi kahle kwe-microsatellite (MSI) kanye nokulungiswa kokungafani (MMR) ngokuvamile akulona ifa, lokhu akubandakanyi amathumba abangelwe i-Lynch syndrome, etholakala ku-1% womdlavuza we-colorectal we-BRAF V600E Okhona. Uma unomlando womndeni oqinile, kufanele wenze ukuhlolwa kofuzo.
Imihlahlandlela yakamuva ikhombisa ukusetshenziswa kwe-immunohistochemistry ukuthola izakhi zofuzo ezine eziguqukayo ezikhona kuLynch syndrome: MLH1, MSH2, MSH6 ne-PMS2.
Eziqondisweni ze-NCCN eziphambili noma ze-metastatic colorectal treatment, umugqa wokuqala immunotherapy izinketho zeziguli ezine-MSI-H ne-dMMR i-nivolumab (nivolumab, Opdivo) noma i-pembrolizumab (pembrolizumab, Keytruda), noma i-nivolumab ne-ipilimumab (Ukwelashwa Okuhlanganisiwe kwe-Iraq ne-Pitimab, Yervoy). Lezi zincomo ziyizincomo zesigaba 2B futhi zisebenza ezigulini ezingafaneleki inhlanganisela yemithi ye-cytotoxic chemotherapy. Lezi zinketho zemishanguzo ye-immunotherapy nazo zibaliwe eziqondisweni njengezincomo zokwelapha zomugqa wesibili nowesithathu weziguli ze-dMMR/MSI-H.
Okwe-NTRK
I-Larotrectinib (i-Larotinib, i-Vitrakvi) manje iyindlela yokwelashwa komugqa wesibili ezigulini ezinomdlavuza we-metastatic colorectal. Ukuhlolwa kofuzo lwesiguli kudinga ukuthola ukuxubana okuhle kofuzo lwe-NTRK. Imininingwane yocwaningo lomtholampilo yomuthi ishicilelwe ku-2018 New England Journal of Medicine.
Ngakho-ke, ngoNovemba 2018, i-FDA yavuma ukusetshenziswa kwe-larotinib ekwelapheni iziguli ezindala nezingane ezinamathumba aqinile avuvukile. Inqobo nje uma isiguli sine-NTRK gene fusion futhi kungekho ukushintsha kokumelana okutholakele okwaziwayo, lesi sifo sine-metastasised and resection yokuhlinzwa ingaholela engozini enkulu yokufa, alukho uhlelo lokwelashwa okunye olwanelisayo noma inqubekela phambili yenzekile ngemuva kokwelashwa.
Kulesi silingo esigcwele somdlavuza, iziguli ezine ezinomdlavuza we-metastatic colorectal zabhaliswa, futhi isiguli se-4 siphendule kahle.
Okwe-BRAF ne-MEK
Kulokhu kubuyekezwa kwemihlahlandlela ye-NCCN, kungezwe izindlela zokwelapha zomugqa wesibili zale biomarker, okungukuthi:
(1) dabrafenib (dalafinib, Tafinlar; BRAF) + trametinib (trametinib, Mekinist; MEK), kuhlanganiswe ne-cetuximab noma i-panitumumab (i-EGFR monoclonal antibody);
(2) I-Encorafenib (i-Braftovi; i-BRAF) kanye ibinimetinib (Mektovi; MEK) kanye ne-cetuximab noma i-panitumumab.
The encorafenib / Imithi yokwelapha ye-binimetinib kanye ne-EGFR inhibitor isekelwa idatha evela ekwethulweni kokuhlolwa kwesigaba III se-BEACON. Ezigulini ezingama-30 ezinomdlavuza we-metastatic colorectal nokuguqulwa kwe-BRAF V600E, ukwelashwa okuhlanganisiwe nge-encolafenib / binimetinib kanye ne-cetuximab kwalandelwa izinyanga eziyi-18.2, okulinganiselwa ukuthi kwasinda izinyanga eziyi-15.3. Ngokwemiphumela yokuhlola yendawo, okuhlanganisiwe Izinga elisebenzayo lokwelashwa lalingama-48%, futhi iziguli ezi-3 zithole ukuxolelwa okuphelele.
Lokhu kubuyekezwa kwemihlahlandlela ye-NCCN yomdlavuza we-colorectal kuphinde kuqinisekisa indima ebalulekile yokuhlolwa kofuzo ekwelapheni umdlavuza. Ngenketho eyodwa yokwelashwa, kunethemba elengeziwe! Abangane bomdlavuza kufanele bayeke ukungabaza isimo sokuhlolwa kofuzo. Izindaba ezinhle ukuthi miningi kakhulu imithi ehlosiwe egunyaziwe yomdlavuza we-colorectal. Ngicela ukwazise okusezandleni zakho.
