Ngaphambi kokuqala kwendatshana, ukubukwa kokuqala kwesayensi.
Ukuqonda kweMSI-H, MSS, MSI-L
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I-MSS (ukuzinza kweMicroSatellite), ukuqina kwemicrosatellite, uma kuqhathaniswa neMSI, ayikho iMSI esobala.
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I-MSI-H (i-MicroSatellite Instability-High, i-high-frequency microsatellite instability), okungukuthi, imvamisa yokungazinzi kwe-microsatellite iphezulu, imvamisa iphakeme kune-30%;
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I-MSI-L (i-MicroSatellite Instability-Low, low frequency microsatellite instability), okungukuthi, imvamisa yokungazinzi kwe-microsatellite iphansi, imvamisa ingaphansi kwama-30%.
Friends who are concerned about the latest progress in cancer treatment know that the broad-spectrum anticancer drugs pembrolizumab and nivolumab have been approved for the treatment of all solid tumor patients with MSI-H (high microsatellite instability). Especially for colorectal patients, the detection rate of MSI-H is relatively high, so some cancer patients benefit from this type of treatment to prolong survival.
In the NCCN advanced or metastatic colorectal cancer treatment guidelines, the first-line immunotherapy options for patients with MSI-H and dMMR are nivolumab (nivolumab, Opdivo) or pembrolizumab (pembrolizumab, Keytruda), or nivolumab and ipilimumab (Iraq Combined therapy with Pitimab, Yervoy).
These recommendations are category 2B recommendations and apply to patients who are not suitable for a combination cytotoxic chemotherapy regimen. These immunotherapy drug options are also listed in the guidelines as second- and third-line treatment recommendations for dMMR / MSI-H patients.
Ezigulini ezinomdlavuza ongasetshenziswanga ongaphakeme endaweni noma we-metastatic colorectal othole isifo noma okungenani ongazweli emishanguzweni emibili yangaphambilini ye-chemotherapy, ama-95% awo angathola i-MSS esikhundleni seMSI-H. Ngakho-ke, ungazikhetha kanjani iziguli ezinomdlavuza we-MSS?
Recently, the IMblaze370 trial was published as a phase III open-label trial, and 363 patients with metastatic colorectal cancer whose genetic test results were MSS were randomly assigned to atezolizumab (atezolizumab) in combination with cobimetinib (cobititib) at 2: 1: 1 Ni, MEK targeted drug) group, attuzumab monotherapy group, regorafenib (regorafenib, multi-target kinase inhibitor) group. Patients with MSS colorectal cancer have historically not responded to immunotherapy.
Imiphumela yalolu cwaningo iqinisekisa futhi: Iziguli ezinomdlavuza we-MSS aziphenduli kahle kumuthi we-immunotherapy (PD-L1) atuzumab. Ukusinda okumaphakathi kwe-atezumab kuhlanganiswe neqembu le-cobtinib kwakuyizinyanga eziyi-8.87, uma kuqhathaniswa nezinyanga eziyi-7.10 eqenjini le-atezumab kuphela nezinyanga eziyi-8.51 eqenjini le-regofenib, kungakhathalekile ukuthi i-immunotherapy iyodwa noma ihlanganisiwe Ayikho inzuzo ebalulekile yokuphila.
Ngokusinda okungenamkhawulo kokuqhubeka, amaqembu amathathu okwelashwa ayeyizinyanga eziyi-1.91, izinyanga eziyi-1.94, nezinyanga eziyi-2.00, kungekho mehluko. Izinga lebanga elingu-3/4 lezehlakalo ezingezinhle lalingama-61% eqenjini lokwelashwa okuhlanganisiwe, ama-31% eqenjini le-atuzumab monotherapy, kanye ne-58% eqenjini le-regofenib.
"Le miphumela iveza umehluko oqinile webhayoloji phakathi kwe-MSS ne-MSI-H, futhi igcizelela izidingo zokwelashwa ezihlukile phakathi kwalezi zinhlobo zezifo ezimbili," kusho uDkt.Cathy Eng, ongumcwaningi e-University of Texas Anderson Cancer Center.
That is to say, the colorectal cancer patients whose MSS is found by genetic testing do not recommend the choice of immunotherapy, and use other methods instead. At present, the targets and targeted drugs that can be achieved by patients with colorectal cancer are:
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I-VEGF: Bevacizumab, i-Apsip
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VEGFR: ramucirumab, rigofinib, fruquintinib
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EGFR: cetuximab, panitumumab
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PD-1 / PDL-1: pembrolizumab, nivolumab
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I-CTLA-4: Ipilimumab
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IBRAF: IVelofini
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I-NTRK: Larotinib
Uma kutholakala okunye ukuguqulwa okuqondisiwe okuhambisanayo, kungakhonjwa ukwelashwa kwezidakamizwa okuqondisiwe okuhambisanayo.
Ezigulini zomdlavuza we-colorectal, ungakhetha isethi ejwayelekile ye-chemotherapy-FOLFOXIRI (fluorouracil + leucovorin + oxaliplatin + irinotecan), eyinhlanganisela yeqembu lama-cytotoxic chemotherapeutic agents, elungele bonke abantu.
After drug resistance, the genetic test result is not MSI-H. You can also choose multi-target kinase inhibitors regorafenib (regorafenib, Stivarga) and TAS-102 (trifluridine / tipiracil; Lonsurf).
Cetuximab is also a star drug often selected by colorectal patients, which is a drug that often appears in individualized treatment plans. Evaluation methods include: Is the tumor on the left or right? Does it contain KRAS / NRAS mutations? Before selecting cetuximab or panitumumab, the RAS gene mutation must be considered.
