In the past two years, with the deepening of research related to targeting and immunotherapy and genotyping, more and more drugs with good effects and fewer side effects have become new options for individualized treatment and comprehensive treatment of colorectal cancer patients. Treatment strategies have also advanced from third-line or second-line treatment of colorectal cancer to first-line treatment. The overall treatment expectation of colorectal cancer patients has been greatly improved.
- umdlavuza Colorectal must be genetically tested before use. If you can’t obtain tissue sections, you can choose blood for testing. At this time, you mainly look at the NRAS, KRAS and BRAF genes.
- Ukukhethwa kwemithi yomdlavuza obala ngokweqile imvamisa kuyinhlanganisela yezidakamizwa eziningi kanye nezidakamizwa ze-chemotherapy ezihlangene nezidakamizwa eziqondisiwe.
- Ngemuva kokwelashwa okujwayelekile komdlavuza obala ngokobulili, kusenemithi eminingi ehlosiwe engazanywa. Noma umphumela wokwelashwa ungafani nolayini wokuqala nolayini wesibili, usengaletha izinzuzo zokusinda.
- Ngemuva kokuthi ukwelashwa kolayini wokuqala nolayini wesibili kungazweli, kunconywa ukuthi uphinde wenze ukuhlolwa kofuzo. Uma kutholakala ukuguqulwa kokuhlanganiswa kwe-MSI-H noma i-NTRK, i-immunotherapy noma i-larotinib ingakhethwa.
Ngakho-ke, iziguli ezinomdlavuza wamathumbu kufanele zinqume kanjani uhlelo lwemithi?
Ngemuva kokutholakala komdlavuza obala ngokombala, odokotela bazoncoma ukuthi isiguli ngasinye esinomdlavuza we-metastatic colorectal (mCRC) sihlolwe izakhi zofuzo ukuthola iqembu elincane lalesi sifo, ngoba lolu lwazi lungaqagela ukwelashwa. Izakhi zofuzo ezidinga ukuhlolwa yilezi:
I-MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK
Izidakamizwa ezihlosiwe ezihlobene:
I-MSI (H) -pembrolizumab; nivolumab
I-BRAF (+) - iDalafenib, iTrimetinib; I-Verofinil
I-RAS (KRAS- / NRAS -) - i-cetuximab; i-panitumumab (elwa ne-EGFR)
I-HER2 (+) - trastuzumab
I-NTRK (+) - Larotinib
Izidakamizwa ezibhekiswe ku-anti-angiogenesis
I-VEGF: i-bevacizumab, i-abercept
I-VEGFR: i-ramucirumab, i-rigofinib, i-fruquintinib
Chemotherapy drugs include:5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil)
Ukubona izinhlobo eziningi kangaka zezidakamizwa, ukuthi ungakhetha kanjani nokuthi ungahlangana kanjani nomphumela omuhle kakhulu? UVicki uzokunikeza uhlu oluningiliziwe ukubona ukuthi ungowasiphi isigaba, vele uhambe uyothola isihlalo!
Ukwelashwa komugqa wokuqala kumdlavuza obomvu
Before taking the medicine, the doctor will definitely look at the results of the genetic test. If the genetic test report shows that there are no mutations in the RAS or BRAF genes, chemotherapy and anti-EGFR targeted drugs are recommended. It is generally recommended that anti-EGFR targeted drugs must be used on the first line, because the effect will be greatly reduced if used in the back line.
Uma umphumela walokhu kwelashwa ungemuhle, shintshela ekuhlanganisweni kwe-chemotherapy kanye ne-anti-angiogenesis inhibitors, i-bevacizumab isetshenziswa kakhulu.
Uma isiguli singazifanele izidakamizwa ezibhekiswe ku-anti-EGFR, bese usebenzisa ngqo i-chemotherapy ehlanganiswe nama-anti-angiogenesis inhibitors.
Lapho kungekho nolunye lwalezi zinhlobo ezingenhla olusebenzayo, kuzolungiswa enye i-chemotherapy regimen kanye ne-anti-angiogenesis inhibitor.
I-chemistry yomdlavuza obala ngokweqile imvamisa ikhetha ukuhlanganiswa kwezidakamizwa eziningi. Odokotela bahlangana futhi bahambisane ngokuya ngesimo sangempela seziguli. Okuvame ukusetshenziswa yilena:
- I-FOLFOX (i-fluorouracil, i-calcium folinate, i-oxaliplatin) noma i-FOLFIRI (i-fluorouracil, i-calcium folinate, i-irinotecan), noma ihlanganiswe ne-cetuximab (enconyelwe iziguli ezinohlobo lwe-KRAS- / NRAS-BRAF gene)
- CapeOx (capecitabine, oxaliplatin), FOLFOX or FOLFIRI, or combined with bevacizumab
- I-FOLFIRINOX (i-fluorouracil, i-calcium folinate, i-irinotecan, i-oxaliplatin)
Ukwelashwa kolayini wesibili
Ekwelashweni kolayini wesibili, sinezithiyo ezihlukile zokulwa nama-angiogenesis esingakhetha kuzo.
Kulayini wokuqala, sizosebenzisa i-bevacizumab ehlangene ne-chemotherapy. Uma ukwelashwa kungasebenzi, singashintsha i-chemotherapy regimen bese siqhubeka nokusebenzisa i-bevacizumab. Vele, kungenzeka futhi ukuthi ushintshe omunye umuthi ohlosiwe ngasikhathi sinye nohlobo lwemithi yokwelashwa ngamakhemikhali, ukushintshela ku-abercept, noma i-ramucirumab.
Ukwelashwa komugqa wesithathu nokwasemuva
Ukukhethwa kwezidakamizwa zomugqa wokuqala nezesibili zomdlavuza we-colorectal imvamisa kuyizidakamizwa ezijwayelekile zamakhemikhali kanye nezidakamizwa ezihlosiwe.
Starting from the third-line treatment is a back-line treatment. The back-line treatment plan can use some oral chemotherapeutics that have just come out, including TAS-102, as well as S-1 (tegio), rifafine, or some immunotherapy, such as pembrolizumab (MSI-H).
I-TAS-102
I-TAS-102, isidakamizwa somlomo se-chemotherapeutic, umkhiqizo wenhlanganisela we-trifluridine (i-nucleoside metabolism inhibitor) ne-tipiracil (i-thymidine phosphorylase inhibitor). Umuthi ufuna kakhulu, futhi njalo emavikini amane kuyindlela yokwelashwa. Thatha umuthi kusukela ngoMsombuluko kuya kuLwesihlanu esontweni lokuqala nasevikini lesibili, umise umuthi ngoMgqibelo nangeSonto, umise umuthi ngesonto lesithathu nangesine, bese uqala umjikelezo olandelayo. Ngalesi sikhathi, uma isiguli singenakho ukuguqulwa kwe-RAS, singasetshenziswa ngokuhlangana ne-panitumumab. Isisekelo salesi simiso ukuthi isiguli asikaze sisebenzise i-panitumumab phambilini.
UTigio
I-S-1 (Teggio) nayo iyisidakamizwa somlomo somlomo, esingokwesigaba esivela ku-fluorouracil. Amaphilisi we-Oral Teggio 80 mg / m2 / ngosuku, ama-2 ngosuku, kanye ngemuva kokudla kwasekuseni nangemva kwesidlo sakusihlwa, ngisho nezikhathi eziyi-14 Izinsuku, khipha umuthi izinsuku eziyi-7;
Regafini
URegefini umuthi ohlosiwe we-anti-angiogenesis womlomo. Ithebhulethi elikhanyayo elifana ne-oval elibomvana. IRegofenib inomphumela omuhle ekwelashweni komdlavuza wamathumbu futhi ingakhulisa kakhulu ukusinda okuphelele kweziguli ezinomdlavuza wamathumbu. Umthamo onconyiwe: Umthamo onconyiwe ngu-160 mg (amaphilisi ama-4, ngalinye liqukethe ama-40 mg we-rifafenib), kanye ngosuku, ngomlomo ezinsukwini zokuqala ezingama-21 zenkambo ngayinye yokwelashwa, nezinsuku ezingama-28 njengenkambo yokwelashwa.
Ukwelashwa komzimba
If the patient finds MSI-H through genetic testing, immunotherapy may be considered. You can consider pembrolizumab only if you want to use a single drug. For patients with MSI-H colorectal cancer, pembrolizumab has a 50% chance of shrinking the isisu.
Ngokungeziwe ku-immunotherapy ye-single-agent, ungacabanga nokuhlanganisa i-immunotherapy ehlukile, njengokusebenzisa inhlanganisela yeNivolumab (nivolumab) ne-Ipilimumab (Ipilimumab), ithuba lokunciphisa isimila ngu-55%.
I-Pembrolizumab iyodwa, i-nivolumab ehlangene ne-ipilimumab ivunyelwe yi-FDA ukwelashwa okulandelanayo kweziguli ezinomdlavuza onemibala ene-MSI-H. Idatha ivuthwe ngokuqhathaniswa.
I-Larotinib
I-Larotinib iyi-inhibitor enamandla, yomlomo, ekhethiwe ye-tropomyosin kinase inhibitor esebenza ku-TRKB, TRKB, naku-TRKC kinases. Yavunywa ngoNovemba 2018 yomdlavuza ongafinyelela kwayi-17, kufaka phakathi i-Colorectal Cancer, kepha ukuguqulwa kokuhlangana kwe-NTRK1 / 2/3 gene kudinga ukutholwa, ngakho-ke iLarotinib nayo iyindlela yokwelashwa okulandelayo. Iziguli zabantu abadala zithatha i-100 mg ngomlomo kabili ngosuku.
Umphumela wokwelashwa komugqa ongemuva imvamisa awubonakali njengokulashwa komugqa wokuqala nolayini wesibili, kepha futhi kungandisa isikhathi sokusinda. Ngakho-ke, uma singakhetha izinketho zokwelashwa ezahlukahlukene zangemuva, kusetshenziswa izidakamizwa ezahlukahlukene ngokuzungeza, futhi impilo nayo inganwetshwa.
Yini okufanele ngiyenze uma ngingakubekezeleli ukwelashwa ngamakhemikhali?
Ngaphezu kwalokho, kufanele kubhekwe izici zokubikezela zeziguli ezinomdlavuza obala kakhulu, okungukuthi, izimo ezizothinta umphumela wokwelashwa. Izici eziyinhloko yilezi: i-metastasis ekude yamaseli womdlavuza, indawo yesimila sokuqala, isici
Ukushintshwa kwezakhi zofuzo, impendulo nesikhathi semithi yangaphambilini, Izinga lobuthakathaka besiguli luzothinta umphumela wokwelashwa nokukhethwa kohlelo lwezidakamizwa.
Ikakhulukazi ezigulini ezibuthakathaka futhi ezingakwazi ukuthwala imiphumela emibi yokwelashwa ngamakhemikhali, ukuthi ungakhetha kanjani uhlelo lwemithi?
Izincomo ezijwayelekile zingokulandelayo:
①Single targeted drug therapy, if there is no RAS gene mutation, you can choose cetuximab or panitumumab
②Anti-angiogenesis inhibitors ayinakusetshenziswa yodwa, futhi kufanele isetshenziswe kanye ne-chemotherapy, ukuze ukhethe inhlanganisela yemithi yokwelapha ngamakhemikhali enemiphumela emibi emincane kanye nokwelashwa okuqondisiwe, njenge-irinotecan + bevacizumab (noma i-cetuximab)
③Single drug immunotherapy, njengeMSI-H, khetha i-pembrolizumab
Ukubuyekezwa kokhiye
- Umdlavuza ocacile kufanele uhlolwe ngokofuzo ngaphambi kokusetshenziswa. Uma ungeke ukwazi ukuthola izingxenye zezicubu, ungakhetha igazi ukuze lihlolwe. Ngalesi sikhathi, ubheka ikakhulukazi izinhlobo zofuzo ze-NRAS, KRAS ne-BRAF.
- Ukukhethwa kwemithi yomdlavuza obala ngokweqile imvamisa kuyinhlanganisela yezidakamizwa eziningi kanye nezidakamizwa ze-chemotherapy ezihlangene nezidakamizwa eziqondisiwe.
- Ngemuva kokwelashwa okujwayelekile komdlavuza obala ngokobulili, kusenemithi eminingi ehlosiwe engazanywa. Noma umphumela wokwelashwa ungafani nolayini wokuqala nolayini wesibili, usengaletha izinzuzo zokusinda.
- Ngemuva kokuthi ukwelashwa kolayini wokuqala nolayini wesibili kungazweli, kunconywa ukuthi uphinde wenze ukuhlolwa kofuzo. Uma kutholakala ukuguqulwa kokuhlanganiswa kwe-MSI-H noma i-NTRK, i-immunotherapy noma i-larotinib ingakhethwa.
