First immunotherapy has been approved for esophageal cancer treatment. Esophageal cancer is a common malignant tumor. The International Center for Cancer Research of the World Health Organization points out that esophageal cancer has now become the 6th highest incidence cancer in the world. China is also one of the regions with the highest incidence of umdlavuza we-esophageal in the world. Some are squamous cell carcinoma.
Izindlela zokwelapha eziyinhloko zomdlavuza womphimbo zihlanganisa ukuhlinzwa, i-radiotherapy, kanye ne-chemotherapy. I-squamous cell carcinoma izwela ngokumaphakathi ku-chemotherapy. Izidakamizwa zendabuko ze-chemotherapeutic kanye nokwelashwa ngemisebe zinezinga eliphezulu ekwelapheni i-esophageal squamous cell carcinoma. Kodwa-ke, ukubikezela kweziguli ezinomdlavuza we-esophageal othuthukile ngemva kokwelashwa ngamakhemikhali komugqa wokuqala kubi, futhi izindlela zokwelapha zilinganiselwe. I-Taxane ne-irinotecan zisetshenziswe ngemva kokwelashwa komugqa wokuqala, kodwa ayikho inzuzo yokusinda iyonke ebonwe ocwaningweni lweSigaba 3 se-chemotherapy.
In recent years, there have been many new attempts in the treatment of esophageal squamous cell carcinoma-molecular targeted drugs and immunotherapy, and great progress has been made.
Recently Merck announced:
The U.S. Food and Drug Administration (FDA) has approved PD-1 isisu immunotherapy Keytruda (creta, common name: pembrolizumab, pabolizumab) as a single drug therapy for PD-L1 (combined positive score [CPS] ≥ 10) and treatment of patients with recurrent locally advanced or metastatic esophageal squamous cell carcinoma (ESCC) who have progressed after one or more systemic therapies.”
I-immunotherapy yokuqala yomdlavuza wokuqopha
Ukuvunyelwa kususelwa kwimiphumela yekhodi yokuhlola ebizwa ngegama elithi KEYNOTE-181 (NCT02564263).
I-KEYNOTE-181 i-multicenter, i-randomized, ilebula evulekile, isilingo esilawulwa ngokusebenzayo. Iziguli ezingama-628 ezinomdlavuza ophindaphindiwe wakuleli noma we-metastatic esophageal zifakiwe. Lezi ziguli ezithuthukile zathuthuka ngaphambi nangemva kokwelashwa okuhleliwe komugqa wokuqala.
Iziguli zabelwa ngokungahleliwe ukuthola i-palmumab 200 mg kanye njalo emavikini amathathu, noma i-chemotherapy elandelayo emthanjeni wemithi: paclitaxel, docetaxel per, noma irinotecan.
Imiphumela ikhombise ukuthi uma kuqhathaniswa neqembu le-chemotherapy, iziguli ezinamathumba ezine-PD-L1 CPS-10 zikhombise ukuthuthuka ku-OS ezigulini ezaphathwa ngokungahleliwe ngeKeytruda. Izinga lokuphendula eliphelele le-pembrolizumab nalo liphakeme kune-chemotherapy. Le mininingwane iphakamisa ukuthi i-pembrolizumab kufanele ibhekwe njengezinga elisha lokunakekelwa ezigulini ezine-PD-L1 CPS ye-10 noma ngaphezulu ekwelashweni komugqa wesibili.
Imiphumela emibi engaba khona: I-pneumonia, nesifo, isifo sofuba, isifo se-endocrine, i-nephritis kanye nokungasebenzi kahle kwezinso, ukusabela okukhulu kwesikhumba, ukwenqatshwa kokufakelwa isitho esiqinile kanye nezinkinga ze-allogeneic hematopoietic stem cell transplantation (HSCT). Ngokuya ngobunzima bokusabela okubi, i-pembrolizumab kufanele iyekwe noma iyekwe, futhi ukwelashwa kwe-corticosteroid kufanele kunikezwe lapho kufanele.
Ezinye izinketho zokwelashwa komdlavuza wokuqopha
I-Chemotherapy kumdlavuza we-esophageal
Ekwelapheni umdlavuza wokuqopha, i-chemotherapy ingasetshenziswa ngezikhathi ezahlukahlukene.
I-Adjuvant chemotherapy: i-chemotherapy ngemuva kokuhlinzwa. Umgomo ukubulala noma yimaphi amangqamuzana omdlavuza angahle asale ngesikhathi senqubo, ngoba mancane kakhulu ukuthi angabonwa ngamehlo, ngakho-ke awakwazi ukukhishwa ngokuhlinzwa. Kungenzeka futhi ukuthi amangqamuzana omdlavuza aphunyuke kwizicubu ezinkulu bese eba nezimpande kwezinye izingxenye zomzimba.
I-Neoadjuvant chemotherapy: Eminye imidlavuza, i-chemotherapy (evame ukuhlanganiswa nokwelashwa ngemisebe) inikezwa ngaphambi kokuhlinzwa ukuzama ukunciphisa isimila nokwenza ukuhlinzwa kube lula ukusula.
I-Chemotherapy yomdlavuza osuthuthukile: Emdlavuzeni wokuqunjelwa osofakele kwezinye izitho, njengesibindi, i-chemotherapy nayo ingasetshenziswa ukusiza ukunciphisa izicubu nokuqeda izimpawu. Yize kungenzeki ukuthi welaphe umdlavuza, uvame ukusiza abantu ukuthi baphile isikhathi eside.
Izidakamizwa ezivamile ezisetshenziswa ekwelashweni komdlavuza wokuqhafaza
- I-Carboplatin ne-paclitaxel (ingasetshenziswa ngokuhlanganiswa ne-radiotherapy)
- I-Cisplatin ne-5-fluorouracil (5-FU) (imvamisa kuhlanganiswa nokwelashwa ngemisebe)
- I-ECF: i-epirubicin, i-cisplatin, ne-5-FU (ikakhulukazi izicubu lapho kuhlangana khona i-gastroesophagus)
- I-DCF: i-docetaxel, i-cisplatin, ne-5-FU
- I-Cisplatin ne-capecitabine
- i-oxaliplatin ne-5-FU noma i-capecitabine
- I-Irinotecan
Ukwelashwa okubhekiswe kumdlavuza we-esophageal
I-Ramucirumab (Cyramza)
Rumizumab is a humanized monoclonal antibody that specifically blocks vascular endothelial growth factor receptor 2 (VEGFR2) and downstream angiogenesis-related pathways. The currently approved indication is monotherapy or in combination with paclitaxel for advanced gastric cancer / gastroesophageal junction i-adenocarcinoma that progresses during or after chemotherapy with or without fluorouracil or platinum. In addition, it has been approved for the treatment of umdlavuza wamaphaphu weselula ongewona omncane and metastatic colorectal cancer.
I-Trastuzumab (Trastuzumab, Herceptin)
I-Trastuzumab, i-anti-monoclonal antibody elwa ne-Her2, ivimbela ukukhula komuntu kwe-epidermal factor ekunamatheleni ku-Her2 ngokuzihlanganisa noHer2, ngaleyo ndlela kuvimbele ukukhula kwamangqamuzana omdlavuza. I-Herceptin nayo ingakhuthaza amaseli omzimba omzimba ukuba aqede amangqamuzana omdlavuza.
I-Esophageal squamous cell carcinoma, njengesitho esihluke kakhulu kwizicubu zomgudu wokugaya ongaphezulu, sithinta ngqo ukudla. Ngaphezu kwalokho, i-squamous cell carcinoma iyahlasela kakhulu futhi isengozini yokuvinjelwa, ukuvuza nokuphuma kwegazi. Ngakho-ke, kuyo yonke inqubo yokwelashwa kwe-squamous cell carcinoma, noma sizosebenzisa izindlela zokwelashwa zendabuko futhi sibheke neminye imizamo emisha, kufanele sisebenzise umqondo wokuphathwa kwezifundo ezigcwele kuyo yonke inqubo yokwelashwa. Ngokuthuthuka kwezokwelapha, kuzoba nobuchwepheshe obengeziwe bokulwa nomdlavuza wokucinana kwemisipha, njenge-proton radiotherapy, i-immunotherapy yeselula, njll. Wonke umuntu kumele azethembe.
