Umthwalo womdlavuza wesibindi
Liver cancer is a common malignant tumor accounting for more than half of the global liver cancer. The onset of hepatocellular carcinoma (HCC) is hidden, and early symptoms are not obvious. Most people have lost the opportunity for surgery at the time of treatment. Whether it is surgery, interventional therapy or chemotherapy, the treatment effect on liver cancer is still not very satisfactory. The survival rate is still very low.
With the development of science and technology, liver cancer targeted drugs have made great progress, and a variety of targeted drugs and immunotherapy izidakamizwa zivunyiwe, ziletha ithemba elisha ekusindeni kwesikhathi eside kweziguli ezinomdlavuza wesibindi!
I-Cancer Cancer Yesibindi
I-Chemotherapy ukwelashwa ngezidakamizwa ukuqeda amangqamuzana omdlavuza. I-systemic chemotherapy isebenzisa imishanguzo elwa nomdlavuza ejojowe ngomjovo noma ngomlomo. Le mithi ingena egazini futhi ifinyelela kuzo zonke izindawo zomzimba, okwenza le ndlela yokwelashwa ibe wusizo kumdlavuza osabalalele ezithweni ezikude.
Nokho, umdlavuza wesibindi is resistant to most chemotherapy drugs. The most effective drugs for systemic chemotherapy in liver cancer are doxorubicin (doxorubicin), 5-fluorouracil and cisplatin. But even these drugs will only shrink a small part of the isisu, and the response usually does not last long. Even with a combination of drugs, in most studies, systemic chemotherapy did not help patients live longer.
Transcatheter hepatic artery infusion chemotherapy due to poor response to systemic chemotherapy, doctors study placing chemotherapy drugs directly into the hepatic artery for treatment. This technique is called transcatheter hepatic artery infusion chemotherapy, and continuous infusion of anticancer drugs is suitable for hepatic artery intubation For the treatment of liver cancer patients who can not be resected or undergo palliative resection, because the blood supply of liver cancer mainly comes from the arteries, this method can make the drug directly act on the tumor tissue, increase the local drug concentration, reduce the systemic response, and achieve the treatment of the tumor and relieve the symptoms And the purpose of prolonging life.
Uma kuqhathaniswa ne-chemotherapy yesistimu, i-transcatheter hepatic artery infusion chemotherapy iyasebenza kakhulu, kepha ayikhulisi imiphumela emibi. Izidakamizwa ezisetshenziswa kakhulu zihlanganisa i-fluorouracil, i-cisplatin, i-mitomycin C ne-doxorubicin.
Izidakamizwa zivunyelwe ukwelashwa okuqondisiwe komdlavuza wesibindi
I-Sorafenib (Sorafenib, Dorjemi),
I-Sorafenib yisidakamizwa esiqondisiwe esinemiphumela emibili. Eyokuqala ukuvimbela imithambo yegazi emisha edingekayo ekukhuleni kwesimila, futhi ingakhomba namaprotheni akhuthaza ukukhula kwamangqamuzana omdlavuza. Izinhloso ezinkulu yi-VEGFR-1 / 2/3, RET, FLT3, BRAF njalonjalo.
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.
I-Sorafenib ngumuthi womlomo, kabili ngosuku. Imiphumela emibi kakhulu yalo muthi ifaka ukukhathala kwezintende zezandla noma amathe, ukuqubuka, ukungathandi ukudla, isifo sohudo, umfutho wegazi ophakeme, ububomvu, ubuhlungu, ukuvuvukala noma amabhamuza. Imiphumela emibi kakhulu (engajwayelekile) ifaka phakathi izinkinga zokugeleza kwegazi liye enhliziyweni nokugcwala kwesisu noma kwamathumbu.
i-regorafenib (Regofenib, Baivango),
I-Regefenib ingavimba i-tumor angiogenesis, futhi ingakhomba namaprotheni amaningana ebusweni bamangqamuzana omdlavuza ukuvimbela ukukhula kwamangqamuzana omdlavuza. Kuyi-oral multi-target kinase inhibitor engavimbela i-VEGFR-1, 2, 3, TIE-2, BRAF, KIT, RET, PDGFR ne-FGFR, futhi ukwakheka kwayo kuyefana ne-sorafenib.
NgoDisemba 12, 2017, i-State Food and Drug Administration (i-CFDA) yavuma i-oral multi-kinase inhibitor regorafenib yeziguli ezine-hepatocellular carcinoma (HCC) eyayikade yelashwa nge-sorafenib. Yithathe ngomlomo kanye ngosuku amasonto ama-3 alandelanayo, bese uphumula isonto, bese uqhubekela emjikelezweni olandelayo.
Imiphumela emibi ejwayelekile ye-chemotherapy
Imiphumela emibi ejwayelekile ifaka phakathi ukukhathala, ukungathandi ukudla, isifo sezandla nezinyawo (ububomvu nokucasuka kwezandla nezinyawo), umfutho wegazi ophakeme, umkhuhlane, ukutheleleka, ukwehla kwesisindo, isifo sohudo nobuhlungu besisu (besisu). Imiphumela emibi kakhulu (engajwayelekile) ingafaka ukulimala okukhulu kwesibindi, ukopha okukhulu, izinkinga zokuhamba kwegazi lenhliziyo, nokugcwala kwesisu noma kwamathumbu.
i-lenvatinib (Levatinib, Levira)
ILenvatinib yisidakamizwa esiqondiswe kakhulu. Izinhloso ezinkulu ze-levatinib zifaka phakathi i-vascular endothelial growth factor receptor VEGFR1-3, i-fibroblast growth factor receptor FGFR1-4, i-platelet-etholwe ukukhula factor receptor PDGFR-α, cKit, Ret et al. Sebenza ngokuvimbela izicubu ekwakheni imithambo yegazi emisha edinga ukukhula.
In August this year, Eisai (Eisai) and Merck (MSD) lovastinib were approved by the US FDA for marketing. Leweima was included in the first-line treatment of non-surgical advanced liver cancer by the CSCO liver cancer guideline (2018 version), China’s most authoritative tumor diagnosis and treatment guideline.
I-Lenvatinib ilawulwa ngomlomo kanye ngosuku. Imiphumela emibi ejwayelekile yalo muthi i-palmar-footed redness syndrome, ukuqubuka kwesikhumba, ukungathandi ukudla, isifo sohudo, umfutho wegazi ophakeme, ubuhlungu bamalunga noma besisipha, ukwehla kwesisindo, ubuhlungu besisu noma amabhamuza. Imiphumela emibi kakhulu (engajwayelekile) ingafaka izinkinga zokopha nokulahleka kwamaprotheni emchameni.
I-Cabozantinib
I-Cabozantinib (i-Cabozantinib) iyinhlayiyana encane ye-multi-target inhibitor eyenziwe yi-Exelixis yase-United States, engakhomba i-VEGFR, MET, NTRK, RET, AXL ne-KIT. Inegama elaziwa kangcono iningi leziguli, "i-XL184".
NgoMeyi 29, 2018, i-FDA ivume iCarbotinib ukwelashwa komugqa wesibili komdlavuza wesibindi osezingeni eliphakeme. Ukuvunyelwa kususelwa esivivinyweni somtholampilo sesigaba III CELESTIAL. Iziguli ezinesifo se-hepatocellular carcinoma esithuthukile ngemuva kokwelashwa kwe-sorafenib zikuthuthukise kakhulu ukusinda okuphelele uma kuqhathaniswa ne-placebo. Ukusinda okungenazinqubekela phambili kanye nezinga lokuphendula ngenhloso nakho kuthuthuke kakhulu.
I-Larotinib, umuthi olwa nomdlavuza obanzi obanzi
On November 26, 2018, the legendary anticancer drug larotrectinib (Vitrakvi, Larotinib, LOXO-101) was finally approved by the FDA for the treatment of adult and pediatric patients with locally advanced or metastatic solid tumors with NTRK gene fusion . Regardless of the type of cancer, as long as it is a solid tumor positive for genetic testing for NTRK fusion, this broad-spectrum targeted drug can be used!
In some rare cancers, NTRK fusion often occurs. These include infantile fibrosarcoma, secretory umdlavuza webele, etc. These rare cancers usually find NTRK fusion, and these patients may benefit from drugs such as larotrectinib. This targeted drug is not only effective, but also a broad-spectrum anti-cancer drug, effective for many different tumors! This is why this medicine is so eye-catching.
In the experiment, these patient tumor types included 10 different soft tissue sarcomas, salivary adenocarcinoma, infantile fibrosarcoma, thyroid cancer, lung cancer, melanoma, colorectal cancer, isisu se-stromal esiswini (GIST), breast cancer, osteosarcoma , Cholangiocarcinoma, primary unknown cancer, congenital mesoderm kidney cancer, appendix and pancreatic cancer.
Ngaphezu kwalokho, iziguli zomdlavuza osezihambile eziye zahlolwa umdlavuza we-genome zingathola ukuthi izicubu zazo zine-NTRK fusion, ngoba i-NTRK gene fusion ingenzeka kwizicubu zomdlavuza ezahlukahlukene, kubandakanya nomdlavuza wesibindi.
Ukuhlolwa okujwayelekile kwezakhi zofuzo ezihlanganayo kudinga ukusetshenziswa kobuchwepheshe besizukulwane sesibili sokuhlola izakhi zofuzo. Futhi kufanele kuqashelwe ukuthi ukuguqulwa kokuhlanganiswa kwe-NTRK gene nezinye izakhi zofuzo, kunokuguqulwa kwamaphoyinti okungahleliwe.
Izinkampani eziphezulu kakhulu emhlabeni zokuhlola izakhi zofuzo iKerris neSisekelo Medicine nazo zisanda kuvela
i-oped Foundation One CDx yokuhlolwa kokuhlanganiswa kwe-NTRK. Iziguli ezifuna ukwazi zingashayela uMnyango Wezokwelapha we-Global Oncologist Network ukuze ubonisane (400-626-9916).
Izidakamizwa zomdlavuza wesibindi ocwaningweni
① u-Everolimus
I-inhibitor ekhethiwe ye-mTOR. I-MTOR iyi-key serine-threonine kinase. I-Everolimus ingahlangana namaprotheni we-intracellular FKBP12 ukwakha i-inhibitor mTORC1. Ingakhiqiza izinhloso zokulwa nesimila ngokugxambukela kumjikelezo weseli ne-angiogenesis. .
However, the results of the current clinical trials suggest that Everolimus is not effective in the treatment of patients with advanced HCC, and its clinical value as a second-line drug therapy still needs to be further discussed.
②Bevacizumab
It is the first anti-angiogenic drug approved by the FDA for clinical use. It is a recombinant human IgG-1 monoclonal antibody against VEGF. It can prevent VEGF from binding to VEGFR by binding to VEGF and inhibit the proliferation and activation of vascular endothelial cells. , Thereby exerting anti-angiogenesis and anti-tumor effects. Current research shows that bevacizumab alone or combined chemotherapy or other targeted drugs are effective in the treatment of liver cancer.
AtinApatinib
Apatinib is the world’s first small molecule anti-angiogenesis targeted drug that has been proven to be safe and effective in advanced gastric cancer. It is also a single drug that significantly prolongs survival after standard chemotherapy for advanced gastric cancer fails. It is also a self-developed anti-cancer targeted drug in China, which has achieved certain effects in liver cancer, gastric cancer, umdlavuza wamaphaphu weselula ongewona omncane and breast cancer, and has been included in medical insurance.
Aitan (Apatinib) is through highly selective competition for intracellular VEGFR-2 ATP binding site, blocking downstream signal transduction, thereby potently anti-tumor tissue angiogenesis, and ultimately achieve the goal of combating tumors in all directions.
Izidakamizwa zivunyelwe i-immunotherapy yomdlavuza wesibindi
Immunotherapy drugs help 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 that are 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.
Pembrolizumab (Pembrolizumab, Keytruda) and Nivolumab (Nivolumab, Opdivo) are drugs targeting PD-1. By blocking PD-1, these drugs can enhance the immune response to cancer cells. This can shrink some tumors or slow their growth. These drugs can be used in patients with liver cancer who have previously undergone treatment with the targeted drug sorafenib (dojime).
I-Pembrolizumab (Pembrolizumab, Keytruda)
