Ukwelashwa komdlavuza wesibindi, uhlelo lokwelashwa komdlavuza wesibindi, indlela yokwelashwa komdlavuza wesibindi, indlela yokwelashwa komdlavuza wesibindi, umuthi wokwelapha umdlavuza wesibindi.
Umdlavuza wesibindi oyinhloko
Umdlavuza wesibindi oyinhloko ungenye yezimbangela ezivame kakhulu zamathumba amabi nokufa kwezimila emazweni asathuthuka, okusongela kakhulu impilo yabantu nezempilo. Ukulinganisa ukutholakala nokwelashwa komdlavuza wesibindi kubaluleke kakhulu ukuthuthukisa ukuxilongwa nokwelashwa kweziguli ezinomdlavuza wesibindi nokwenza ngcono izinga lempilo yeziguli.
There are many treatment options for umdlavuza wesibindi, including surgery, radiotherapy, radiofrequency ablation, venous embolization, and drug treatment. Among them, the chemotherapy effect of liver cancer is not good, because most liver cancer cells are not sensitive to chemotherapeutic drugs, even if the benefit of using chemotherapeutic drugs may be smaller than the side effects. Therefore, the proportion of patients with liver cancer treated with chemotherapy is not large.
Kusukela ngo-2007, ukufika kwe-sorafenib, umuthi wokuqala ohlosiwe womdlavuza wesibindi, kwephule isimo sokuthi awukho umuthi otholakalayo womdlavuza wesibindi, kodwa uqhubeke iminyaka engaphezu kwengu-10. I-sorafenib kuphela engasetshenziswa njengokwelashwa komugqa wokuqala komdlavuza wesibindi onganqandeki. Ngemuva kokumelana nemithi, awazi ukuthi ukhethe kanjani?
However, through unremitting efforts, scientists broke through obstacles. In 2018, the second targeted drug that could replace sorafenib was successfully launched, that is, lovatinib! Both sorafenib and lovatinib It is a targeted drug used for first-line treatment of liver cancer. Later, a variety of second-line treatment drugs have also come out one after another!
Since 2017, many new high-level evidences in line with the principles of evidence-based medicine have emerged in the diagnosis, staging and treatment of liver cancer at home and abroad, especially research results adapted to China’s national conditions. This article focuses on the drug treatment plan and sequence in the latest edition of the “Specifications for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition)”, giving a clear guide for liver cancer friends.
Imihlahlandlela yokwelashwa komdlavuza wesibindi yi-FDA
abangane bomdlavuza wesibindi.
| Usuku | I-FDA igunyaza umuthi ohlosiwe womdlavuza wesibindi | Isiboniso | Ukugunyazwa kwasekhaya |
| 2007-11 | I-Sorafenib (Sorafenib, Nexavar) | Ekwelapheni i-hepatocellular carcinoma noma umdlavuza wesibindi onganqandeki | Kubhalwe ekhaya futhi kwahlanganiswa ngumshwalense wezokwelapha |
| 2018-8 | I-Lenvatinib (Levatinib, Lenvima) | Ukwelashwa komugqa wokuqala we-hepatocellular carcinoma enganqandeki | Uhlu lwasekhaya |
| 2017-4 | I-Regorafenib (Sigvarga) | Ukwelashwa kolayini wesibili komdlavuza wesibindi omelana nesorafenib | Imakethe yasekhaya |
| 2017-9 | INivolumab (navumab, Opdivo) | Ukwelashwa kolayini wesibili komdlavuza wesibindi omelana nesorafenib | Imakethe yasekhaya |
Ukukhethwa kokwelashwa komugqa wokuqala komdlavuza wesibindi
(1) uSorafenib
Ucwaningo oluningi lwezokwelapha lubonise ukuthi i-Sorafenib inezinzuzo ezithile zokusinda ezigulini ezinomdlavuza wesibindi othuthukile emazweni ahlukene nezizinda ezinezifo zesibindi ezahlukene (izinga lobufakazi 1).
Ukusetshenziswa okujwayelekile okunconyiwe kungu-400 mg ngomlomo, kabili ngosuku. Ingasetshenziselwa iziguli ze-Child-Pugh Class A noma B ezinokusebenza kwesibindi. Uma kuqhathaniswa nokusebenza kwesibindi se-Child-Pugh B, i-Child-Pugh Inzuzo yokusinda kweziguli isobala kakhulu.
Udinga ukunaka umthelela ku-HBV nokusebenza kwesibindi, futhi ukhuthaze ukuphathwa kwezifo eziyisisekelo zesibindi kuyo yonke inqubo. Izimpawu ezimbi kakhulu ezivame kakhulu uhudo, ukwehla kwesisindo, isifo sezandla nezinyawo, ukuqubuka, i-myocardial ischemia, nomfutho wegazi ophezulu, okuvame ukwenzeka phakathi kwamasonto amabili kuya kwayisithupha ngemuva kokuqala kokwelashwa.
(2) iLemvatinib
ILenvatinib ilungele iziguli ezingaphindaphindeki ezinesigaba IIb, IIIa, IIIb, ukusebenza kwesibindi Ingane-Pugh Umdlavuza wesibindi, kanti ukwelashwa kwayo kolayini wokuqala akuyona ngaphansi kwe-sorafenib. Umdlavuza wesibindi ohlobene ne-HBV unezinzuzo ezingcono zokusinda [185] (izinga lobufakazi 1).
ILenvatinib ivunyelwe ukusetshenziswa ezigulini ezinomdlavuza wesibindi i-Child-Pugh A ezinomdlavuza ophakeme wesibindi. Ukusetshenziswa: 12mg, ngomlomo, kanye ngosuku ngesisindo somzimba ≥60kg; I-8mg, yomlomo, kanye nsuku zonke isisindo somzimba <60kg. Ukusabela okuvamile okungajwayelekile kuyisifo somfutho wegazi ophezulu, isifo sohudo, ukuncipha kwesifiso sokudla, ukukhathala, isifo sezinyawo, i-proteinuria, isicanucanu ne-hypothyroidism.
(3) Ukwelashwa ngamakhemikhali okuhleliwe
I-FOLFOX4 (i-fluorouracil, i-calcium folinate, i-oxaliplatin) ivunyiwe I-China yokwelashwa kwesibindi esithuthukisiwe sasekhaya kanye ne-metastatic umdlavuza ongafanele ukuhlinzwa noma ukwelashwa kwendawo (izinga lobufakazi 1).
Izifundo eziningi zesigaba sesibili zibike ukuthi i-systemic chemotherapy ene-oxaliplatin ehlanganiswe ne-sorafenib ingathuthukisa amazinga okuphendula okwenziwe, inwebe ukusinda okungenazinqubekela phambili nokusinda okuphelele, futhi inikeze ukuphepha okuhle (izinga lobufakazi 3).
Ezigulini ezinokusebenza okuhle kwesibindi nesimo somzimba, le nhlanganisela yokwelashwa ingacatshangelwa, kepha izifundo ezilawulwa ngokungahleliwe zomtholampilo zisadingeka ukunikeza ubufakazi bezinga eliphezulu lobufakazi obususelwa ebufakazini. Ngaphezu kwalokho, i-arsenic trioxide inomphumela othile wokwelashwa okunciphisayo kumdlavuza wesibindi osezingeni eliphakeme (izinga lobufakazi 3). Ekusetshenzisweni komtholampilo, ukunakekelwa kufanele kuthathwe ukuqapha nokuvimbela ubuthi besibindi nezinso.
Ukwelashwa komugqa wesibili komdlavuza wesibindi
(1) I-Regofini
I-Regorafenib ivunyelwe ukusetshenziswa ezigulini ezinesifo somdlavuza wesibindi i-IIb, IIIa, no-IIIb CNLC abake baphathwa nge-sorafenib (level level 1). Ukusetshenziswa kungu-160mg kanye nsuku zonke amasonto ama-3 futhi kuyekisiwe iviki elingu-1.
E-China, umthamo wokuqala ungaba yi-80mg noma i-120mg kanye, kanye ngosuku, futhi ukhule kancane ngokuya ngokubekezelelana kwesiguli. Imicimbi emibi ejwayelekile ingumfutho wegazi ophezulu, ukusabela kwesikhumba sonyawo lwezandla, ukukhathala, nohudo.
(2) i-Navumab ne-Paimumab
I-US FDA igunyaze ukusetshenziswa kwe-Navulinu monoclonal antibodies (Nivolumab) kanye ne-Pabrolizumab monoclonal antibodies (Pembrolizumab) ezigulini ezinomdlavuza wesibindi eziye zathuthuka noma ezingakwazi ukubekezelela i-sorafenib ngemva kokwelashwa kwangaphambili kwe-sorafenib (izinga lobufakazi 2).
Njengamanje, izivikeli mzimba zokuhlolwa kokuzivikela ezakhiwe ngokuzimela izinkampani zaseChina, ezinjenge-Carellidizum monoclonal antibodies, Treplepril monoclonal antibodies, kanye ne-Xindili monoclonal antibodies, ziyaqhubeka nokwenza ucwaningo. Inhlanganisela ye- immunotherapy and targeted drugs, chemotherapeutic drugs, and topical treatments is also constantly being explored.
Amanye ama-immunomodulators (njenge-interferon α, i-thymosin α1, njll.), i-cellular immunotherapy (njenge i-chimeric antigen receptor T cell therapy, CAR-T, kanye ne-cytokine-induced killer cell therapy, CIK) konke kunemiphumela ethile yokulwa nesimila. Nokho, kusazoqinisekiswa izifundo zomtholampilo ezinkulu.
