Ukwelashwa okubhekiswe kumdlavuza obala

Yimiphi imishanguzo ebhekiswe kumdlavuza obala kakhulu?

17 years ago, the number of drugs available for advanced colorectal cancer was very limited. There were only a few chemotherapeutic drugs and almost no targeted drugs. Once diagnosed, the survival period is only between half a year and one year. But now, cancer treatment is entering the era of precision treatment, and more and more targeted and immune drugs are on the market.

In the 2017 version of the colorectal cancer treatment guidelines, the recommendations for genetic testing only involve KRAS, NRAS, dMMR, and MSI-H. In the latest treatment guidelines for 2019, new targets such as BRAF, HER2, NTRK are newly included Point, through genetic testing, to understand more molecular information about colorectal cancer, can help us find more medication options. The average patient survival rate is more than 3 years, which is a huge improvement brought by precision medicine.

Yiziphi izakhi zofuzo okufanele zihlolwe ezigulini zomdlavuza ezibalabala?

Ngemuva kokuxilongwa, odokotela kumele bahlole ngofuzo isiguli ngasinye esinomdlavuza we-metastatic colorectal (mCRC) kusenesikhathi ukunquma iqembu elincane lalesi sifo, njengoba lolu lwazi lungaqagela ukubikezelwa kokwelashwa, njengokukhuliswa kwe-HER2 okuphakamisa ukuthi i-anti-EGFR therapy Resistant. Izakhi zofuzo ezilandelayo kufanele zihlolwe!

I-MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK.

Okuqondiwe nezidakamizwa ezihlosiwe njengamanje ziyatholakala ukwelashwa

I-VEGF: i-bevacizumab, i-aparcept

VEGFR: Ramulizumab, Regigofinil, Fruquintinib

EGFR: Cetuximab, Panitumumab

PD-1 / PDL-1: Pamumab, Navumab

I-CTLA-4: Ipilizumab

IBRAF: iWimofenib

I-NTRK: Larotinib

List of colorectal cancer targeting and immunotherapy drugs that have been approved so far at home and abroad:

Izinkomba ze-bevacizumab: umdlavuza we-metastatic colorectal kanye nomdlavuza wamaphaphu osethuthukile, we-metastatic noma ophindelelayo ongewona omncane omncane.

Izinkomba ze-trastuzumab: HER2-positive metastatic breast cancer, HER2-positive early breast cancer, and HER2-positive metastatic gastric adenocarcinoma or gastroesophageal junction adenocarcinoma.

Izinkomba zikaPertuzumab: This product is suitable for combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer with a high risk of recurrence.

Izinkomba zikaNivolumab: negative epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) negative, disease progression or intolerable locally advanced or metastatic disease after previous platinum-containing chemotherapy Adult patients with non-small cell lung cancer (NSCLC).

Izinkomba zikaRegorafenib: previously treated metastatic colorectal cancer patients. Durvalumab, Tremelimumab, Ipilimumab, lapatinib are not yet available in China.

Ukwelashwa Okuhlosiwe Ngokusobala (Buyekeza i-2019)

Ukwelashwa okubhekiswe kumdlavuza we-Kras-negative colorectal

Umdlavuza wekholoni we-KRAS wohlobo lwasendle uwumugqa wokuqala wokwelapha oqondiswe ku-chemotherapy ohlanganiswe ne-chemotherapy. Ngakho hlobo luni lwe-chemotherapy olukhethiwe?

Ngenkathi ukhetha umuthi ohlosiwe, kunconywa ukuthi ukhethe uhlobo lwe-chemotherapy nge-OS ende, okungukuthi, i-cetuximab ilungele i-FOLFOX, futhi i-bevacizumab ifaneleka kakhulu i-FOLFIRI. Yiluphi uhlelo okufanele ulukhethe kuncike ekuhlaziyweni komtholampilo okuthile

Uma kukhona ithemba lokwelashwa, i-cetuximab ehlanganiswe ne-chemotherapy ngokuvamile iyathandwa ngoba ukusebenza kwamuva kwe-cetuximab kuphakeme kune-bevacizumab;

Ezigulini ezinesifo esingelapheki esithuthukile, i-bevacizumab ehlanganiswe ne-chemotherapy ingasetshenziswa kulayini wokuqala, ilandelwe yi-cetuximab noma i-panitumumab.

2. Ukwelashwa komdlavuza obomvu we-Kras-positive

Iziguli ezinomdlavuza we-colon we-metastatic zidinga ukuhlolwa isimo sokuguqulwa kwe-RAS kufaka phakathi i-KRAS ne-NRAS, futhi okungenani isimo se-KRAS exon 2 sidinga ukucaca.

Uma kungenzeka, isimo sezinye izikhulu ngaphandle kwe-KRAS Exon 2 kanye nesimo sokuguquka kwe-NRAS kufanele sicaciswe.

Bevacizumab combined with two-drug chemotherapy can bring PFS (median progression-free survival) and OS (overall survival) benefits to patients with KRAS mutations.

Ezigulini ezinezinguquko ze-RAS, ukusetshenziswa kwe-cetuximab kungaba nomthelela omubi ekusebenzeni okuphelele. Iziguli ezinezinguquko ze-KRAS noma ze-NRAS akufanele zisebenzise i-cetuximab noma i-panitumumab.

Ukwelashwa komdlavuza we-BRAF mutant colorectal

I-7-10% yeziguli ezinomdlavuza wekoloni zithwala ukuguqulwa kwe-BRAF V600E. Ukuguqulwa kwe-BRAF V600E kungukuguqulwa okwenziwe yi-BRAF futhi kunesilinganiso esiphakeme kakhulu sezinguquko ze-BRAF. Inezici ezihlukile zomtholampilo: ivela kakhulu kwi-hemicolon efanele; Isilinganiso se-dMMR siphezulu, sifinyelela kuma-20%; Ukuguqulwa kwe-BRAF V600E kunesibikezelo esibi; amaphethini we-metastatic atypical;

Ucwaningo luthole ukuthi i-FOLFOXIRI + bevacizumab ingaba yindlela yokwelashwa engcono kakhulu yeziguli ezinokushintshwa kwe-BRAF. Umhlahlandlela we-2019 V2 NCCN uncoma izinketho zokwelashwa komugqa wesibili komdlavuza we-metastatic colorectal: verofinib + irinotecan + cetuximab / panitumumab Dabarafenib + trametinib + cetuximab / panit MAb

I-Encorafenib + Binimetinib + Cetux / Pan

Ukukhuliswa kwe-4.HER2

HER2 amplification or overexpression is found in 2% to 6% of patients with advanced or metastatic colorectal cancer. Pertuzumab and trastuzumab bind to different HER2 domains to produce synergistic inhibitory effects on tumor cells. MyPathway is the first clinical study to investigate the efficacy of Pertuzumab + Trastuzumab in patients with HER2 expansion metastatic colorectal cancer (regardless of KRAS mutation status). This study shows that HER2 dual-targeted therapy, Pertuzumab + Trastuzumab, is well tolerated or could be used as a treatment option for patients with HER2 expansion metastatic colorectal cancer. Early genetic testing to identify HER2 mutations and consider early use of HER2 targeted therapy may benefit patients.

5. Ukwelashwa komdlavuza we-NTRK fusion colorectal

Ukuhlanganiswa kwe-NTRK kwenzeka cishe ku-1 kuye ku-5% weziguli ezinomdlavuza wekoloni, futhi kunconywa ukuhlolwa kwe-NGS. ILorarectinib ivunyelwe ukuhlelwa kabusha kwe-NTRK ezigulini ezinamathumba aqinile, nge-ORR engama-62% kanye ne-3 yazo ene-CRC. Ukuvela kwama-TRK inhibitors afana ne-larotinib ne-emtricinib kunikeza imibono emisha yokwelapha i-NTRK gene fusion CRC.

Owesifazane oneminyaka engama-75 ubudala onomdlavuza we-metastatic colorectal (CRC) unenhlanhla enkulu:

Isigaxa esiyinhloko samakholoni.

Umdlavuza wePeritoneal.

Isibindi se-metastases.

I-1600 mg / m 2 ye-emtricinib ilawulwa ngomlomo kanye ngesonto izinsuku ezi-4 zilandelana (okungukuthi, izinsuku ezi-4 / izinsuku ezi-3 zokuphumula) namasonto ama-3 alandelanayo njalo ezinsukwini ezingama-28. Aft
ukwelashwa amasonto ayisishiyagalombili, izilonda zinciphise kakhulu.

Ukuphetha Okushiwo

Ukufaka inkathi yokwelashwa okuhlosiwe, sonke isiguli esinomdlavuza obala ngokweqile kufanele sidlulise ukuhlolwa kwe-MSI, ukuhlaziywa kwe-RAS ne-BRAF, futhi senze ukukhuliswa kwe-HER2 ngangokunokwenzeka, ukutholakala kwezakhi zofuzo ezifana ne-NTRK, nokuhlolwa kofuzo (NGS) kuzofakwa ku izindlela ezinkulu zokuqala ukuhlolwa kweziguli eziningi.

Ngeminye imininingwane shayela ku-+91 96 1588 1588 noma ubhalele ku-cancerfax@gmail.com.