CHICAGO-Neoadjuvant chemotherapy sichingafanane ndi opareshoni yam'tsogolo kuti apulumuke khansa yapancreatic yotuluka, mayeso ang'onoang'ono osasinthika akuwonetsa.
Mosayembekezereka, odwala omwe adachitidwa opaleshoni kwa nthawi yoyamba amakhala ndi moyo woposa chaka chimodzi kuposa omwe adalandira maphunziro afupipafupi a FOLFIRINOX chemotherapy asanayambe opaleshoni.Chotsatirachi ndichodabwitsa kwambiri chifukwa chakuti chithandizo cha neoadjuvant chinali chokhudzana ndi kuchuluka kwa maopaleshoni oipa (R0) komanso kuti odwala ambiri omwe ali m'gulu lachipatala adapeza kuti alibe node.
"Kutsatira kwina kungathe kufotokozera bwino zotsatira za nthawi yaitali za kusintha kwa R0 ndi N0 mu gulu la neoadjuvant," anatero Knut Jorgen Laborie, MD, University of Oslo, Norway, American Society of Clinical Oncology.ASCO) msonkhano."Zotsatira zake sizigwirizana ndi kugwiritsa ntchito neoadjuvant FOLFIRINOX ngati chithandizo chokhazikika cha khansa ya kapamba."
Chotsatirachi chinadabwitsa Andrew H. Ko, MD, wa yunivesite ya California, San Francisco, yemwe adaitanidwa kukambitsirana, ndipo adavomereza kuti sakugwirizana ndi neoadjuvant FOLFIRINOX monga njira ina yopangira opaleshoni yam'tsogolo.Koma iwonso samapatula mwayi umenewu.Chifukwa cha chidwi ndi kafukufukuyu, sizingatheke kunena motsimikiza za tsogolo la FOLFIRINOX neoadjuvant.
Ko adanenanso kuti theka la odwalawo adamaliza magawo anayi a neoadjuvant chemotherapy, "omwe ndi otsika kwambiri kuposa momwe ndimayembekezera kwa gulu ili la odwala, omwe chithandizo chamankhwala anayi nthawi zambiri sichimakhala chovuta kwambiri ......Chachiwiri, chifukwa chiyani zotsatira zabwino za opaleshoni ndi matenda [R0, N0 status] zimatsogolera ku zotsatira zoyipa mu gulu la neoadjuvant?kumvetsa chifukwa chake ndipo potsirizira pake sinthani ku ma regimens ozikidwa pa gemcitabine.”
"Choncho, sitingathe kunena motsimikiza kuchokera mu kafukufukuyu zokhudzana ndi zotsatira za FOLFIRINOX pa zotsatira za kupulumuka ...Matenda.”
Laborie adanenanso kuti opaleshoni yophatikizidwa ndi chithandizo chamankhwala chogwira ntchito bwino chimapereka zotsatira zabwino kwambiri za khansa yapang'onopang'ono.Mwachikhalidwe, muyezo wa chisamaliro umaphatikizapo opaleshoni yam'tsogolo ndi adjuvant chemotherapy.Komabe, chithandizo cha neoadjuvant chotsatiridwa ndi opaleshoni ndi adjuvant chemotherapy chayamba kutchuka pakati pa akatswiri ambiri a oncologist.
Thandizo la Neoadjuvant limapereka maubwino ambiri omwe angakhalepo: kuwongolera msanga kwa matenda am'thupi, kupititsa patsogolo kasamalidwe ka mankhwala amphamvu a chemotherapy, komanso zotsatira zabwino za histopathological (R0, N0), Laborie anapitiriza.Komabe, mpaka pano, palibe kuyesedwa kosasinthika komwe kwawonetsa bwino kupulumuka kwa neoadjuvant chemotherapy.
Pofuna kuthana ndi kusowa kwa deta m'mayesero osasinthika, ofufuza ochokera ku malo 12 ku Norway, Sweden, Denmark ndi Finland adalembera odwala omwe ali ndi khansa ya m'mawere.Odwala opangidwa mwachisawawa kupita ku opaleshoni yam'mwamba adalandira mikombero ya 12 ya adjuvant-modified FOLFIRINOX (mFOLFIRINOX).Odwala omwe amalandila chithandizo cha neoadjuvant adalandira mikombero ya 4 ya FOLFIRINOX ndikutsatiridwa ndi kubwereza masitepe ndi opaleshoni, kutsatiridwa ndi mizungu 8 ya adjuvant mFOLFIRINOX.Chomaliza chachikulu chinali kupulumuka kwathunthu (OS), ndipo phunziroli linapatsidwa mphamvu zowonetsera kusintha kwa moyo wa miyezi 18 kuchokera ku 50% ndi opaleshoni kutsogolo mpaka 70% ndi neoadjuvant FOLFIRINOX.
Deta inaphatikizapo odwala 140 omwe ali ndi vuto la ECOG 0 kapena 1. Pagulu loyamba la opaleshoni, 56 mwa odwala 63 (89%) anachitidwa opaleshoni ndipo 47 (75%) anayamba adjuvant chemotherapy.Mwa odwala 77 omwe adapatsidwa chithandizo cha neoadjuvant, 64 (83%) adayambitsa chithandizo, 40 (52%) adamaliza kulandira chithandizo, 63 (82%) adadulidwa, ndipo 51 (66%) adayamba chithandizo cha adjuvant.
Zovuta za Gulu ≥3 (AEs) zidawonedwa mu 55.6% ya odwala omwe amalandila neoadjuvant chemotherapy, makamaka kutsegula m'mimba, nseru ndi kusanza, ndi neutropenia.Panthawi ya adjuvant chemotherapy, pafupifupi 40% ya odwala pagulu lililonse lamankhwala adakumana ndi ≥3 AEs.
Pakuwunika kwa cholinga chochiza, kupulumuka kwapakatikati ndi chithandizo cha neoadjuvant chinali miyezi 25.1 poyerekeza ndi miyezi 38.5 yochitidwa opaleshoni kutsogolo, ndipo neoadjuvant chemotherapy inawonjezera chiopsezo chokhala ndi moyo ndi 52% (95% CI 0.94-2.46, P = 0.06).Kupulumuka kwa miyezi 18 kunali 60% ndi neoadjuvant FOLFIRINOX ndi 73% ndi opaleshoni yamtsogolo.Kuyesa kwa protocol kumapereka zotsatira zofanana.
Zotsatira za histopathological zimakonda chemotherapy ya neoadjuvant popeza 56% ya odwala adapeza R0 poyerekeza ndi 39% ya odwala opaleshoni yam'tsogolo (P = 0.076) ndi 29% adapeza mwayi wa N0 poyerekeza ndi 14% ya odwala (P = 0.060).Kusanthula kwa per-protocol kunasonyeza kusiyana kwakukulu kwa chiwerengero ndi neoadjuvant FOLFIRINOX mu R0 udindo (59% vs. 33%, P = 0.011) ndi N0 udindo (37% vs. 10%, P = 0.002).
Charles Bankhead ndi mkonzi wamkulu wa oncology komanso amafotokoza za urology, dermatology ndi ophthalmology.Adalowa nawo MedPage Today mu 2007.
Kafukufukuyu adathandizidwa ndi Norwegian Cancer Society, Regional Health Authority ya South-East Norway, Swedish Sjoberg Foundation ndi Helsinki University Hospital.
Ko 披露了与 Clinical Care Options、Gerson Lehrman Group、Medscape、MJH Life Sciences、Research to Practice、AADi、FibroGen、Genentech、GRAIL、Ipsen、Merus、Roche、AbGenomics、Apexigen、Astellas、BioMed Valley’s Discoveries” .Celgene, CrystalGenomics, Leap Therapeutics ndi makampani ena.
Source Citation: Labori KJ et al."FOLFIRINOX yaifupi ya neoadjuvant motsutsana ndi opaleshoni yam'tsogolo ya khansa yam'mutu yapang'onopang'ono: kuyesa kosiyanasiyana kwa gawo II (NORPACT-1)," ASCO 2023;Chithunzi cha LBA4005
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Nthawi yotumiza: Sep-22-2023