Neoadjuvant chemotherapy ndi opaleshoni yoyambirira ya khansa ya kapamba yomwe ingachotsedwe

CHICAGO—Chifukwa cha mankhwala a Neoadjuvant sichingafanane ndi opaleshoni yoyambirira kuti munthu apulumuke khansa ya kapamba yomwe ingachotsedwe, kafukufuku wochepa wosankha mwachisawawa akusonyeza.
Mosayembekezereka, odwala omwe adachitidwa opaleshoni koyamba adakhala ndi moyo wautali kuposa chaka chimodzi kuposa omwe adalandira chithandizo cha FOLFIRINOX chemotherapy asanayambe opaleshoni. Zotsatirazi ndizodabwitsa kwambiri chifukwa chithandizo cha neoadjuvant chinali chogwirizana ndi kuchuluka kwa margins opareshoni (R0) komanso kuti odwala ambiri m'gulu la chithandizocho adapeza mkhalidwe wopanda ma node.
"Kutsatira kwina kungafotokoze bwino momwe kusintha kwa R0 ndi N0 kumakhudzira gulu la neoadjuvant," adatero Knut Jorgen Laborie, MD, University of Oslo, Norway, American Society of Clinical Oncology. ASCO pamsonkhano. "Zotsatira zake sizikugwirizana ndi kugwiritsa ntchito neoadjuvant FOLFIRINOX ngati chithandizo chokhazikika cha khansa ya kapamba yomwe ingachotsedwe."
Zotsatirazi zinadabwitsa Andrew H. Ko, MD, wa ku Yunivesite ya California, San Francisco, yemwe anaitanidwa kukakambiranako, ndipo anavomera kuti sakugwirizana ndi FOLFIRINOX ya neoadjuvant ngati njira ina m'malo mwa opaleshoni yoyambirira. Koma sachotsanso mwayi umenewu. Chifukwa cha chidwi ndi kafukufukuyu, sizingatheke kupereka chiganizo chomveka bwino chokhudza momwe FOLFIRINOX neoadjuvant idzakhalire mtsogolo.
Ko adanena kuti theka lokha la odwala adamaliza ma cycle anayi a neoadjuvant chemotherapy, "zomwe ndizochepa kwambiri kuposa momwe ndimayembekezera kwa gulu la odwala awa, omwe ma cycle anayi a chithandizo nthawi zambiri samakhala ovuta kwambiri .... ..Chachiwiri, chifukwa chiyani zotsatira zabwino kwambiri za opaleshoni ndi matenda [R0, N0 status] zimapangitsa kuti pakhale zotsatira zoyipa kwambiri mu gulu la neoadjuvant? kumvetsetsa chomwe chimayambitsa ndikusintha kugwiritsa ntchito njira zochiritsira zokhala ndi gemcitabine."
"Chifukwa chake, sitingathe kupeza mfundo zenizeni kuchokera mu kafukufukuyu pankhani ya momwe FOLFIRINOX imakhudzira zotsatira za kupulumuka ... FOLFIRINOX ikadalipo, ndipo maphunziro angapo omwe akupitilizabe akuwonetsa kuthekera kwake pakuchita opaleshoni yobwezeretsa." Matenda.
Laborie adanena kuti opaleshoni pamodzi ndi chithandizo chogwira mtima cha thupi zimapereka zotsatira zabwino kwambiri pa khansa ya kapamba yomwe ingachotsedwe. Mwachikhalidwe, muyezo wa chisamaliro umaphatikizapo opaleshoni yoyambirira ndi mankhwala othandizira. Komabe, chithandizo cha neoadjuvant chomwe chimatsatiridwa ndi opaleshoni ndi mankhwala othandizira ayamba kutchuka pakati pa madokotala ambiri a khansa.
Chithandizo cha Neoadjuvant chimapereka zabwino zambiri: kuwongolera matenda a m'thupi mwachangu, kupereka bwino mankhwala a chemotherapy, komanso zotsatira zabwino za histopathological (R0, N0), Laborie adapitiliza. Komabe, mpaka pano, palibe kafukufuku wosankhidwa mwachisawawa yemwe wasonyeza bwino kuti chithandizo cha neoadjuvant chemotherapy chili ndi phindu lopulumuka.
Pofuna kuthana ndi kusowa kwa deta m'mayesero osankhidwa mwachisawawa, ofufuza ochokera m'malo 12 ku Norway, Sweden, Denmark ndi Finland adalemba odwala omwe ali ndi khansa ya mutu wa kapamba yomwe ingachotsedwe. Odwala omwe adachitidwa opaleshoni yoyambirira adalandira ma cycle 12 a FOLFIRINOX (mFOLFIRINOX) yosinthidwa ndi adjuvant. Odwala omwe adalandira chithandizo cha neoadjuvant adalandira ma cycle 4 a FOLFIRINOX kutsatiridwa ndi kubwerezabwereza komanso opaleshoni, kutsatiridwa ndi ma cycle 8 a mFOLFIRINOX yothandiza. Cholinga chachikulu chinali kupulumuka konse (OS), ndipo kafukufukuyu adathandizidwa kuwonetsa kusintha kwa kupulumuka kwa miyezi 18 kuchokera pa 50% ndi opaleshoni yoyambirira mpaka 70% ndi neoadjuvant FOLFIRINOX.
Deta inali ndi odwala 140 omwe adasankhidwa mwachisawawa omwe ali ndi vuto la ECOG 0 kapena 1. Mu gulu loyamba la opaleshoni, odwala 56 mwa odwala 63 (89%) adachitidwa opaleshoni ndipo 47 (75%) adayamba kulandira chithandizo chamankhwala chothandizira. Mwa odwala 77 omwe adapatsidwa chithandizo chamankhwala chothandizira, 64 (83%) adayamba kulandira chithandizo, 40 (52%) adamaliza kulandira chithandizo, 63 (82%) adachitidwa opaleshoni yochotsa ziwalo, ndipo 51 (66%) adayamba kulandira chithandizo chothandizira.
Zochitika zoyipa za giredi ≥3 (AEs) zidawonedwa mwa 55.6% ya odwala omwe adalandira mankhwala a neoadjuvant chemotherapy, makamaka kutsegula m'mimba, nseru ndi kusanza, komanso neutropenia. Pa nthawi ya mankhwala a adjuvant chemotherapy, pafupifupi 40% ya odwala m'gulu lililonse la chithandizo adakumana ndi ma giredi ≥3 AE.
Mu kusanthula komwe kunkafunika kuchitidwa chithandizo, kupulumuka kwapakati pa chithandizo cha neoadjuvant kunali miyezi 25.1 poyerekeza ndi miyezi 38.5 ndi opaleshoni yochitidwa opaleshoni isanakwane, ndipo mankhwala a neoadjuvant chemotherapy adawonjezera chiopsezo cha kupulumuka ndi 52% (95% CI 0.94–2.46, P=0.06). Chiŵerengero cha kupulumuka kwa miyezi 18 chinali 60% ndi neoadjuvant FOLFIRINOX ndi 73% ndi opaleshoni isanakwane. Kuyesa kwa protocol pa protocol kunapereka zotsatira zofanana.
Zotsatira za histopathologic zimalimbikitsa neoadjuvant chemotherapy popeza 56% ya odwala adapeza R0 status poyerekeza ndi 39% ya odwala omwe adachitidwa opaleshoni yoyambirira (P = 0.076) ndipo 29% adapeza N0 status poyerekeza ndi 14% ya odwala (P = 0.060). Kusanthula kwa protocol iliyonse kunawonetsa kusiyana kwakukulu kwa ziwerengero ndi neoadjuvant FOLFIRINOX mu R0 status (59% vs. 33%, P = 0.011) ndi N0 status (37% vs. 10%, P = 0.002).
Charles Bankhead ndi mkonzi wamkulu wa khansa ndipo amalembanso za matenda a mkodzo, matenda a khungu ndi matenda a maso. Analowa nawo MedPage Today mu 2007.
Kafukufukuyu adathandizidwa ndi Norwegian Cancer Society, Regional Health Authority of 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 Discoveries "Bristol Myers Squibb". Celgene, CrystalGenomics, Leap Therapeutics ndi makampani ena.
Chitsime: Labori KJ et al. “Folfirinox yocheperako yochitidwa opaleshoni yoyambirira ya khansa ya mutu wa kapamba yomwe ingachotsedwe: mayeso a multicenter randomized phase II (NORPACT-1),” ASCO 2023; Chidule cha LBA4005.
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