CHICAGO—Kuongororwa kudiki kunoratidza kuti chemotherapy yeNeoadjuvant haifanirwe kuenzaniswa nekuvhiyiwa kwekutanga kuti urarame nekenza yepancreatic inogona kubviswa, kana ikashandiswa nenzira isina kurongeka.
Zvisingatarisirwi, varwere vakavhiyiwa kekutanga vakararama kwenguva inopfuura gore kupfuura avo vakapihwa FOLFIRINOX chemotherapy pfupi vasati vavhiyiwa. Mhedzisiro iyi inoshamisa zvikuru tichifunga kuti kurapwa neoadjuvant kwakabatana nehuwandu hwakakwira hwema "negative surgical margins" (R0) uye kuti varwere vakawanda muboka rekurapwa vakawana mamiriro e "node-negative".
"Kutevera kumwe kunogona kutsanangura zviri nani mhedzisiro yenguva refu yekuvandudzwa kweR0 neN0 muboka reneoadjuvant," akadaro musangano waKnut Jorgen Laborie, MD, University of Oslo, Norway, American Society of Clinical Oncology. ASCO. "Mhedzisiro yacho haitsigire kushandiswa kweneoadjuvant FOLFIRINOX senzira yakajairika yekurapa kenza yepancreatic inogona kubviswa."
Mhedzisiro iyi yakashamisa Andrew H. Ko, MD, weYunivhesiti yeCalifornia, San Francisco, uyo akakokwa kuhurukuro iyi, uye akabvuma kuti havatsigire FOLFIRINOX yevana vacheche senzira yekuvhiyiwa pachine nguva. Asi havabvisi mukana uyu. Nekuda kwekufarira kwakati muchidzidzo ichi, hazvigoneke kutaura zvakajeka nezveramangwana reFOLFIRINOX yevana vacheche.
Ko akataura kuti hafu chete yevarwere vakapedza madenderedzwa mana ekurapa neoadjuvant chemotherapy, "izvo zvakaderera pane zvandaitarisira kuboka iri revarwere, avo madenderedzwa mana ekurapwa kazhinji kacho asiri akaoma zvikuru .... ..Chechipiri, sei mhedzisiro yakanaka yekuvhiya uye yezvirwere [R0, N0 status] ichitungamira kune mafambiro emhedzisiro yakaipa muboka reneoadjuvant? nzwisisa chikonzero uye pakupedzisira chinja kune mishonga yakagadzirwa negemcitabine."
"Saka, hatigone kuwana mhedziso dzakasimba kubva muchidzidzo ichi nezvemhedzisiro chaiyo yeFOLFIRINOX inobatwa ne perioperative pamigumisiro yekurarama ... FOLFIRINOX ichiripo, uye zvidzidzo zvakawanda zviri kuenderera mberi zvinotarisirwa kuti zvichajekesa kugona kwayo mukuvhiyiwa kunogona kubviswa nhengo." Zvirwere.
Laborie akataura kuti kuvhiyiwa pamwe chete nekurapwa kwemuviri kunoshanda zvinopa mhedzisiro yakanakisa yekenza yepancreas inobviswa. Pachivanhu, mwero wekurapa waisanganisira kuvhiyiwa kwekutanga uye chemotherapy ye adjuvant. Zvisinei, kurapwa kwe neoadjuvant kunoteverwa nekuvhiyiwa uye chemotherapy ye adjuvant kwatanga kufarirwa pakati pevanachiremba vazhinji vekenza.
Kurapa kweNeoadjuvant kune zvakawanda zvinogona kubatsira: kudzora chirwere chemuviri nekukurumidza, kurapa kwakawedzerwa kwechemotherapy, uye mhedzisiro ye histopathological iri nani (R0, N0), Laborie yakaenderera mberi. Zvisinei, kusvika pari zvino, hapana bvunzo yakasarudzika yakaratidza pachena kuti chemotherapy yeneoadjuvant inobatsira pakurarama.
Kuti vagadzirise kushomeka kwedata mumiedzo yakasarudzika, vaongorori vanobva kunzvimbo gumi nembiri muNorway, Sweden, Denmark neFinland vakatsvaga varwere vane kenza yemusoro wepancreas inobviswa. Varwere vakavhiyiwa nekukurumidza vakapihwa ma cycle gumi nemaviri e adjuvant-modified FOLFIRINOX (mFOLFIRINOX). Varwere vaigamuchira neoadjuvant therapy vakagamuchira ma cycle mana e FOLFIRINOX zvichiteverwa nekudzokorora kuvhiyiwa, zvichiteverwa ne cycle masere dze adjuvant mFOLFIRINOX. Mugumo mukuru waive wekurarama kwese (OS), uye chidzidzo ichi chakapihwa simba rekuratidza kuvandudzika mukurarama kwemwedzi gumi nemisere kubva pa50% nekuvhiyiwa kwekutanga kusvika pa70% ne neoadjuvant FOLFIRINOX.
Ruzivo rwaisanganisira varwere 140 vakasarudzirwa vane ECOG status 0 kana 1. Muboka rekutanga rekuvhiyiwa, 56 pavarwere 63 (89%) vakavhiyiwa uye 47 (75%) vakatanga kurapwa ne adjuvant chemotherapy. Pavarwere 77 vakapihwa neoadjuvant therapy, 64 (83%) vakatanga kurapwa, 40 (52%) vakapedza kurapwa, 63 (82%) vakavhiyiwa resection, uye 51 (66%) vakatanga kurapwa ne adjuvant.
Zviitiko zvakaipa zveGiredhi ≥3 (AEs) zvakaonekwa mu55.6% yevarwere vaigamuchira neoadjuvant chemotherapy, kunyanya manyoka, kuda kurutsa nekurutsa, uye neutropenia. Munguva yeadjuvant chemotherapy, vanenge 40% yevarwere muboka rega rega rekurapwa vakasangana neGiredhi ≥3 AEs.
Mukuongorora kwakaitwa nechinangwa chekurapa, avhareji yekurarama kwese ne neoadjuvant therapy yaive mwedzi 25.1 zvichienzaniswa nemwedzi 38.5 ne kuvhiyiwa kwekutanga, uye neoadjuvant chemotherapy yakawedzera njodzi yekurarama ne52% (95% CI 0.94–2.46, P=0.06). Mwero wekurarama kwemwedzi gumi nemisere waive 60% ne neoadjuvant FOLFIRINOX uye 73% ne kuvhiyiwa kwekutanga. Kuongororwa kweprotocol kwakawana mhedzisiro yakafanana.
Mhedzisiro yekuongorora histopathologies inotsigira neoadjuvant chemotherapy sezvo 56% yevarwere vakawana R0 status zvichienzaniswa ne39% yevarwere vakavhiyiwa kare (P = 0.076) uye 29% vakawana N0 status zvichienzaniswa ne14% yevarwere (P = 0.060). Ongororo yeprotocol yakaratidza mutsauko wakakosha ne neoadjuvant FOLFIRINOX mu R0 status (59% vs. 33%, P=0.011) uye N0 status (37% vs. 10%, P=0.002).
Charles Bankhead mupepeti mukuru wezvekenza uye anonyorawo nezveurology, dermatology uye ophthalmology. Akabatana neMedPage Today muna 2007.
Chidzidzo ichi chakatsigirwa neNorwegian Cancer Society, Regional Health Authority yeSouth-East Norway, Swedish Sjoberg Foundation neHelsinki 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 nedzimwe makambani.
Chinyorwa: Labori KJ nevamwe. “Folfirinox yekukurumidza kwenguva pfupi ichienzaniswa nekuvhiyiwa kwekutanga kwekenza yemusoro wepancreatic inobviswa: bvunzo yechikamu chechipiri chemasero akawanda (NORPACT-1),” ASCO 2023; Pfupiso LBA4005.
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Nguva yekutumira: Gunyana-22-2023