I-Neoadjuvant chemotherapy kunye notyando lwangaphambili lomhlaza wepancreatic

I-CHICAGO-i-Neoadjuvant chemotherapy ayinakuhambelana notyando lwangaphambili ukuze uphile umhlaza we-pancreatic, uvavanyo oluncinci lubonisa.
Ngokungalindelekanga, izigulane ezatyandwa okokuqala ziphila ixesha elingaphezu konyaka kunezo zafumana ikhosi emfutshane ye-FOLFIRINOX chemotherapy ngaphambi kokuhlinzwa.Esi siphumo simangalisa ngokukodwa kuba unyango lwe-neoadjuvant lwalunxulunyaniswa nesantya esiphezulu semida yotyando olubi (R0) kwaye izigulane ezininzi kwiqela lonyango zifumene isimo se-node-negative.
"Ulandelelwano olongezelelweyo lunokuthi luchaze kangcono impembelelo yexesha elide lokuphucula kwi-R0 kunye ne-N0 kwiqela le-neoadjuvant," kusho uKnut Jorgen Laborie, MD, University of Oslo, eNorway, American Society of Clinical Oncology.ASCO) intlanganiso."Iziphumo azikuxhasi ukusetyenziswa kwe-neoadjuvant FOLFIRINOX njengonyango oluqhelekileyo lomhlaza wepancreatic."
Esi siphumo samangalisa u-Andrew H. Ko, MD, weYunivesithi yaseCalifornia, eSan Francisco, owamenywa kwingxoxo, kwaye wavuma ukuba abaxhasi neoadjuvant FOLFIRINOX njengenye indlela yokuhlinzwa kwangaphambili.Kodwa kwakhona abakhupheli ngaphandle oku kunokwenzeka.Ngenxa yomdla othile kwisifundo, akunakwenzeka ukwenza ingxelo eqinisekileyo malunga nobume bexesha elizayo beFOLFIRINOX neoadjuvant.
U-Ko uphawule ukuba sisiqingatha kuphela sezigulana ezigqibe imijikelo emine ye-neoadjuvant chemotherapy, “ephantsi kakhulu kunento ebendiyilindele kweli qela lezigulana, apho imijikelo emine yonyango ayinzima kakhulu…...Okwesibini, kutheni iziphumo zotyando ezithandekayo kunye ne-pathologic [i-R0, isimo se-N0] zikhokelela kwindlela eya kwiziphumo ezibi kakhulu kwiqela le-neoadjuvant?baqonde unobangela baze ekugqibeleni batshintshele kwiirejimeni ezisekelwe kwi-gemcitabine.”
"Ke ngoko, asinakukwazi ukufikelela kwizigqibo eziqinileyo kolu phononongo malunga nefuthe elithile le-perioperative FOLFIRINOX kwiziphumo zokusinda ... I-FOLFIRINOX ihlala ikhona, kwaye izifundo ezininzi eziqhubekayo ziya kunika ukukhanya malunga nokuba nokwenzeka kotyando olubuyiselwayo."Izifo.”
I-Laborie yaqaphela ukuba utyando oludityaniswe nonyango olusebenzayo lwenkqubo lubonelela ngezona ziphumo zibalaseleyo zomhlaza wepancreatic.Ngokwesiko, umgangatho wokhathalelo ubandakanya utyando lwangaphambili kunye ne-adjuvant chemotherapy.Nangona kunjalo, unyango lwe-neoadjuvant olulandelwa lutyando kunye ne-adjuvant chemotherapy sele iqalile ukufumana ukuthandwa phakathi kwee-oncologists ezininzi.
Unyango lwe-Neoadjuvant lubonelela ngeenzuzo ezininzi ezinokubakho: ukulawula kwangoko isifo senkqubo, ukuhanjiswa okuphuculweyo kwechemotherapy, kunye nokuphuculwa kweziphumo ze-histopathological (R0, N0), iLaborie iqhubekile.Nangona kunjalo, ukuza kuthi ga ngoku, akukho lulingo olungakhethiyo lubonise ngokucacileyo isibonelelo sokusinda kwi-neoadjuvant chemotherapy.
Ukujongana nokungabikho kwedatha kwiimvavanyo ezingahleliwe, abaphandi abavela kumaziko e-12 eNorway, eSweden, eDenmark naseFinland baqesha izigulane ezinomhlaza wentloko ye-pancreatic.Izigulane eziye zafumana utyando lwangaphambili lwafumana imijikelo ye-12 ye-adjuvant-modified FOLFIRINOX (mFOLFIRINOX).Izigulane ezifumana unyango lwe-neoadjuvant lufumene imijikelezo ye-4 ye-FOLFIRINOX elandelwa ngokuphindaphindiweyo kwesiteji kunye nokuhlinzwa, kulandelwa yimijikelezo ye-8 ye-adjuvant mFOLFIRINOX.Isiphelo esiphambili sasikukusinda ngokubanzi (OS), kwaye isifundo sinikwe amandla okubonisa ukuphuculwa kweenyanga ze-18 ukusuka kwi-50% kunye nokuhlinzwa kwangaphambili ukuya kwi-70% kunye ne-neoadjuvant FOLFIRINOX.
Iinkcukacha zibandakanya izigulane ze-140 ezinesimo se-ECOG 0 okanye i-1. Kwiqela lokuqala lotyando, i-56 yezigulane ze-63 (89%) zahlinzwa kwaye i-47 (75%) yaqala i-adjuvant chemotherapy.Kwizigulane ezingama-77 ezabelwe unyango lwe-neoadjuvant, i-64 (83%) iqalise unyango, i-40 (52%) yagqiba unyango, i-63 (82%) yafumana unyango, kwaye i-51 (66%) yaqala unyango lwe-adjuvant.
IBanga ≥3 iziganeko ezibi (AEs) zabonwa kwi-55.6% yezigulane ezifumana i-neoadjuvant chemotherapy, ikakhulukazi isifo sohudo, isicaphucaphu kunye nokuhlanza, kunye ne-neutropenia.Ngexesha le-adjuvant chemotherapy, malunga ne-40% yezigulane kwiqela ngalinye lonyango bafumana ibakala ≥3 AEs.
Kuhlalutyo lwenjongo yokunyanga, ukusinda okupheleleyo kunye nonyango lwe-neoadjuvant lwaluziinyanga ezingama-25.1 xa kuthelekiswa neenyanga ze-38.5 ngotyando olungaphambili, kwaye i-neoadjuvant chemotherapy yandisa umngcipheko wokusinda nge-52% (95% CI 0.94-2.46, P = 0.06).Izinga lokusinda leenyanga ze-18 laliyi-60% kunye ne-neoadjuvant FOLFIRINOX kunye ne-73% ngotyando olungaphambili.Uvavanyo lweprotokholi nganye luvelise iziphumo ezifanayo.
Iziphumo ze-Histopathologic zikhetha i-neoadjuvant chemotherapy njengoko i-56% yezigulane zifumene isimo se-R0 xa kuthelekiswa ne-39% yezigulane zotyando lwangaphambili (P = 0.076) kunye ne-29% iphumelele i-N0 imeko xa kuthelekiswa ne-14% yezigulane (P = 0.060).Uhlalutyo lweprotocol nganye lubonise ukungafani okubonakalayo kunye ne-neoadjuvant FOLFIRINOX kwisimo se-R0 (59% vs. 33%, P = 0.011) kunye nesimo se-N0 (37% vs. 10%, P = 0.002).
UCharles Bankhead ngumhleli ophezulu we-oncology kwaye ukwabandakanya uurology, dermatology kunye ne-ophthalmology.Wajoyina iMedPage Namhlanje kwi-2007.
Uphononongo luxhaswe yiNorwegian Cancer Society, uGunyaziwe wezeMpilo weNgingqi waseMzantsi-mpuma yeNorway, iSwedish Sjoberg Foundation kunye nesibhedlele saseYunivesithi yaseHelsinki.
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 .Celgene, CrystalGenomics, Leap Therapeutics kunye nezinye iinkampani.
Umthombo wocaphulo: Labori KJ et al."Ikhosi emfutshane ye-neoadjuvant FOLFIRINOX ngokubhekiselele kukuhlinzwa kwangaphambili kwi-cancer yentloko ye-pancreatic: i-multicenter randomized phase II trial (NORPACT-1)," i-ASCO 2023;Inkcazo ye-LBA4005.
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