I-CHICAGO—I-Neoadjuvant chemotherapy ayinakufaniswa notyando oluqhutywa kwangaphambili lokusinda kumhlaza wepancreatic onokuthi ususwe, uvavanyo oluncinci olucwangcisiweyo lubonisa.
Ngokungalindelekanga, izigulane ezatyandwa okokuqala zaphila ixesha elingaphezu konyaka ngaphezulu kwezo zafumana ikhosi emfutshane ye-FOLFIRINOX chemotherapy ngaphambi kotyando. Esi siphumo simangalisa ngokukodwa kuba unyango lwe-neoadjuvant lwalunxulunyaniswa nezinga eliphezulu le-negative surgery margins (R0) kwaye izigulane ezininzi kwiqela lonyango zifumene imeko ye-node-negative.
“Ulandelelwano olongezelelweyo lunokuchaza ngcono impembelelo yexesha elide yokuphuculwa kwe-R0 kunye ne-N0 kwiqela le-neoadjuvant,” utshilo uKnut Jorgen Laborie, MD, kwiYunivesithi yaseOslo, eNorway, kwi-American Society of Clinical Oncology. ASCO) intlanganiso. “Iziphumo azixhasi ukusetyenziswa kwe-neoadjuvant FOLFIRINOX njengonyango oluqhelekileyo lomhlaza wepancreatic onokuthi ususwe.”
Esi siphumo sammangalisa uAndrew H. Ko, MD, weYunivesithi yaseCalifornia, eSan Francisco, owayemenyiwe kwingxoxo, waza wavuma ukuba abayixhasi i-neoadjuvant FOLFIRINOX njengendlela eyahlukileyo kunotyando olucwangcisiweyo. Kodwa abakwakhuseli oku kunokwenzeka. Ngenxa yomdla othile kolu phando, akunakwenzeka ukwenza ingxelo ecacileyo malunga nemeko yexesha elizayo ye-FOLFIRINOX neoadjuvant.
UKo uqaphele ukuba sisiqingatha kuphela sezigulana esigqibe imijikelo emine ye-neoadjuvant chemotherapy, “ephantsi kakhulu kunendlela endandiyilindele kweli qela lezigulana, apho imijikelo emine yonyango ngokubanzi ingekho nzima kakhulu…. ..Okwesibini, kutheni Ngaba iziphumo zotyando kunye ne-pathologic ezilungileyo [R0, N0 status] zikhokelela kwindlela eya kwiziphumo ezimbi kwiqela le-neoadjuvant? ukuqonda unobangela kwaye ekugqibeleni utshintshele kwiirejimeni ezisekelwe kwi-gemcitabine.”
“Ngenxa yoko, asinakufikelela kwizigqibo eziqinileyo kolu phononongo malunga nempembelelo ethile ye-FOLFIRINOX eyenzeka ngexesha lotyando kwiziphumo zokusinda… I-FOLFIRINOX isafumaneka, kwaye izifundo ezininzi eziqhubekayo ngethemba lokuba ziya kukhanyisa amandla ayo otyando olunokucocwa.” Izifo.”
ULaborie uqaphele ukuba utyando oludityaniswe nonyango olusebenzayo lwenkqubo lubonelela ngeziphumo ezilungileyo zomhlaza wepancreatic osuswayo. Ngokwesiko, umgangatho wonyango ubandakanya utyando oluqhutywa kwangaphambili kunye ne-adjuvant chemotherapy. Nangona kunjalo, unyango lwe-neoadjuvant olulandelwa lutyando kunye ne-adjuvant chemotherapy luqalile ukuthandwa phakathi koogqirha abaninzi be-oncologists.
Unyango lweNeoadjuvant lubonelela ngeenzuzo ezininzi ezinokubakho: ulawulo lwangethuba lwesifo senkqubo yomzimba, ukuphuculwa kokunikezelwa kwechemotherapy, kunye nokuphuculwa kweziphumo ze-histopathological (R0, N0), uLaborie uqhubekile. Nangona kunjalo, ukuza kuthi ga ngoku, akukho vavanyo olucwangcisiweyo oluye lwabonisa ngokucacileyo inzuzo yokusinda kwe-neoadjuvant chemotherapy.
Ukujongana nokunqongophala kwedatha kwiimvavanyo ezingacwangciswanga, abaphandi abavela kumaziko ali-12 eNorway, eSweden, eDenmark naseFinland baqeshe izigulane ezinomhlaza wentloko yepancreatic onokuthi ususwe. Izigulane ezicwangciswe kwangaphambili zafumana imijikelo eli-12 ye-FOLFIRINOX eguqulweyo (mFOLFIRINOX). Izigulane ezifumana unyango lwe-neoadjuvant zafumana imijikelo emi-4 ye-FOLFIRINOX kulandele ukuphinda kuqaliswe kunye notyando, kulandele imijikelo esi-8 ye-mFOLFIRINOX encedisayo. Isiphelo esiphambili yayikukusinda ngokupheleleyo (OS), kwaye uphando lwalunikwe amandla okubonisa ukuphucuka kokusinda kweenyanga ezili-18 ukusuka kwi-50% ngotyando olucwangcisiweyo ukuya kwi-70% nge-FOLFIRINOX encedisayo.
Idatha yayiquka izigulana ezili-140 ezingacwangciswanga ezinesimo se-ECOG esingu-0 okanye u-1. Kwiqela lokuqala lotyando, izigulana ezingama-56 kwezingama-63 (89%) zatyandwa kwaye ezingama-47 (75%) zaqala unyango lwe-adjuvant chemotherapy. Kwizigulana ezingama-77 ezabelwe unyango lwe-neoadjuvant, ezingama-64 (83%) zaqala unyango, ezingama-40 (52%) zagqiba unyango, ezingama-63 (82%) zanqunyulwa, kwaye ezingama-51 (66%) zaqala unyango lwe-adjuvant.
Iziganeko ezimbi zeBanga ≥3 (ii-AE) zibonwe kwi-55.6% yezigulana ezifumana i-neoadjuvant chemotherapy, ikakhulu isifo sohudo, isicaphucaphu nokuhlanza, kunye ne-neutropenia. Ngexesha le-adjuvant chemotherapy, malunga ne-40% yezigulana kwiqela ngalinye lonyango ziye zafumana ii-AE zeBanga ≥3.
Kuhlalutyo olujoliswe ekunyangeni, umlinganiselo wokuphila jikelele nge-neoadjuvant therapy yayiziinyanga ezingama-25.1 xa kuthelekiswa neenyanga ezingama-38.5 xa kutyandwa kwangaphambili, kwaye i-neoadjuvant chemotherapy yonyusa umngcipheko wokuphila nge-52% (95% CI 0.94–2.46, P=0.06). Izinga lokusinda kweenyanga ezili-18 yayiyi-60% xa kutyandwa kwangaphambili yi-neoadjuvant FOLFIRINOX kunye ne-73% xa kutyandwa kwangaphambili. Uvavanyo lwe-per-protocol luvelise iziphumo ezifanayo.
Iziphumo ze-histopathologic zikhuthaza i-neoadjuvant chemotherapy njengoko ama-56% ezigulana efumene imeko ye-R0 xa kuthelekiswa nama-39% ezigulana ezityandwa kwangaphambili (P = 0.076) kwaye ama-29% efumene imeko ye-N0 xa kuthelekiswa nama-14% ezigulana (P = 0.060). Uhlalutyo lwe-per-protocol lubonise umahluko obalulekileyo ngokwezibalo nge-neoadjuvant FOLFIRINOX kwisimo se-R0 (59% vs. 33%, P=0.011) kunye nesimo se-N0 (37% vs. 10%, P=0.002).
UCharles Bankhead ngumhleli omkhulu we-oncology kwaye ukwathetha nge-urology, i-dermatology kunye ne-ophthalmology. Ujoyine i-MedPage Today ngo-2007.
Olu phononongo luxhaswe yiNorwegian Cancer Society, iRegional Health Authority yaseSouth-East Norway, iSwedish Sjoberg Foundation kunye neHelsinki University Hospital.
Iinketho zoNyango lweKlinikhi, iGerson Lehrman Group, iMedscape, iMJH Life Sciences, uphando oluya kuQheliswa, iAAdi, iFibroGen, iGenentech, iGRAIL, iIpsen, iMerus, iRoche, iAbGenomics, iApexigen, iAstellas, iBioMed Valley Discoveries “Bristol Myers Squibb”. ICelgene, iCrystalGenomics, iLeap Therapeutics kunye nezinye iinkampani.
Umthombo wesicatshulwa: Labori KJ et al. “I-neoadjuvant FOLFIRINOX yesifundo esifutshane xa kuthelekiswa notyando lwangaphambili lomhlaza wentloko yepancreatic onokuthi ususwe: uvavanyo lwesigaba sesiBini olucwangcisiweyo oluneziko ezininzi (i-NORPACT-1),” ASCO 2023; Isishwankathelo LBA4005.
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Ixesha lokuthumela: Sep-22-2023