I-Neoadjuvant chemotherapy kanye nokuhlinzwa kwangaphambili komdlavuza we-pancreatic rectable

I-CHICAGO—I-Neoadjuvant chemotherapy ayikwazi ukufana nokuhlinzwa kwangaphambili ukuze kusinde kumdlavuza we-pancreatic okwazi ukuphindeka, kukhombisa uhlolo oluncane olungahleliwe.
Ngokungalindelekile, iziguli ezahlinzwa okokuqala zaphila isikhathi esingaphezu konyaka kunalezo ezithole inkambo emfushane ye-FOLFIRINOX chemotherapy ngaphambi kokuhlinzwa.Lo mphumela uyamangaza ikakhulukazi uma kubhekwa ukuthi ukwelashwa kwe-neoadjuvant kwakuhlotshaniswa nezinga eliphezulu lemikhawulo engalungile yokuhlinzwa (R0) nokuthi iziguli eziningi eqenjini lokwelapha zithole isimo se-node-negative.
"Ukulandelela okwengeziwe kungase kuchaze kangcono umthelela wesikhathi eside wokuthuthukiswa kwe-R0 ne-N0 eqenjini le-neoadjuvant," kusho u-Knut Jorgen Laborie, MD, University of Oslo, Norway, American Society of Clinical Oncology.ASCO) umhlangano."Imiphumela ayikusekeli ukusetshenziswa kwe-neoadjuvant FOLFIRINOX njengokwelashwa okujwayelekile komdlavuza we-pancreatic."
Lo mphumela wamangaza u-Andrew H. Ko, MD, weNyuvesi yaseCalifornia, eSan Francisco, owamenywa engxoxweni, futhi wavuma ukuthi abasekeli i-neoadjuvant FOLFIRINOX njengenye indlela yokuhlinzwa kwangaphambili.Kodwa futhi abakushiyi ngaphandle lokhu okungenzeka.Ngenxa yentshisekelo ethile ocwaningweni, akwenzeki ukwenza isitatimende esiqondile mayelana nesimo sesikhathi esizayo se-FOLFIRINOX neoadjuvant.
U-Ko waphawula ukuthi ingxenye kuphela yeziguli eziphothule imijikelezo emine ye-neoadjuvant chemotherapy, “ephansi kakhulu kunalokho ebengikulindele kuleli qembu leziguli, lapho imijikelezo emine yokwelashwa ngokuvamile engenzima kakhulu…...Okwesibili, kungani imiphumela evumayo yokuhlinzwa kanye ne-pathologic [R0, N0 isimo] iholela ekuthambekeni emiphumeleni emibi kakhulu eqenjini le-neoadjuvant?baqonde imbangela futhi ekugcineni bashintshele ezimisweni ezisekelwe ku-gemcitabine.”
"Ngakho-ke, asikwazi ngempela ukufinyelela iziphetho eziqinile kulolu cwaningo mayelana nomthelela othize we-perioperative FOLFIRINOX emiphumeleni yokusinda ... I-FOLFIRINOX isatholakala, futhi izifundo ezimbalwa eziqhubekayo zizokhanyisa amandla ayo ekuhlinzeni okukhiphekayo."Izifo.”
U-Laborie waphawula ukuthi ukuhlinzwa kuhlanganiswe nokwelashwa kwe-systemic okusebenzayo kunikeza imiphumela engcono kakhulu yomdlavuza we-pancreatic.Ngokwesiko, izinga lokunakekelwa lifake ukuhlinzwa kwangaphambili kanye ne-adjuvant chemotherapy.Kodwa-ke, ukwelashwa kwe-neoadjuvant okulandelwa ukuhlinzwa kanye ne-adjuvant chemotherapy sekuqalile ukuthandwa phakathi kodokotela abaningi be-oncologist.
Ukwelashwa kwe-Neoadjuvant kunikeza izinzuzo eziningi ezingaba khona: ukulawulwa kusenesikhathi kwesifo sesistimu, ukulethwa okuthuthukisiwe kokwelashwa ngamakhemikhali, kanye nemiphumela ethuthukisiwe ye-histopathological (R0, N0), i-Laborie yaqhubeka.Kodwa-ke, kuze kube manje, asikho isilingo esingahleliwe esibonise ngokusobala inzuzo yokusinda ye-neoadjuvant chemotherapy.
Ukuze kubhekwane nokuntuleka kwedatha ezivivinyweni ezingahleliwe, abacwaningi abavela ezikhungweni eziyi-12 eNorway, eSweden, eDenmark naseFinland baqasha iziguli ezinomdlavuza wekhanda we-pancreatic rectable.Iziguli ezingahleliwe zokuhlinzwa kwangaphambili zithole imijikelezo engu-12 ye-adjuvant-modified FOLFIRINOX (mFOLFIRINOX).Iziguli ezithola ukwelashwa kwe-neoadjuvant zithole imijikelezo ye-4 ye-FOLFIRINOX elandelwa ukuphindaphinda kwesiteji nokuhlinzwa, kulandelwa imijikelezo ye-8 ye-adjuvant mFOLFIRINOX.Isiphetho esiyinhloko kwaba ukusinda kukonke (i-OS), futhi ucwaningo lwanikwa amandla okukhombisa ukuthuthuka kokusinda kwezinyanga eziyi-18 ukusuka ku-50% ngokuhlinzwa okusengaphambili kuya ku-70% nge-neoadjuvant FOLFIRINOX.
Idatha yayihlanganisa iziguli ze-140 ezingahleliwe ezinesimo se-ECOG 0 noma i-1. Eqenjini lokuqala lokuhlinzwa, i-56 yeziguli ze-63 (89%) zahlinzwa futhi i-47 (75%) yaqala i-adjuvant chemotherapy.Ezigulini ezingama-77 ezabelwe ukwelashwa kwe-neoadjuvant, ezingama-64 (83%) zaqala ukwelapha, ezingama-40 (52%) zaqeda ukwelapha, ezingama-63 (82%) zahlinzwa, kwathi ezingama-51 (66%) zaqala ukwelapha nge-adjuvant.
Izehlakalo ezingezinhle zeBanga ≥3 (AEs) zibonwe ku-55.6% weziguli ezithola i-neoadjuvant chemotherapy, ikakhulukazi isifo sohudo, isicanucanu nokuhlanza, kanye ne-neutropenia.Phakathi ne-adjuvant chemotherapy, cishe u-40% weziguli eqenjini ngalinye lokwelapha wabhekana nebanga ≥3 AEs.
Ekuhlaziyweni kwenhloso yokwelapha, ukusinda okuphelele okumaphakathi ngokwelashwa kwe-neoadjuvant kwakuyizinyanga ezingama-25.1 uma kuqhathaniswa nezinyanga ezingama-38.5 ngokuhlinzwa kwangaphambili, kanye ne-neoadjuvant chemotherapy kwandisa ubungozi bokusinda ngo-52% (95% CI 0.94–2.46, P=0.06).Izinga lokusinda lezinyanga eziyi-18 lalingu-60% nge-neoadjuvant FOLFIRINOX kanye nama-73% ngokuhlinzwa kwangaphambili.Ukuhlolwa kwephrothokholi ngayinye kuveze imiphumela efanayo.
Imiphumela ye-Histopathologic ivuna i-neoadjuvant chemotherapy njengoba u-56% weziguli zithole isimo sika-R0 uma kuqhathaniswa no-39% weziguli ezihlinzwe ngaphambi kwesikhathi (P = 0.076) kanye nama-29% athole isimo se-N0 uma kuqhathaniswa no-14% weziguli (P = 0.060).Ukuhlaziywa kwephrothokholi ngayinye kubonise umehluko ophawulekayo wezibalo nge-neoadjuvant FOLFIRINOX esimweni se-R0 (59% vs. 33%, P=0.011) nesimo se-N0 (37% vs. 10%, P=0.002).
UCharles Bankhead ungumhleli omkhulu we-oncology futhi uhlanganisa i-urology, dermatology kanye ne-ophthalmology.Ujoyine i-MedPage Namuhla ngo-2007.
Ucwaningo lusekelwe yiNorwegian Cancer Society, i-Regional Health Authority yaseNingizimu-East Norway, iSwedish Sjoberg Foundation kanye 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 Valleyl Discoveries .Celgene, CrystalGenomics, Leap Therapeutics nezinye izinkampani.
Umthombo wokucaphuna: Labori KJ et al."I-FOLFIRINOX yesikhathi esifushane ye-neoadjuvant ngokumelene nokuhlinzwa kwangaphambili komdlavuza wekhanda we-pancreatic rectable: isivivinyo se-multicenter randomized phase II (NORPACT-1)," i-ASCO 2023;Umfanekiso we-LBA4005.
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