I-CHICAGO—I-Neoadjuvant chemotherapy ayikwazi ukulingana nokuhlinzwa kwangaphambilini ukuze kusindiswe umdlavuza we-pancreatic ongase ususwe, kusho ucwaningo oluncane olungahleliwe.
Ngokungalindelekile, iziguli ezahlinzwa okokuqala zaphila isikhathi esingaphezu konyaka kunalezo ezathola inkambo emfushane ye-FOLFIRINOX chemotherapy ngaphambi kokuhlinzwa. Lo mphumela uyamangalisa ikakhulukazi uma ubheka ukuthi ukwelashwa kwe-neoadjuvant kwakuhlotshaniswa nesilinganiso esiphezulu semingcele yokuhlinzwa engemihle (R0) nokuthi iziguli eziningi eqenjini lokwelashwa zathola isimo se-node-negative.
“Ukulandelela okwengeziwe kungachaza kangcono umthelela wesikhathi eside wokuthuthuka ku-R0 kanye ne-N0 eqenjini le-neoadjuvant,” kusho umhlangano kaKnut Jorgen Laborie, MD, eNyuvesi yase-Oslo, eNorway, e-American Society of Clinical Oncology. ASCO. “Imiphumela ayisekeli ukusetshenziswa kwe-neoadjuvant FOLFIRINOX njengokwelashwa okujwayelekile komdlavuza we-pancreatic ongase ususwe.”
Lo mphumela wamangaza u-Andrew H. Ko, MD, wase-University of California, eSan Francisco, owayemenyiwe engxoxweni, futhi wavuma ukuthi abasekeli i-FOLFIRINOX ye-neoadjuvant njengendlela ehlukile yokuhlinzwa kwangaphambili. Kodwa futhi abakukhiphi lokhu kungenzeka. Ngenxa yesithakazelo esithile ocwaningweni, akunakwenzeka ukwenza isitatimende esiqondile mayelana nesimo sesikhathi esizayo se-FOLFIRINOX neoadjuvant.
UKo waphawula ukuthi ingxenye kuphela yeziguli eqede imijikelezo emine ye-neoadjuvant chemotherapy, “okuphansi kakhulu kunalokho engangikulindele kuleli qembu leziguli, lapho imijikelezo emine yokwelashwa ngokuvamile ingeyona enzima kakhulu…. ..Okwesibili, kungani Ingabe imiphumela emihle kakhulu yokuhlinzwa neye-pathologic [R0, isimo se-N0] iholela ekuthambekeleni emiphumeleni emibi eqenjini le-neoadjuvant? qonda imbangela bese ekugcineni ushintshela emithini esekelwe ku-gemcitabine.”
"Ngakho-ke, asikwazi ngempela ukuthola iziphetho eziqinile kulolu cwaningo mayelana nomthelela othize we-FOLFIRINOX eyenzeka ngesikhathi sokuhlinzwa emiphumeleni yokusinda... I-FOLFIRINOX isatholakala, futhi izifundo eziningana eziqhubekayo ngethemba lokuthi zizokhanyisa amandla ayo ekuhlinzeni okungasetshenziswa kabusha." Izifo.
ULaborie waphawula ukuthi ukuhlinzwa okuhlangene nokwelashwa okusebenzayo kwesistimu kunikeza imiphumela emihle kakhulu yomdlavuza we-pancreatic osuswayo. Ngokwesiko, izinga lokunakekelwa lifaka phakathi ukuhlinzwa kwangaphambilini kanye ne-adjuvant chemotherapy. Kodwa-ke, ukwelashwa kwe-neoadjuvant okulandelwa ukuhlinzwa kanye ne-adjuvant chemotherapy sekuqalile ukuthandwa phakathi kodokotela abaningi be-oncologists.
Ukwelashwa kwe-Neoadjuvant kunikeza izinzuzo eziningi ezingaba khona: ukulawulwa kwangaphambi kwesikhathi kwezifo zesistimu, ukulethwa okuthuthukisiwe kwe-chemotherapy, kanye nemiphumela ethuthukisiwe ye-histopathological (R0, N0), kuqhubeka uLaborie. Kodwa-ke, kuze kube manje, akukho sivivinyo esingahleliwe esibonise ngokusobala inzuzo yokusinda kwe-neoadjuvant chemotherapy.
Ukuze kulungiswe ukuntuleka kwedatha ezivivinyweni ezingahleliwe, abacwaningi abavela ezikhungweni ezingu-12 eNorway, eSweden, eDenmark naseFinland baqashe iziguli ezinomdlavuza wekhanda le-pancreatic ongase ususwe. Iziguli ezihlinzwe ngokungahleliwe ngaphambi kokuhlinzwa zithole imijikelezo engu-12 ye-FOLFIRINOX (mFOLFIRINOX) eguquliwe njenge-adjuvant. Iziguli ezithola ukwelashwa kwe-neoadjuvant zithole imijikelezo engu-4 ye-FOLFIRINOX elandelwe ukuphindaphinda kanye nokuhlinzwa, kulandelwe imijikelezo engu-8 ye-mFOLFIRINOX e-adjuvant. Isiphetho esiyinhloko kwakuwukusinda okuphelele (i-OS), futhi ucwaningo lwalunikwe amandla okukhombisa ukuthuthuka kokusinda kwezinyanga ezingu-18 kusuka ku-50% ngokuhlinzwa kusengaphambili kuya ku-70% nge-FOLFIRINOX e-neoadjuvant.
Idatha yayihlanganisa iziguli ezingu-140 ezingahleliwe ezinesimo se-ECOG esingu-0 noma esingu-1. Eqenjini lokuqala lokuhlinzwa, iziguli ezingu-56 kwezingu-63 (89%) zahlinzwa kanti ezingu-47 (75%) zaqala ukwelashwa ngamakhemikhali angewona awe-adjuvant. Ezigulini ezingu-77 ezanikezwa ukwelashwa nge-neoadjuvant, ezingu-64 (83%) zaqala ukwelashwa, ezingu-40 (52%) zaqeda ukwelashwa, ezingu-63 (82%) zahlinzwa, kanti ezingu-51 (66%) zaqala ukwelashwa nge-adjuvant.
Izehlakalo ezimbi zebanga ≥3 (ama-AE) zabonwa ku-55.6% weziguli ezithola i-neoadjuvant chemotherapy, ikakhulukazi isifo sohudo, isicanucanu nokuhlanza, kanye ne-neutropenia. Ngesikhathi se-adjuvant chemotherapy, cishe u-40% weziguli eqenjini ngalinye lokwelashwa zathola i-grade ≥3 AEs.
Ekuhlaziyweni okuhloswe ngakho ukwelapha, ukusinda okumaphakathi okuphelele ngokwelashwa kwe-neoadjuvant kwakuyizinyanga ezingu-25.1 uma kuqhathaniswa nezinyanga ezingu-38.5 ngokuhlinzwa kusenesikhathi, kanti ukwelashwa ngamakhemikhali kwe-neoadjuvant kwandisa ingozi yokusinda ngo-52% (95% CI 0.94–2.46, P=0.06). Izinga lokusinda kwezinyanga ezingu-18 lalingu-60% nge-neoadjuvant FOLFIRINOX kanye no-73% ngokuhlinzwa kusenesikhathi. Ukuhlolwa kwephrothokholi ngayinye kuveze imiphumela efanayo.
Imiphumela ye-histopathologic ithanda ukwelashwa ngamakhemikhali kwe-neoadjuvant njengoba iziguli ezingu-56% zithole isimo se-R0 uma kuqhathaniswa neziguli ezingu-39% ezihlinzwe kusengaphambili (P = 0.076) kanye neziguli ezingu-29% zithole isimo se-N0 uma kuqhathaniswa neziguli ezingu-14% (P = 0.060). Ukuhlaziywa kwephrothokholi ngayinye kubonise umehluko obalulekile ngokwezibalo nge-neoadjuvant FOLFIRINOX esimweni se-R0 (59% vs. 33%, P=0.011) kanye nesimo se-N0 (37% vs. 10%, P=0.002).
UCharles Bankhead ungumhleli omkhulu we-oncology futhi uhlanganisa ne-urology, i-dermatology kanye ne-ophthalmology. Wajoyina i-MedPage Today ngo-2007.
Ucwaningo lusekelwe yiNorwegian Cancer Society, iRegional Health Authority yaseNingizimu-mpumalanga yeNorway, iSwedish Sjoberg Foundation kanye neHelsinki University Hospital.
Izinketho Zokunakekelwa Kwemitholampilo zeKo 披露了与 I-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”. I-Celgene, i-CrystalGenomics, i-Leap Therapeutics nezinye izinkampani.
Umthombo Wokucaphuna: Labori KJ nabanye. “I-neoadjuvant FOLFIRINOX yesifundo esifushane uma kuqhathaniswa nokuhlinzwa kwangaphambili komdlavuza wekhanda le-pancreatic ongase ususwe: isivivinyo sesigaba II esingahleliwe esisezindaweni eziningi (i-NORPACT-1),” i-ASCO 2023; Isifinyezo se-LBA4005.
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Isikhathi sokuthunyelwe: Septhemba-22-2023