CHICAGO—E ai ki tētahi whakamātautau matapōkere iti, kāore e taea e te chemotherapy neoadjuvant te whakataurite i te pokanga o mua mō te oranga o te mate pukupuku repe taikaha ka taea te tango.
I te mea ohorere, i roa ake te ora o ngā tūroro i pokangahia mō te wā tuatahi i te hunga i whiwhi i te rongoā chemotherapy FOLFIRINOX poto i mua i te pokanga. He tino miharo tēnei hua i te mea i honoa te rongoā neoadjuvant ki te reiti teitei ake o ngā tawhē pokanga kino (R0) me te nui ake o ngā tūroro i roto i te rōpū maimoatanga i eke ki te tūnga pona-kino.
"Tērā pea mā te whai ake i ētahi atu arotakenga ka pai ake te whakamārama i te pānga roa o ngā whakapainga i roto i te R0 me te N0 i roto i te rōpū neoadjuvant," te kī a Knut Jorgen Laborie, MD, Te Whare Wānanga o Oslo, Norway, te hui a te American Society of Clinical Oncology. ASCO). "Kāore ngā hua e tautoko i te whakamahinga o te neoadjuvant FOLFIRINOX hei maimoatanga paerewa mō te mate pukupuku repe taikaha ka taea te tango."
I ohorere a Andrew H. Ko, MD, o Te Whare Wānanga o California, San Francisco, i tēnei hua, i karangatia ki te kōrero, ā, i whakaae ia kāore rātou e tautoko i te neoadjuvant FOLFIRINOX hei huarahi kē atu ki te pokanga o mua. Engari kāore hoki rātou e whakakore i tēnei tūponotanga. Nā te hiahia ki te rangahau, kāore e taea te whakaputa i tētahi kōrero tino tika mō te āhua o te FOLFIRINOX neoadjuvant ā muri ake nei.
I kī a Ko ko te haurua anake o ngā tūroro i whakaoti i ngā huringa e whā o te chemotherapy neoadjuvant, "he iti iho i taku i tumanako ai mō tēnei rōpū tūroro, kāore i te tino uaua ngā huringa maimoatanga e whā mō rātou…. ..Tuarua, he aha te take e pai ake ai ngā putanga pokanga me ngā putanga mate [R0, N0] ki te ia o ngā putanga kino ake i roto i te rōpū neoadjuvant? kia mārama ki te take, ā, hei whakamutunga ka huri ki ngā tikanga gemcitabine."
"Nō reira, kāore e taea e mātou te whakatau i ngā whakatau pakari mai i tēnei rangahau mō te pānga motuhake o te FOLFIRINOX i te wā o te pokanga ki ngā putanga oranga… Kei te wātea tonu te FOLFIRINOX, ā, e tūmanakohia ana ka whakamāramahia e ētahi rangahau kei te haere tonu tōna pūmanawa ki te pokanga ka taea te tango." Ngā mate."
I kī a Laborie ko te pokanga me te rongoā pūnaha whai hua ka puta ai ngā hua pai rawa atu mō te mate pukupuku repe taikaha ka taea te tango. I ngā wā o mua, ko te paerewa tiaki ko te pokanga i mua me te chemotherapy adjuvant. Heoi, kua tīmata te rongonui o te rongoā neoadjuvant i muri mai i te pokanga me te chemotherapy adjuvant i waenga i te tini o ngā tākuta mate pukupuku.
He maha ngā painga pea o te rongoā neoadjuvant: te whakahaere wawe i te mate pūnaha, te whakapai ake i te tukunga o te chemotherapy, me te whakapai ake i ngā putanga histopathological (R0, N0), ka haere tonu a Laborie. Heoi, tae noa ki tēnei wā, kāore anō kia whakaaturia he hua ora tonu mai i te rongoā neoadjuvant i roto i tētahi whakamātautau matapōkere.
Hei whakatika i te korenga o ngā raraunga i roto i ngā whakamātautau matapōkere, i kimihia e ngā kairangahau mai i ngā pokapū 12 i Nōwei, Huitene, Tenemāka me Pinirana ngā tūroro he mate pukupuku pane repe ka taea te tango. I whiwhi ngā tūroro i matapōkeretia ki te pokanga wawe i te 12 huringa o te FOLFIRINOX whakarerekē-āpiti (mFOLFIRINOX). I whiwhi ngā tūroro i whiwhi i te rongoā neoadjuvant i te 4 huringa o te FOLFIRINOX, ā, i muri mai ko te whakatauranga me te pokanga anō, ā, i muri mai ko te 8 huringa o te mFOLFIRINOX āwhina. Ko te mutunga matua ko te oranga whānui (OS), ā, i whakamanahia te rangahau ki te whakaatu i te whakapainga o te oranga 18-marama mai i te 50% me te pokanga wawe ki te 70% me te FOLFIRINOX neoadjuvant.
I roto i ngā raraunga, 140 ngā tūroro matapōkeretia me te tūnga ECOG 0, 1 rānei. I te rōpū pokanga tuatahi, 56 o te 63 ngā tūroro (89%) i pokangahia, ā, 47 (75%) i tīmata i te chemotherapy adjuvant. Mai i te 77 ngā tūroro i tohua ki te rongoā neoadjuvant, 64 (83%) i tīmata i te rongoā, 40 (52%) i whakaoti i te rongoā, 63 (82%) i tangohia te puku, ā, 51 (66%) i tīmata i te rongoā adjuvant.
I kitea ngā pānga kino (AE) taumata ≥3 i roto i te 55.6% o ngā tūroro i whiwhi i te chemotherapy neoadjuvant, ko te nuinga ko te korere, te whakapairuaki me te ruaki, me te neutropenia. I te wā o te chemotherapy adjuvant, tata ki te 40% o ngā tūroro i ia rōpū maimoatanga i pāngia e ngā AE taumata ≥3.
I roto i tētahi tātaritanga mō te rongoā-ā-roto, ko te roanga oranga whānui mō te hunga i whiwhi i te rongoā neoadjuvant he 25.1 marama, ki te whakaritea ki te 38.5 marama i whiwhi i te pokanga i mua, ā, nā te rongoā neoadjuvant i whakapiki ake te mōrearea o te oranga mā te 52% (95% CI 0.94–2.46, P=0.06). Ko te reiti oranga mō ngā marama 18 he 60% me te neoadjuvant FOLFIRINOX, ā, 73% me te hunga i whiwhi i te pokanga i mua. He rite tonu ngā hua i puta mai i ngā whakamātautau ia-tikanga.
E tautokona ana e ngā hua histopathologic te chemotherapy neoadjuvant i te mea 56% o ngā tūroro i eke ki te tūnga R0 i whakaritea ki te 39% o ngā tūroro i pokanga wawe (P = 0.076) ā, 29% i eke ki te tūnga N0 i whakaritea ki te 14% o ngā tūroro (P = 0.060). I whakaatuhia e te tātaritanga ia-tikanga he rerekētanga nui i roto i te tūnga R0 me te neoadjuvant FOLFIRINOX (59% vs. 33%, P=0.011) me te tūnga N0 (37% vs. 10%, P=0.002).
He ētita matua a Charles Bankhead mō te matepukupuku, ā, e kapi ana hoki i ngā mahi urology, dermatology me ophthalmology. I uru atu ia ki MedPage Today i te tau 2007.
I tautokona te rangahau e te Norwegian Cancer Society, te Mana Hauora Rohe o te Tonga-Rawhiti o Norway, te Swedish Sjoberg Foundation me te Hōhipera Whare Wānanga o Helsinki.
Ko ētahi atu kamupene ko 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 me ētahi atu kamupene.
Tohutoro Pūtake: Labori KJ et al. “Te pokanga poto-wāhanga neoadjuvant FOLFIRINOX versus te pokanga ā-mua mō te mate pukupuku pane repe taikaha ka taea te tango: he whakamātautau wāhanga II matapōkere maha-pokapū (NORPACT-1),” ASCO 2023; Whakarāpopototanga LBA4005.
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Wā tuku: Hepetema-22-2023