CHICAGO—ʻAʻole hiki i ka chemotherapy Neoadjuvant ke hoʻokūkū i ke ʻoki mua ʻana no ke ola ʻana no ka maʻi ʻaʻai pancreatic hiki ke resectable, e like me ka hōʻike ʻana o kahi hoʻokolohua liʻiliʻi randomized.
ʻO ka mea i manaʻo ʻole ʻia, ʻo nā maʻi i hana ʻia no ke ʻoki kino no ka manawa mua ua ola ma mua o hoʻokahi makahiki ma mua o ka poʻe i loaʻa i kahi papa pōkole o ka chemotherapy FOLFIRINOX ma mua o ke ʻoki kino. He mea kupanaha loa kēia hopena no ka mea ua pili ka lāʻau neoadjuvant me kahi kiʻekiʻe o nā palena ʻoki kino maikaʻi ʻole (R0) a ʻoi aku ka nui o nā maʻi i loko o ka hui lapaʻau i loaʻa ke kūlana node-negative.
"Hiki paha i ka hahai hou ʻana ke wehewehe maikaʻi i ka hopena lōʻihi o nā hoʻomaikaʻi ʻana ma R0 a me N0 i ka hui neoadjuvant," wahi a Knut Jorgen Laborie, MD, Ke Kulanui o Oslo, Norewai, ka hālāwai ʻo American Society of Clinical Oncology. ASCO). "ʻAʻole kākoʻo nā hopena i ka hoʻohana ʻana i ka neoadjuvant FOLFIRINOX ma ke ʻano he lāʻau maʻamau no ka maʻi kanesa pancreatic hiki ke hoʻopau ʻia."
Ua kāhāhā kēia hopena iā Andrew H. Ko, MD, o ke Kulanui o Kaleponi, Kapalakiko, ka mea i kono ʻia i ke kūkākūkā ʻana, a ua ʻae ʻo ia ʻaʻole lākou e kākoʻo i ka neoadjuvant FOLFIRINOX ma ke ʻano he koho ʻē aʻe i ke ʻoki mua. Akā, ʻaʻole lākou e kāpae i kēia hiki. Ma muli o kekahi hoihoi i ke aʻo ʻana, ʻaʻole hiki ke hana i kahi ʻōlelo paʻa e pili ana i ke kūlana o ka FOLFIRINOX neoadjuvant i ka wā e hiki mai ana.
Ua ʻōlelo ʻo Ko ʻo ka hapalua wale nō o nā maʻi i hoʻopau i ʻehā mau pōʻaiapuni o ka chemotherapy neoadjuvant, "ʻoi aku ka haʻahaʻa ma mua o kaʻu i manaʻo ai no kēia hui o nā maʻi, nona nā pōʻaiapuni ʻehā o ka mālama ʻana ʻaʻole paʻakikī loa .... ..ʻO ka lua, no ke aha ʻoi aku ka maikaʻi o nā hopena ʻokiʻoki a me nā pathologic [R0, N0 status] e alakaʻi ai i kahi ʻano i nā hopena ʻino aʻe i ka hui neoadjuvant? e hoʻomaopopo i ke kumu a hoʻololi hope i nā regimens gemcitabine-based."
"No laila, ʻaʻole hiki iā mākou ke huki i nā hopena paʻa mai kēia haʻawina e pili ana i ka hopena kikoʻī o ka FOLFIRINOX perioperative i nā hopena ola ... Loaʻa mau ʻo FOLFIRINOX, a ke manaʻolana nei e hoʻomālamalama kekahi mau haʻawina e hana nei i kona hiki ke hana i ke ʻoki hiki ke hoʻopau ʻia." Nā maʻi.
Ua ʻōlelo ʻo Laborie ʻo ke ʻoki ʻana i hui pū ʻia me ka lāʻau lapaʻau systemic kūpono e hāʻawi i nā hopena maikaʻi loa no ka maʻi kanesa pancreatic hiki ke wehe ʻia. ʻO ka mea maʻamau, ua hoʻokomo pū ʻia ke kūlana mālama i ka ʻoki mua a me ka chemotherapy adjuvant. Eia nō naʻe, ua hoʻomaka ka lāʻau lapaʻau neoadjuvant i ukali ʻia e ke ʻoki ʻana a me ka chemotherapy adjuvant e kaulana i waena o nā oncologists he nui.
Hāʻawi ka lāʻau lapaʻau Neoadjuvant i nā pono he nui: ka kaohi mua ʻana i nā maʻi ʻōnaehana, ka hoʻomaikaʻi ʻana i ka hāʻawi ʻana o ka chemotherapy, a me ka hoʻomaikaʻi ʻana i nā hopena histopathological (R0, N0), hoʻomau ʻo Laborie. Eia nō naʻe, a hiki i kēia lā, ʻaʻohe hoʻokolohua randomized i hōʻike maopopo i kahi pono ola o ka chemotherapy neoadjuvant.
No ka hoʻoponopono ʻana i ka nele o ka ʻikepili i nā hoʻokolohua randomized, ua hoʻopaʻa inoa nā mea noiʻi mai 12 mau kikowaena ma Norewai, Suedena, Denemaka a me Finland i nā maʻi me ke kanesa poʻo pancreatic hiki ke wehe ʻia. Ua loaʻa i nā maʻi i randomized ʻia i ke ʻoki mua he 12 mau pōʻaiapuni o ka FOLFIRINOX i hoʻololi ʻia e ka adjuvant (mFOLFIRINOX). Ua loaʻa i nā maʻi e loaʻa ana i ka lāʻau neoadjuvant he 4 mau pōʻaiapuni o FOLFIRINOX a ukali ʻia e ke kahua hana hou a me ke ʻoki ʻana, a ukali ʻia e 8 mau pōʻaiapuni o ka adjuvant mFOLFIRINOX. ʻO ke kumu nui ʻo ke ola holoʻokoʻa (OS), a ua hoʻoikaika ʻia ke aʻo ʻana e hōʻike i kahi hoʻomaikaʻi ʻana i ke ola 18 mahina mai 50% me ke ʻoki mua a i 70% me ka neoadjuvant FOLFIRINOX.
Ua komo pū ka ʻikepili me 140 mau maʻi randomized me ke kūlana ECOG 0 a i ʻole 1. I ka hui ʻoki kino mua, ua hana ʻia ke ʻoki kino he 56 o 63 mau maʻi (89%) a ua hoʻomaka ʻo 47 (75%) i ka chemotherapy adjuvant. No nā maʻi 77 i hāʻawi ʻia i ka lāʻau neoadjuvant, ua hoʻomaka ʻo 64 (83%) i ka lāʻau, ua hoʻopau ʻo 40 (52%) i ka lāʻau, ua hana ʻia ke resection he 63 (82%), a ua hoʻomaka ʻo 51 (66%) i ka lāʻau adjuvant.
Ua ʻike ʻia nā hanana ʻino (AE) papa ≥3 ma 55.6% o nā maʻi e loaʻa ana i ka chemotherapy neoadjuvant, ʻo ia hoʻi ka maʻi diarrhea, ka nausea a me ka luaʻi, a me ka neutropenia. I ka wā o ka chemotherapy adjuvant, ma kahi o 40% o nā maʻi i kēlā me kēia hui lapaʻau i loaʻa i ka papa ≥3 AEs.
Ma kahi loiloi manaʻo-e-lāʻau ai, ʻo ke ola holoʻokoʻa me ka lāʻau neoadjuvant he 25.1 mau mahina i hoʻohālikelike ʻia me 38.5 mau mahina me ke ʻoki mua ʻana, a ua hoʻonui ka chemotherapy neoadjuvant i ka pilikia o ke ola ʻana ma 52% (95% CI 0.94–2.46, P=0.06). ʻO ka helu ola 18 mahina he 60% me ka neoadjuvant FOLFIRINOX a me 73% me ke ʻoki mua ʻana. Ua hāʻawi nā hoʻāʻo per-protocol i nā hopena like.
ʻOi aku ka maikaʻi o nā hopena histopathologic i ka chemotherapy neoadjuvant ʻoiai he 56% o nā maʻi i loaʻa ke kūlana R0 i hoʻohālikelike ʻia me 39% o nā maʻi i hana ʻoki mua ʻia (P = 0.076) a he 29% i loaʻa ke kūlana N0 i hoʻohālikelike ʻia me 14% o nā maʻi (P = 0.060). Ua hōʻike ka loiloi per-protocol i nā ʻokoʻa koʻikoʻi me ka neoadjuvant FOLFIRINOX ma ke kūlana R0 (59% vs. 33%, P=0.011) a me ke kūlana N0 (37% vs. 10%, P=0.002).
He luna hoʻoponopono oncology kiʻekiʻe ʻo Charles Bankhead a uhi pū kekahi i ka urology, dermatology a me ophthalmology. Ua hui pū ʻo ia me MedPage Today i ka makahiki 2007.
Ua kākoʻo ʻia ke aʻo ʻana e ka Norwegian Cancer Society, ka Regional Health Authority of South-East Norway, ka Swedish Sjoberg Foundation a me ka Halemai Kulanui ʻo Helsinki.
ʻO 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 “Bristol Myers Squibb”. ʻO Celgene, CrystalGenomics, Leap Therapeutics a me nā ʻoihana ʻē aʻe.
Kumu Kuhikuhi: Labori KJ et al. “ʻO ka FOLFIRINOX neoadjuvant pōkole e kūʻē i ke ʻoki mua ʻana no ka maʻi ʻaʻai poʻo pancreatic hiki ke hoʻopau ʻia: kahi hoʻokolohua pae II randomized multicenter (NORPACT-1),” ASCO 2023; ʻŌlelo Pōkole LBA4005.
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Ka manawa hoʻouna: Sep-22-2023