【佳學(xué)基因靶向藥物基因檢測】基于突變的短期“新輔助”治療可使 IVB 期和 C 期甲狀腺間變癌實現(xiàn)可切除性

中國基因檢測公司排名詳解

討論了腫瘤個體化藥物研究路徑做備注《Eur Arch Otorhinolaryngol》在?2023 Jan 13.發(fā)表了一篇題目為《》腫瘤靶向藥物治療基因檢測臨床研究文章。該研究由Elisabeth Maurer,?F Eilsberger,?S W?chter,?J Riera Knorrenschild,?A Pehl,?K Holzer,?A Neubauer,?M Luster,?D K Bartsch等完成。促進了腫瘤的正確治療與個性化用藥的發(fā)展，進一步強調(diào)了基因信息檢測與分析的重要性。

腫瘤基因檢測及靶向藥物治療研究關(guān)鍵詞：

間變性甲狀腺癌,基于突變的治療,新輔助治療。

腫瘤治療檢測基因臨床應(yīng)用結(jié)果

簡介：很少有可用數(shù)據(jù)表明，基于突變的“新輔助”治療晚期甲狀腺未分化癌 (ATC) 可能會將賊初無法切除的原發(fā)性腫瘤轉(zhuǎn)化為可切除的，并優(yōu)化局部腫瘤控制。我們在三名 ATC IVB 期和 C 期患者中評估了術(shù)前短期“新輔助”治療與 BRAF 定向治療，或者在 BRAF 非突變腫瘤的情況下，mKI/檢查點抑制劑組合。佳學(xué)基因解碼的途徑：在盡快開始術(shù)前診斷、免疫組織化學(xué) (IHC) 評估和基因分析。樂伐替尼抗血管生成治療在 ATC 診斷后立即開始作為橋接治療。在 BRAF 突變的 ATC 的情況下，dabrafenib 和曲美替尼聯(lián)合治療，在 BRAF 野生型 ATC 的情況下，給予 pembrolizumab 和 lenvatinib 的聯(lián)合治療 4 周。如果重新分期顯示由于大小減少 > 50% 而產(chǎn)生顯著的治療反應(yīng)，則重新考慮手術(shù)切除。首先進行了原發(fā)性腫瘤切除術(shù)。第二步，在甲狀腺手術(shù)后大約 4 周切除了有限的遠(yuǎn)處轉(zhuǎn)移。術(shù)后恢復(fù)后，繼續(xù)進行靶向全身治療。患者：2例BRAF野生型ATC IVC期患者，1例BRAF突變ATC IVB期患者。所有患者在診斷為 ATC 時均接受了外科、核醫(yī)學(xué)和腫瘤學(xué)評估。靶向藥物研究的客觀數(shù)據(jù)：在所有三例中，“新輔助”治療引起了顯著的反應(yīng)，并導(dǎo)致了主要不可切除的 ATC IVB 或 C 期的局部可切除性。我們有新穎選擇短期“新輔助”治療期以降低由于潛在的快速腫瘤縮小而導(dǎo)致出血和/或瘺管的風(fēng)險。僅經(jīng)過短期“新輔助”治療后的手術(shù)結(jié)果顯示兩個 R0 切除和一個 R1 切除。術(shù)后組織病理學(xué)結(jié)果證實我們患者的腫瘤壞死或退行性纖維化組織的范圍在 60% 到 > 95% 之間。藥物指導(dǎo)及病因判斷的依據(jù)：短期基于突變的“新輔助”療法可以在賊初不可切除的 ATC IVB 期或 C 期實現(xiàn)局部可切除性。大約 4 周的新輔助治療期似乎與至少 3 個月的治療期表現(xiàn)出相似的反應(yīng)?；谕蛔兊闹委?；新輔助治療。

腫瘤發(fā)生與革命國際數(shù)據(jù)庫描述：

Introduction:?Few available data indicate that a mutation-based "neoadjuvant" therapy in advanced anaplastic thyroid carcinoma (ATC) might convert an initially unresectable primary tumor to resectable and optimize local tumor control. We evaluated a preoperative short-term "neoadjuvant" therapy with a BRAF-directed therapy or, in case of BRAF non-mutated tumors, an mKI/checkpoint inhibitor combination in three patients with ATC stage IVB and C.Methods:?In the context of preoperative diagnostics, immunohistochemistry (IHC) assessment and genetic analysis was started as soon as possible. The antiangiogenetic therapy with lenvatinib was immediately after diagnosis of ATC started as bridging therapy. In case of a BRAF-mutated ATC, a combination therapy of dabrafenib and trametinib, in case of BRAF-wildtype ATC a combination of pembrolizumab and lenvatinib was given for 4 weeks. If re-staging has shown a significant therapy response due to a decrease in size of > 50%, surgical resection was reconsidered. A primary tumor resection was performed first. As a second step, limited distant metastasis have been resected approximately 4 weeks after thyroid surgery. After postoperative recovery, the targeted systemic therapy was continued.Patients:?Two patients presented with BRAF-wildtype ATC stage IVC, one with BRAF-mutated ATC stage IVB. All patients were evaluated by surgery, nuclear medicine and oncology upon diagnosis of ATC.Results:?In all three cases, the "neoadjuvant" therapy induced a dramatic response and led to local resectability in primarily non-resectable ATC stage IVB or C. We have chosen for the first time a short-term "neoadjuvant" treatment period to reduce the risk of bleeding and/or fistula due to potential rapid tumor shrinkage. The results of surgery after only short-term "neoadjuvant" therapy showed two R0 und one R1 resections. Postoperative histopathological findings confirmed an extent of tumor necrosis or regressive fibrotic tissue between 60 and > 95% in our patients.Conclusions:?A short-term mutation-based "neoadjuvant" therapy can achieve local resectability in initially unresectable ATC stage IVB or C. A neoadjuvant treatment period of about 4 weeks seems to show similar response as a treatment duration of at least 3 months.Keywords:?Anaplastic thyroid cancer; Mutation-based therapy; Neoadjuvant therapy.