Form the auxiliary treatment _'s treatment of rectal cancer

Form the auxiliary treatment _'s treatment of rectal cancer
It has not had disease life cycle (DFS) that complementary chemotherapy has improved a one that forms rectal cancer greatly . Before the complementary treatment appears, one formed rectal cancer (CRC) 3 year disease survival rate is 44%~52% probably.
5 Fluorine urine pyrimidine( 5-FU) Single medicine treatment
DFS in a 3 years forming the rectal cancer patient improves to 61%~67% through using 5 different - FU scheme to make. The vein injects 5 - FU and unites inferior folic acid (LV) Serial clinical research establish 5- FU status as standard chemotherapy of aid. The result of study has really provided some for single medicine healing solution to guide, curative effect of the course of treatment is the same such as course of treatment and 12 months of 6 months; The curative effect of the course of treatment is not obviously superior to 24 weeks in 36 weeks; Low dose of LV is the same as heavy dose of result. Subsequent research reveals the scheme of infusing 5 - FU continuously is better than to inject 5 - FU tolerance, the two efficient and equivalent to survival rate. As to CRC patient of one, the oral card banks up his bank with earth better than the tolerance of injecting 5 - FU/LV, its curative effect is analogous to too ' DFS is 64% 61%) correctlies in 3 . It is beneficial to point out 2 stage patients and carry on auxiliary 5 - FU treatment in result of QUASAR clinical trial, with assisting treating to compare non-, assist treating and lowering the recuring rate (22% to 26%) for 5 years ,And improved total survival rate ' 80% 77%) correctlies
Jointly treat
5 - FU/LV unite Iraq, set up, take the place of health and the intersection of and the intersection of sand and favourable platinum often in complementary chemotherapy. 5 - FU unites Iraq to set up and has not made the encouraging result yet for the scheme of the health generally. The vein injects 5 - FU/LV and Iraq and sets up and correlates with prominent toxic function for the union healing solution of the health. Reveal CALGB C89803 clinical trial that be included in 1264 case patient,5- FU/LV be set up to IFL scheme and if you can't last 5 - FU/LV, compare alone of health to be lasted Iraq, DFS is still a bit lower slightly. It includes 400 in to be high to endanger ACCORD 2 test of patient, reveal, instil 5 - FU/LV unite Iraq stand for the health scheme and instil 5 - FU/LV to compare alone, DFS is low slightly even (51% to 60%, P in the former's 3 =0.22). PETACC3 clinical trial reported recently is larger, include 2094 patients. Result reveal, compared with instilling 5 - FU/LV alone, instil 5- FU/LV unite Iraq set up DFS has been raised by 3% (63.3% to 60.3% for 3 such as health, there is no prominent difference) . Correct, analyze, indicate, DFS though have prominent differences (65.2% to 60.4% very much little to raise the intensity in 3 jointly treating the group, P =0.021).
The union healing solution that sand of favourable platinum and vein inject 5 - FU/LV has obvious toxicity; However, sand favourable platinum and union healing solution of instilling 5 - FU/LV can reduce toxicity and improve curative effect. Including in 2246 2 stages ' 40%) With a patient's MOSAIC clinical trial, compared with 5 simple - FU/LV scheme, instils favourable platinum ( FOLFOX4) of sand that LV5FU2 adds 85 mg/m2 Jointly if you can't treat, make DFS to raise by 6.6% (Plt on the 4 year; 0.001). Though no matter 2 stage patient or 2 stage high to it endangers degree of danger of patient to be decline obvious ' Have dropped by 18% and 24%) separately ,But reduce the intensity equivalent to a patient, prove the therapeutic effect is more steady. According to report FOLFOX4 scheme common toxicity react and neutral leucocyte reduce disease, diarrhoea, vomit and 3 neuropathy. However, the death case correlated with treating has not increased. It shows to include in NSABP C07 clinical trial of 2407 patients, with instilling 5 - FU/LV to compare alone, 5- the union healing solutions (FLOX scheme) of FU/LV and sand favourable platinum May enable 3 -year DFS raise by 4.9% (76.5% to 71.6%, Plt; 0.004). FLOX the intersection of 3/4 and neuropathy 4% low the intersection of FOLFOX4 and scheme than MOSAIC have in the test in the scheme, but 3/4 suffer from diarrhoea relatively high incidence (38% to 11%) .
The target is to the molecule medicine
In studying a gleam of of CRC or clinical trial of Line two drug therapy of later period, have already found the shellfish against skin growth factor in the blood vessel cuts down and resists (bevacizumab) only Resist (cetuximab) with the west against epidermis growth factor receptor only in proper former times Can improve a lot and contain 5 - FU/LV and sand favourable platinum or Iraq and set up the curative effect of the union healing solution which take the place of the health. Do not generally increase the serious side effect while improving curative effect. For example, after cutting down and resisting with the shellfish only in the chemotherapy scheme, the neutral leucocyte will not increase to reduce the incidence of disease, diarrhoea, irritation or rash, but will increase thrombus disease ' 2%~3%) ,Hypertension( 6%) With intestinal perforation ' 1%~2%) Incidence. Incidence improvement 15%, 1% and 9% separately of diarrhoea, irritation and rash after adding the west to resist in the chemotherapy scheme only in proper former times, but does not increase the incidence that the neutral leucocyte reduces disease, thrombus disease, hypertension or intestinal perforation.
The shellfish cuts down and resists only
In AVANT test, 3450 2 stages or one (N =2880)Knot rectal cancer patient following without being accepted it is therapeutic: ( 1) It is accepted that FOLFOX4 treatment is observed 24 weeks more 24 weeks later; ( 2) Accept FOLFOX4 unite shellfishes cut down and resist only ' 5 mg/kg) every 2 weeks Treat after the 24 week continuing, accepting shellfishing cut down resist only ' Every 3 weeks 5 mg/kg) Treat for 24 weeks; Or ( 3) Accept XELOX unite shellfishes cut down and resist only ' Every 3 weeks 7.5 mg/kg) The shellfish of dosage of accepting etc. cuts down and resists and treats for 24 weeks only after treating for 24 weeks. The main terminal is DFS in 3 years of a patient's; The ones that include security, total survival rate, medicine economics and treat in secondary terminal facilitate the intensity. To endangering in the patient's ECOG E5202 test of 2 stage high, but little the intersection of satellite and stability at the chromosome have, mix, shut son nature missing patient distribute the intersection of FOLFOX and group into at random and FOLFOX unite shellfishes cut down and resist and treat the group only 18. This test is to carry on a clinical trial from target to treatment according to the biological mark of tumour for the first time.
Prospect
Other a lot of auxiliary problems being treated need solving through the clinical trial. Compare the FOLFOX schemes of 6 and 12 courses of treatment will contribute to verifying whether can reduce the morbidity of neuropathy involved in FOLFOX on the premise of not reducing curative effect. In addition should compare the curative effect of XELOX scheme and FOLFOX scheme, in order to determine a oral card banks up his bank with earth to replace 5 - FU in the standard is assisted and treated. And shellfish of course of treatment cut down, resist curative effect, contribute to, confirm shellfish cut down the best course of treatment resisted only only 12 month through compare 6 month course of treatment directly.
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