Example sound Hui 丨 Lie is lying flat if you can't cheat chemotherapy?Envolimu brings a big PR to the patient (partial relief) (partial relief)

*For medical professionals for reading reference

Hyepermia of colorectal cancer is invalid?

New type of immunotherapy drug

Colorectal cancer is a common malignant tumor, and the incidence and mortality rate are on the rise. Data show that colorectal cancer is the third malignant tumor in my country [1,2]. In April of this year, the "China Clinical Oncology Society (CSCO) Bullet Cancer Diagnosis and Treatment Guide (2022 Edition)" was released. The new version of the guidelines combined with today's latest cutting -edge progress and the real situation of colorectal cancer in my country. In order to allow domestic tumor doctors to understand the latest points in the guide in a timely manner and promote the standardized diagnosis and treatment process of colorectal cancer, with the support of Xianmin Pharmaceuticals, the China Clinical Oncology Society hosted the "Guidelines for CSCO Calcitancium Cancer Diagnosis and Treatment Guidelines".

On July 10, 2022, the "Tour lecture" of Guangzhou Station was successfully carried out. Dr. Song Jintian from Fujian Cancer Hospital shared a case of advanced colon cancer, which gave a heated discussion on many experts at this case.

"Big PR (partial relief)" -Enwaolim

Bring a "incredible" effect to patients

Pathogenic information

过 过 ▎ ▎ ▎

Year 2009

In August, the patient visited the Quanzhou Straits Hospital due to "changes in bowel habits". On August 18, CT testing indicated that the tube wall of the colon and liver curvature increased, and colon cancer was considered. On September 2nd, the lower amplit of the Full Majesty of the Xiehe Hospital of Fujian and the "laparoscopic auxiliary right half colon resection" was underwent for 4 cylinder chemotherapy after surgery. After that, the side effects of chemotherapy were unable to withstand chemotherapy and did not continue to be treated.

After the pathological results of the surgery, the intestinal bulging type neutralized adenocarcinoma, part of which is mucus adenocarcinoma, invaded the deep muscle, the two cut edges are clean, LN2/9 next to the blind part, LN3/6 next to the colon, LN0/3 next to the back of the intestine , Barne -shaped adenoma is accompanied by low -level epidermal tumors, chronic appendicitis.

2018

In June, the patient was diagnosed with Fujian Xiehe Hospital due to "repeated middle and upper abdomen pain in March". Testing and diagnosis prompts, hypotonoplasty metastasis metastasis. The 1 -cycle of chemotherapy was received on June 28. The pathological test shows that a small amount of alien cells that are squeezed into deformation are seen in the tissue, combined with the result of immunohistochemistry, in line with low differentiation cancer infiltration, and immunohistochemical results indicate the possibility of digestive tract sources.

In July, the Southern Hospital of Southern Medical University, abdominal ultrasound prompts, poly cystic lesions in the liver. The actuality of the bottom of the pancreas is obviously abnormal. Diagnosis prompts "Performance of the Pan head area: migration possibility". Surgical treatment was performed on July 13th, and chemotherapy was continued after surgery. The subsequent treatment of chemotherapy was not tolerated, and the treatment was not continued on time.

Pathological testing reminds that the pancreatic adenocarcinoma is infiltrated, combined with the medical history that meets the metastasis of the bowel cancer, and invades the duodenum muscle layer. Cutting edge, lymph nodes (3/5) are shifted. Genetic tips: KRAS, NRAS, Braf gene wild type.

In October, the patient had a pain in the middle and upper abdomen again. On October 27th, the whole abdomen CT test was performed in Sanming First Hospital. Essence 2. Multi-swollen lymph nodes after peritoneal-peritoneal, comprehensive considerations are the possibility of metastatic lymph nodes.

过 Our hospital diagnosis and treatment

The patient, 47 years old, diagnosed "bowel cancer" for more than 12 years. After more than February after treatment, there is no special past history. He denies the family history of malignant tumors. There is no family history of other genetic diseases. The KPS score is 80 points.

Patients came to the hospital for treatment on November 2, 2018. On November 7, PET-CT monitoring showed that there was a high metabolic mass in the pancreas head, considering the recurrence of tumors, and the possibility of involving the gastrointestinal occlusion port; the abdominal cavity, the rear of the peritoneum, the back of the right side of the right diaphragm and the front of the diaphragm movement metastasis metastasis metastasis metastasis transfer There is also a high metabolic nodule in the signs of the sigmoid, which requires further inspection.

Figure 11 October 7 PET-CT detection images show that the patient's abdominal and post-peritoneal lymph nodes are larger

Subsequently, the patient Ilidi Kang combined with Leitan Sai and Siciestab for treatment, and supplemented with Oskangding for pain relief. However, the patient was suspended after receiving the three -cycle chemotherapy because the patient was unable to withstand the chemotherapy reaction.

Figure 2,33 and February 15th image testing shows that the patient's condition is stable

On January 14, 2019, during the patient receiving chemotherapy, the postoperative pathological test results of the Southern Medical University Southern Medical University were prompted that (pancreatic) see low differentiation cancer infiltration; immunohistochemistry (IHC): MLH1-, PMS2-, MSH2+ , Msh6+. Combined with the results of the patient's past pathological examination, the patient meets the entry requirements of KN035-CN-006 clinical trials. After the patient stopped chemotherapy, it was treated with Envolimu for treatment, 64 times, and the patient refused to continue receiving further after the test.

Figure 4, May 19, May 19, and May 13 showed that the patient's surgery area and post -peritoneal lymph nodes were significantly retracted

In response to this patient, Dr. Song Jintian pointed out that the patients mainly fused lymph nodes in the main preoperative metastases and laculinoma. When the patient was admitted to the hospital, the two lesions were 6.0cm × 5.1cm and 6.9cm × 3.3cm, respectively. During the patient receiving chemotherapy, although both lesions were reduced, they quickly recovered to the level before chemotherapy after the suspension of chemotherapy, which once affected the patient's daily life.

Fortunately, the detection prompts that the patient is suitable for receiving immunotherapy and meets the KN035-CN-006 research entry standard. After receiving 64 times of Envolimab treatment, the patient's preoperative torment was reduced to 2.5cm × 2.0 CM, the fusion lymph nodes are reduced to 1cm. Although patients have not continued to be treated after the study, during the follow -up telephone follow -up process, we can see that the patient's mental state is good and can engage in some physical labor. Expressing their own opinions, a number of experts start a warm discussion

After reporting the case, many experts have elaborated their own opinions

Professor Lin Rongbo:

Professor Lin Rongbo, Fujian Cancer Hospital, said that Envolimab can have a very good effect on patients with MSI-H. Clinically, patients with advanced colorectal cancer in MSI-H/DMMR can even see the hope of cure. Many studies have shown that immunotherapy can bring good survival benefits to this part of patients. In the future, with the continuous deepening of research, immune combined treatment solutions such as dual -exemption and combination of combination may be given to patients with better efficacy.

Professor Cai Guohao:

Professor Cai Guohao of Hainan Provincial People's Hospital pointed out that many experts and cases shared by Dr. Song today can indicate that immunotherapy can have excellent effects on patients with MSI-H/DMMR. Patients received Envolimagumizumumi when they were unable to withstand chemotherapy. The lesions were reduced from 6-7cm to about 1cm, which can be described as "incredible." This also brings us thinking. The clinical IHC test must be done to accurately screen such patients to help them get the greatest clinical benefits.

Professor Li Chunlai:

Professor Li Chunlai, the Second Affiliated Hospital of Nanchang University, believes that the clinicians should now change the treatment of colorectal cancer. For patients with early colorectal cancer, IHC testing should be performed as soon as possible to learn about the patient's microbesin status information. This is for patients for patients. Subsequent treatment is of great significance. The case reported by Dr. Song is a powerful proof of the effect of good efficacy for the immunotherapy drug represented by Envolitab. Nevertheless, patients with MSI-H/DMMR only account for a few of patients with colorectal cancer. In the future, the treatment plan for MSS/PMMR still needs to be further explored.

Professor Liu Hao:

Professor Liu Hao of the South Hospital of Southern Medical University said that patients have been sick for nearly ten years and once affected their living conditions due to their recurrence. Comparative. From the perspective of clinical practice, we must always pay attention to the state of the patient's microbestelling, and then judge whether the patient can benefit from immunotherapy.

Summarize

Envolimaguy is a PD-L1 inhibitor. At present, many studies have confirmed that it can have a better effect on patients with MSI-H/DMMR physical tumors. At the same time, Envoli Mippy is a injection -type drug, which is more convenient to use similar drugs. With the continuous improvement of research, I believe that Envoli Metarios will bring better survival benefits to more patients in the future.

Profile

Song Jintian

Internal Medicine of Fujian Cancer Hospital, attending physician, doctor of medical

Member of the Fujian Anti -Cancer Association Traditional Chinese and Western Medicine Integrated Medicine Commission

Fujian Cancer Hospital Gastrointestinal pancreatic nerve endocrine tumor MDT group secretary

In the provincial and above journals, more than ten papers were published in the first author, including two SCI papers, two subjects at the department, and participated in one provincial topic. Participate in more than ten international multi -center III clinical research and domestic multi -center III phase III clinical research

references:

[1] .sung H, Ferlay J, Siegel R l, et al. Global Cancer Statistics 2020: Globocan Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 COUNTRIES [J]. 209-249.

[2].Cao W, Chen H D, Yu Y W, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021, 134( 7): 783-791.

*This article is only used to provide scientific information to medical people, and does not represent the viewpoint of this platform

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