Youyoung good medical voice | seek throughout the situation, focus on details, advanced colorectal cancer patients managed the whole process of how to "step by step" -the lecture on the full management case of advanced colorectal cancer -Luyu, Hubei Hunan Station

*For medical professionals for reading reference

"You Young Good Medical Sound" is coming to sharing wonderful cases in Luyu, Hubei and Hunan!

In recent years, the incidence and mortality of colorectal cancer (CRC) in my country have shown an upward trend, which seriously threatened the health of our residents in our country and caused a serious social burden. And most patients were in the middle and late stages when they found that the treatment was very difficult. The survival of patients after multi -line treatment was worrying. Therefore, it is necessary to improve the survival of patients with metastatic colorectal (MCRC) receiving multi -line treatment, and it is necessary to do a good job in the whole process of patients.

On August 27, 2022, the "Excellent Young Good Medical Sound of the Outstanding Medical Sound | Givenchy's Full Management Case Speech" jointly organized by the China Clinical Oncology Society (CSCO) colorectal cancer special committee and Huang Medicine — The meeting was held online online online. The meeting aims to explore the diagnosis and treatment ideas and optimize the concept of treatment. The meeting invited a number of well -known domestic experts and young doctors to communicate and discuss through the form of case sharing to convey cutting -edge academic progress and improve the level of diagnosis and treatment of late bowel cancer!

At this meeting, Professor Zhang Enning, Yantai Mountain Hospital, Yantai City, Professor Gao Ming, the First Affiliated Hospital of Zhengzhou University, Professor Zhou Jumei of Hunan Cancer Hospital, and Professor Tang Yan of Huangshi Central Hospital (Pu'ai Ai Hospital) of East Medical Group as the chairman of the conference. At the beginning of the meeting, the four chairmen delivered a speech at the conference.

Figure 1 Professor Ensun's speech

Figure 2 Professor Gao Ming addressed

Figure 3 Weekly Professor Ju Mei Specification

Figure 4 Professor Tang Yan speech

Excellent diagnosis and treatment case sharing -fierce competition, wonderful presentation

The sharing session of the case was chaired by Professor Zhang Enning, Professor Gao Ming, Professor Zhou Jumei, and Professor Tang Yan. Professor Huan, Professor Shi Xiangru of the People's Hospital of Macheng City, Professor Tang Jingwen, Henan Cancer Hospital, and Professor Wang Gang, the First Affiliated Hospital of Henan University of Technology, served as the jury.

Case 1: Tetinib line challenges, the curative effect is still considerable

This case is provided by Qingdao University Affiliated Hospital

Instructor: Professor Zhang Hongjun; Speech: Dr. Cheng Jingjing

The patient was a 54 -year -old man who diagnosed rectal adenocarcinoma in 2015 (PT4AN1BM0 ⅢB). Immunization: Neurdilation (+), vascular cancer (-). From July 2015 to February 2016, the 6 -cycle XELOX scheme chemotherapy. After treatment, the follow -up review reminds the patient's in -liver metastasis and use radio frequency ablation according to the patient's wishes. Two years later, the patient's follow -up review discovered the lungs and liver metastasis again, and the 2 -cycle Bevarzumab+XELOX scheme was given a combined treatment. Progress again. From January 2019 to May 2020, the three -line treatment of 呋喹 呋喹ibinib. During the treatment period, the efficacy evaluation of lung metastases was fully relieved (CR). In November, the chest and abdomen CT reminded that the lung metastases increased again and the liver metastasis was new and increased. After continuing to take oral ribenib treatment, the review reminds the patient's lung metastlasma tumor shrink and liver metastases are stable. Until the medication was used in February 2022, other drugs were switched. The diagnosis and treatment process of this therapy indicates that patients take the three -line treatment of tumor for tumor control. After the tumor stopping the tumor is progressing again, they can still try to challenge the tumor.

Figure 5 Dr. Cheng Jingjing, Affiliated Hospital of Qingdao University, to report cases for cases in cases of cases

Case 2: One wave of three folds and three folds step by step lotus

The case is provided by Linyi Cancer Hospital

Instructor: Professor Liu Shuhong; Speech: Dr. Xiaojuan

The case is a 49 -year -old female patient and diagnosed with rectal cancer (PT4BN1BM1 IVB stage) with liver and biocontonal metastases. After multi -disciplinary discussion (MDT), the patient used Bayand Union Folfiri to treat 12 cycles in front line. Progress (PD). The second -line Bevarzumab combined with Osarbin and the Leartus scheme for 2 cycles for treatment. Third -line treatment was used for the use of 尼binib combined with Schidi Midarity. It was treated for 11 cycles from September 2021 to June 2022. Patients continued to PR and metastases continued to narrow; until July 2022, patients' disease progressed. The four-line therapy uses TAS-102 combined with Bervarzumab. It has been treated with 2 cycles and the patient's condition has been stable. Patients with a long and stable disease control tips for the third line of patients. The backline 呋喹binib combined immunotherapy can bring long -term survival benefits to patients with MCRC.

Figure 6 Dr. Xiaojuan, Linyi Oncology Hospital, to give a case speech

Case 3: The intestinal road is long, the future can be expected

This treatment is provided by Hunan Cancer Hospital

Instructor: Professor Huang Zajie; Speech: Dr. Liu Dian

The patient is a 67 -year -old woman, diagnosed with glandular cancer in the rectum (PT4N1M1 IV), PMMR. There were "right breast cancer" surgery and history of chemotherapy; with level 2 hypertension, coronary atherosclerotic heart disease, stable angina pectoris, and heart function II. After the pathology diagnosis, patients are given surgery+postoperative assistance chemotherapy. Gene test: MSS. The tumor metastasis was found in the follow -up follow -up, and then the 7 -cycle of Yiliti Kang+Siciezab's anti -anti -anti -resistance treatment, the review reminded the disease progress. After replacing the Bevarzumab+Osarina Platinum+Leitetus combined with 10 cycles, the review still indicates that the biocontonal multi -hair metastases are slightly larger than before, and progress is progressing again. Subsequent patients and family members refused to perform genetic testing, re -introduced the previous treatment plan after excluding taboos, and used Folfiri+Siciezab treatment for 7 cycles. After half a year of maintenance, the review of the disease again. Third -line therapy has become the key to the benefit of patients' survival. After consultation with MDT, patients began radiotherapy with a 3 -line triple treatment with a 5mg QD (5mg QD) in February 2022. The disease progressed after 1 month; +Cyntinib combined scheme, the curative effect is SD. So far, patients are still in follow -up, and the tumor control is well controlled. The above diagnosis and treatment cases are prompt: For patients with multiple metastasis in the later stage, targeted combined immunotherapy can still benefit patients after the failure of single drug treatment. Figure 7 Dr. Liu Dian, Hunan Cancer Hospital, to give a case speech

Case 4: The mountains and rivers are doubtful, and there is another village in Liu Dahua Ming

This case is provided by Wuhan University Central South Hospital

Instructor: Professor Wang Wenbo; Speech: Dr. Wu Yan

The patient is a 50 -year -old man. The clinical diagnosis is: the right half -colonic malignant tumor liver metastasis (PT4N1CM1 MSS). In January of the postoperative disease progress, the first -line treatment adopts the Bevarzumab+XELOX combination. Following bead monoclonal. During the treatment period, the gaps in the liver door and gaps in the door cavity increased slightly compared with the front, and local radiation therapy was used. Seven months later, the disease progressed to the second -line treatment. The diagnosis and treatment group selected the Bedvarzumopardia Mipido+Xeliri combined treatment plan for the patient. Unfortunately, after only 2 months of treatment, the review prompts the progress of the disease again. Third -line therapy for patients to choose the combined treatment plan for the use of crichinibbinblyticumab. As of now, the disease control has exceeded 10 months. The efficacy evaluation is SD, and the survival benefits of patients are still continuing. This patient's third -line treatment of disease control time far exceeds the first and second -tier treatment, suggesting that immune combined targeted therapy is in the field of backline metastatic colorectal cancer treatment. It is a great potential diagnosis and treatment strategy. , Bring more research data of the above -mentioned combined treatment schemes, and effectively bring survival benefits to clinical patients.

Figure 8 Dr. Wu Yan of Wuhan University Central South Hospital gives a case speech

Case 5: The target is avoided, for the intestinal station station

This case is provided by Wuhan University Central South Hospital

Instructor: Professor Peng Jin's speech: Dr. Xu Hui

The patient is a 54 -year -old man and diagnosed with multiple liver metastasis (CT4N+M1, IV -stage KRAS G12V mutation, MSS). From October 2019 to January 2020, patients mfolfox6 scheme chemotherapy combined with Bervarzumab, and introduced a large dose of vitamin C scheme for 7 cycles, of which 27%(SD) was reviewed by the liver lump after 2 cycles of chemotherapy. The liver lumps are further narrowed (PR) after the treatment of 5 cycles. Later, due to the interruption of the new crown epidemic treatment for 3 months, the imaging examination in April 2020 prompted the liver metastasis to maintain PR. In May 2020, the patient first performed a left -half colon cancer root treatment, and then the right half hepatitis was removed. One month after surgery, it was reviewed to indicate the progress of the disease. The second -line treatment uses 6 -cycle Folfiri+Bevarzumab, IV degree of bone marrow suppression occurs, and then given Bevarzab the combined Capepechabin maintaid treatment. During the period Liver metastatic lesion. Patients with three-tier treatment using olitinib (5mg D1-D21, Q28D) single medicine for 4.5 months, and later review found that the liver metastases increased slightly compared with the front. Considering the good tolerance of patients before, the fourth -line therapy continues to choose chimotinib (3mg, QD) and combined with the Cyli Mipida and XELOX solutions. As of now, patients have continued to benefit for more than 8 months, and the total survival period (OS) exceeded 34 months. It is prompted to treat the treatment of inhibitors in the inhibitors of the immune examination point, which is expected to bring survival benefits for patients with advanced CRC patients with the failure of back -line single drugs.

Figure 9 Dr. Xu Hui, Wuhan University Central South Hospital, gives a case speech

Case 6: The disease is shallow, so that the medicine is light and light

This case is provided by Henan Provincial People's Hospital

Instructor: Professor Liu Mingyue; Speech: Dr. Xu Yujie

The patient is a 55 -year -old man. He performed sigmical tumor cutting + colon fistula in April 2020. After surgery, he had a semi -monthly incision to crack the abdominal incision VSD implantation and suture of the sinus sinus. Postoperative pathological diagnosis is: colon cancer (PT3N0M0 IIA phase PMMR). From June to November 2020 to November, Folfox chemotherapy is 12 cycles, and the condition is stable during the period. In December 2020, patients with intestinal adhesion+rectal cancer resection+small intestinal removal+colon fistula is also available. Pathological tips for postoperative diseases are not differentiated with tumor metastasis with liver and lungs. In February 2021, the patients were treated with thunderbolt + Ilideo + Siciecci Mipidum. In May 2021, the review of the efficacy was PD. After changing the treatment plan, Xinglei Tasai + Ilidekang + 呋喹 替ib) was treated with stable condition during the period. In August 2021, the patient reviewed again, the curative effect was evaluated as PD, and the treatment plan was synthetic for the treatment plan. After 2 months, the patient's review of the efficacy assessment reached PR. The period (PFS) has exceeded 12 months. It is prompted to manage the importance of management and individual chemical treatment throughout the process, and the correct treatment strategy has a profound impact on the overall benefit of the patient. Figure 10 Dr. Xu Yujie, Henan Provincial People's Hospital, gives a case speech

Case Seven: Intestinal Cancer therapeutic Diagram and Longyinib "Intestinal" for a long time

This case is provided by Nanyang Middle Hospital

Instructor: Professor Zhang Chenghui; Speech: Dr. Wang Yuan

This case is a 63 -year -old female rectal differential glandular cancer with patients with multi -lung metastasis (stage IV). The root cancer treatment of rectal cancer 34 months before diagnosis, 6 cycles for the treatment after surgery, the last chemotherapy time is 2017 1 moon. In June 2019, patients with tumor progress were admitted to the hospital. The first -line treatment plan is selected as: Folfox+Siciecci Mipido combined treatment. After 4 cycles, the efficacy evaluation is PR. After the continuous treatment of 8 cycles, the review indicates the progress of the disease. In January 2020, patients entered Folfiri+Bevarzab the second -line treatment. The patient was tolerated well and did not have obvious side reactions of chemotherapy. After the 6 -cycle, the review of the efficacy was SD, and then continued to maintain the treatment of Koriba Binbin and Bevarzumab. After 2 cycles, the patient's disease progressed again. According to the guideline recommendation, patients began to be treated in August 2020. After the 4 -cycle and 8 -cycle review, the patient's efficacy assessment has been maintained for PR. After 15 months of treatment, patients have liver metastases. Four -line therapy began in November 2021. The liver metastasis intervention embolism+pyrinib+Xindiley Midurate joint plan, as of July 2022, the efficacy evaluation was SD. The diagnosis and treatment process of this case: Cyntinib has a good curative effect on patients who have previously used Siciestab's targeting drugs. At the same time, Petinib combined with Sidelimab showed a pleasing effect and good security in patients with refractory MCRC.

Figure 11 Dr. Wang Yuan, Nanyang Middle Hospital, to give a case speech

Through wonderful cases, the seven doctors fully show their personal style and the thinking and choice of diagnosis and treatment teams in the treatment of the above real world cases. Finally, after the judgment of the jury, Dr. Wu Yan from Wuhan University Zhongnan Hospital performed well and won excellent cases.

Summarize:

At the end of the meeting, the four chairmen summarized the conference, saying that although the meeting was held in the form of online and offline combination, it did not affect the wonderful presentation of the meeting at all. Let us appreciate the talents of the young talents and the strength of the "post -waves". From the process of sharing cases, we can see that the basic skills of doctors are solid and carefully prepared for the speech. It is hoped that through the exchange and study of this meeting, the standardized diagnosis and treatment level of digestive tract tumors will be improved, and more young doctors and patients will participate in clinical research, enrich the treatment methods, and help more advanced CRC patients.

*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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