Youyoung good medical voice | Speech of the full management case of advanced colorectal cancer -Bashu Yunsuo Station

*For medical professionals for reading reference

Youyoung good medical voice -The full management case speech of advanced colorectal cancer is coming. Papuyun and Zhejiang Station is coming. Many experts talk about new strategies for advanced CRC diagnosis and treatment to fully exchange new concepts of diagnosis and treatment.

In order to implement the management of tumorization of the country's great health strategy, standardize and improve the management level of advanced colorectal cancer (CRC), explore new types of diagnosis and treatment, and show the clinical diagnosis and treatment thinking of young doctors and lectures. The "Excellent Young Good Medical Voice -the full -process management case speech of advanced colorectal cancer" projects organized by the China Clinical Oncology Society and Hetai Yellow Medicine continued to optimize this year, and it has come this year. On August 28th, the whole process of gathered colorectal cancer gathered in the "Bashu Yunzhe Station" online. The online online was hot. Professor Pan Hongming, Shao Yifu Hospital of Zhejiang University Medical College, and Professor Qiu Meng of Huaxi Hospital of Sichuan University with the chairman of the conference.

Figure 1 Professor Pan Hongming of Shao Yifu Hospital Affiliated to Zhejiang University Medical College Pan Hongming opening speech opening

Figure 2 Professor Qiu Meng of Huaxi Hospital of Sichuan University opened his speech at the opening

Speech by the full management case of late colorectal cancer -fierce confrontation and fascinating victory

The lecture on the competition competition case was officially opened under the auspices of Professor Xie Weichi of Chongqing Hospital of Traditional Chinese Medicine. Professor Liang Daoming from the Second Affiliated Hospital of Kunming Medical University, Professor Wang Yaxu of the Second Affiliated Hospital of Chongqing Medical University, Professor Xie Ke, Sichuan Provincial People's Hospital, Professor Xie Yanru of Lishui Middle Hospital, Professor Xu Yongqiang, Huzhou First People's Hospital, and Zhejiang University Medical College Professor Zheng Song, the First People's Hospital of Hangzhou, formed a jury to comment on the performance of the speaker and give a scoring.

Case 1: One case of advanced rectal cancer sharing

This case is provided by the Fourth People's Hospital of Zigong City, Sichuan Province.

Instructor: Professor Miao Jidong, speech: Dr. Zhou Xiaobo.

The patient was rectal glandular cancer. In June 2014, rectal cancer was treated in the field of rectal cancer. From 2017 to 2018, patients were transferred to liver tumor radio frequency discharge of liver tumors in the field due to rectal cancer and oral oral Apatinib targeted therapy. The genetic test results were shown in KRAS mutations, microbriets stability (MSS), VEGFR (VEGFR (VEGFR (VEGFR) +).

In 2021, the patient's disease progressed. After admission, the diagnosis of rectal adenocarcinoma with liver metastasis and pleura metastasis RIV period, accepting Koriocbine+Bevarzab+Nutritional support 1 month after the treatment of bilateral pleura lesions; subsequent subsequent subsequent Give patients with first -line XELOX+Bevarzumab 2 treatment. Reviewing tips: Double lung hair nodules, considering metastasis; after the progress of the first line of treatment, the second line is given to the patient mxeliri+Bevarzab the treatment. Progress; the choice of third -line therapy has become the key to the patient extending the time of survival and improving the quality of survival. The diagnosis and treatment group selects the patient for the patient for the patient. After 2 months, the evaluation of the patient's imaging review efficacy has reached partial relief (PR), and the survival benefits brought by the drugs are still continuing. The real world diagnosis and treatment case tips: Three -line 呋喹 替 替 treatment can bring excellent tumor control effects to patients with multiple metastasis CRCs.

Figure 3 Dr. Zhou Xiaobo, the Fourth People's Hospital of Zigong City, Sichuan Province, gave a case speech for cases

Case 2: "Love" circuit turns, "呋" shakes straight up

The case was provided by the Second Hospital of Zhejiang University Medical College.

Instructor: Professor Chen Jiaqi, speech: Dr. Zhang Yan.

This case is patients with sigmal colon cancer accompanied by iliac blood vessels, laculinoma, lymph nodes, and right lower lung metastases, CT3N2BM1B stage, laparoscopic primary stove resection, gene test results: KRAS G13D mutation, HER-2 negative, MSS, postoperative postoperative surgery, postoperative surgery, postoperative surgery, postoperative surgery, postoperative surgery The staging is PT3N2M1B.

The front line is selected for patients: Bervarzumab+Folfiri combined treatment plan for 4 cycles, the curative effect assessment reaches PR. During the treatment, patients with IV scales are fever and diarrhea. At the same time, the genetic detection results are UGT1A16, 28 -siter miscellaneous mutation. Therefore, the treatment of Yili -Kang reduction and preventive long -term treatment. After the first -line treatment of 12 cycles, considering the patient Yili Kang's intolerance and a small tumor load, the patient's wishes were suspended. It is recommended to follow up on a regular basis. After half a year, the patient's left and lower lungs are new. Increase, consider intestinal cancer and lung metastasis, and reduce nodules after SBRT treatment. After 20 months of discontinuation, the patient's disease made a comprehensive progress. After 6 cycles of the second -tier treatment of Bevarzab's Mipido+XELOX scheme, the efficacy was rated as the progress of the disease (PD). Third -line therapy for patients to choose chopperinib+vinsonabicab joint strategy. After 3.5 months, the efficacy assessment shows that PD is still PD. Therefore, the four -line addition on the original 尼binib+Xinyi Metico -resistant solution to the Kaibetaba on the basis. As of now, patients have received 16 cycles of joint treatment, the effect evaluation has reached PR, no progressive survival time (PFS) has reached 14 months, and the total OS of the patient has reached 54 months. It is prompted to generate combined immunity and chemotherapy in the backline, which is expected to become a preferred plan for drug treatment for patients with repeated progress.

Figure 4 Dr. Zhang Yan, Affiliated Hospital of Zhejiang University Medical College, to give a case speech

Case 3: Dao obstruction and "intestine", and the line is coming

This case is provided by Yunnan Cancer Hospital.

Instructor: Professor Hu Fengzheng, speech: Dr. Li Rong.

This case is a patient with multiple metastasis with liver lungs and lymph nodes in the right half -half colulled adenocarcinoma. The CT3N+M1B IVB stage, gene test results prompt: KRAS, NRAS, Braf are all wild types. After the patient was perfected, the first line was given to the Sieccix Mipida+MFOLFOX6 scheme for 8 cycles. The efficacy assessment showed that the PR was reached. After the 12 -cycle of the first -line treatment, Xingkaribabine+Sicium Mipido maintains the treatment. After 2 cycles of maintenance, the image science display progress is reviewed, and the efficacy assessment: PD.

After entering the second -line treatment, the patient received the 8 -cycle treatment of the Bevarzumab+Folfiri solution. The follow -up review reminded the disease progress. After the effect of the PD, the tumor was still rapidly progressing after the treatment of the Siten categami+Folfiri scheme.

Third -line treatment, for patients, chose a pyrinib+nepalidumab joint treatment. The curative effect was evaluated as SD, and the tumor control was good. Unfortunately, the patients developed again after 4 cycles, and liver and lung metastases increased. Because the patient's tumor load is mainly concentrated in the liver and lungs, the hepatic artery HAIC therapy is fully communicated after fully communicating and the 7 -cycle hepatic arteries are treated and the two -time lung iodine 125 particle implantation is performed. The disease is controlled during treatment. At present, the patient uses the whole body of Rigogfini to treat the condition, and the total OS has exceeded 24 months. Patients have better tumor control effects during giving patients with 尼 尼 ​​尼 尼 尼 尼 尼 尼 尼. Prompt+提+immunity or provide new treatment ideas for the above patients.

Figure 5 Dr. Li Rong, Yunnan Cancer Hospital, gives a case speech

Case 4: I and his story -remember the practice and thinking of multi -line therapy for advanced rectal cancer

The case was provided by the First Affiliated Hospital of Zhejiang University Medical College.

Instructor: Professor Jiang Haiping, speech: Dr. Li Ning.

This case is patients with multiple metastases of rectal adenocarcinoma with liver metastasis, CT3N0M1 IV stage, and genetic testing results are KRAS, NRAS, Braf wild type. The first -line treatment plan gives patients in the treatment of Siciecci Mipida+MFOLFOX6 scheme, and the curative effect is evaluated as PR, and the Siciecci Monochriophage is later maintained.

The first -line therapy brought a 13.7 -month PFS for the patient. After 6 months of maintenance treatment, the review prompts the progress of the tumor. The second line adopts Ilido Kang+Leiti Tessel+Bevarzumab. Only 3.5 months later, the patient's review prompts the tumor to progress again and the efficacy assessment is PD.

After the failure of the second -tier treatment, the patient's 呋喹 尼 二+Karrilizumabo Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -Anti -III Treatment was given. During the treatment, the liver lesions were significantly reduced. The effect was evaluated as PR. The PFS reached 21 months. The four-line treatment of patients-102+Bevarzumab was given only 2 months of PFS benefits.

Patients with five -line patients enrolled in IBI321 research and received CD137 monoclonal anti -targeted therapy. As of now, the efficacy assessment is SD, PFS 5.3 months. It is not difficult to see from the clinical diagnosis and treatment case that after the failure of the first and second lines, the PFS time brought the longest PFS time in the treatment process. It reflects the good tumor control effect and excellent drug safety of the tumor.

Figure 6 Dr. Li Ning, the First Affiliated Hospital of Zhejiang University Medical College, gives a case speech

Case 5: The mountains and rivers are doubtful, and there is no way for the mountains and rivers, and another village of Liu Dahuoming — sharing the full management case of advanced bowel cancer

The case is provided by the First People's Hospital of Taizhou City, Zhejiang Province.

Instructor: Professor Tang Xiaowan, speech: Dr. Zhang Zhan.

This case is patients with rectal cancer with liver metastasis, CT3NXM1B IVB stage, gene test results are MSS and KRAS G12C mutations. After the first MDT discussion, the first -line treatment was given to the patient MFOLFOX6+Bevarzumab for 5 cycles, and the review efficacy was evaluated as PR. However, during the use of Osarie Platinum, patients had an allergic shock, so the chemotherapy scheme was changed to the MFOLFIRI solution, and the patient's tumor lesions were significantly reduced during the subsequent treatment. During the period, it was treated with liver metastase resection and local treatment for patients with liver metastases and local treatment. Rectal cancer was given in February 2021, and postoperative pathological reminders of rectal cancer. MFOLFIRI was continued after surgery, and surgery+postoperative adjuvant treatment for a total of 12 cycles. In August 2021, patients had multiple nodules in the lungs. After entering the third -line treatment, the patient chose to be treated for the treatment. So far, the patient has brought up to 11 months of PFS time. At the same time, the patient's review prompts that the tumor control is good. So far, the patient is still in the third -line treatment benefit. The above -mentioned real world diagnosis and treatment cases suggest that among the patients with advanced CRCs, the treatment of three -line 呋喹 oghinib drugs brings a significant tumor control effect to the patient, and the survival benefits are obvious.

Figure 7 Dr. Zhang Zhan, the First People's Hospital of Taizhou City, Zhejiang Province, to give a case speech

Case 6: "Chemotherapy holidays" Dialing clouds -a case of treatment of patients with liver metastatic patients with advanced rectal cancer

The case is provided by Daping Hospital of the Army Featured Medicine Center.

Instructor: Professor Qian Chengyuan, speech: Dr. Su Xiaona.

This case is a patient with low rectal adenocarcinoma with multiple metastases of the liver. The CT3DN1M1 IV stage. The MDT discussion opinion is to evaluate whether there is surgical indications after conversion treatment. The front line is given the patient MFOLFOX6 chemotherapy 2 cycles. During the period, the genetic test results were MSS, KRAS, Braf, NRAS wild type. In the third cycle, the patient's Sicieccipopstraum combined with MFOLFOX reduction scheme was treated. Later, the patient's tumor lesions had no significant changes and adverse reactions were unable to resist the drug. The second line was treated with Sidie Ming+Folfiri (20%reduction) scheme for treatment. After 2 months, the patient's liver metastases increased. Combined with the results of the second MDT discussion and considering the patient's tolerance, the third line was given the patient in the patient with the treatment of the Rayleyzumab. It was treated with TACE during the period. It has reached 20 months to date. This case suggests that the backline of patients with advanced CRC has brought long tumor control in the backline of CRC patients, and has good tolerance. Figure 8 Dr. Su Xiaona, Daiping Hospital of the Army Featured Medicine Center, gives a case speech

Six groups of speakers shared wonderful cases of colorectal cancer diagnosis and treatment, and fully demonstrated the comprehensive thinking and careful choices of the diagnosis and treatment team in it. In the subsequent questions and comments, the speeches are discussed with each other. You confuse me and wonderful. The guest of the speech fully interacted with the jury. The questions and comments of the jury were in -seeking questions and comments. Finally, after the judge of the jury, Dr. Zhang Yan from the Second Affiliated Hospital of Zhejiang University Medical College finally took the lead and successfully entered the National Finals.

Figure 9 conference summary

With the end of the meeting, the chairman of the conference, Professor Pan Hongming and Professor Qiu Meng, congratulated Dr. Zhang Yan and his mentor Professor Chen Jiaqi, and expressed his expectations for Dr. Zhang Yan's subsequent speech sharing. At the same time, the two chairmen concluded that the content of the meeting was rich and detailed, and there were no shortage of humanistic care for patients with advanced CRC. I hope that doctors will further strengthen the standardized diagnosis and treatment and evidence -based medical evidence in subsequent case display. It is expected that through the display and exchanges of this case, it can further promote the standardization of the entire CRC management throughout the process, promote the development of the field, and help more CRC patients to benefit.

*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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