Medical Sound · Medical Road ｜ Having along the shoulders, I and my anti -cancer patients walk through the anti -cancer road together

*For medical professionals for reading reference

The anti -cancer road is long. Doctors and patients are friends and comrades. They are on their shoulders and shoulders, and they have a better life and longer life. It is always our common pursuit.

Colorectal cancer (CRC) is one of the most common digestive tract tumors. According to the latest global cancer burden data in 2020, CRC has become the second largest malignant tumor in my country after lung cancer [1]. 83%of CRC patients have belonged to the middle and late stages at the time of diagnosis, and 44%of patients have metastasized by liver and lungs [2], and metastasis is the main cause of death of CRC patients. At present, CRC has seriously threatened the health of Chinese residents and brings a heavy economic burden to families and society.

In recent years, thanks to the innovative research and development and continuous renewal iteration of drugs, metastatic colorectal cancer (MCRC) patients' general survival (OS) has gradually extended. treat. However, many patients still progress after receiving second -line standard treatment, and urgently need effective third -line and follow -up line treatment. Therefore, on the basis of standardizing the implementation of the first and second -tier treatment, the correct choice of third -line and subsequent treatment plans is also the focus and difficulty of MCRC patients to survive.

There are many classic cases that have obtained excellent survival of survival across the country across the country, which provides reference experience for clinical standardization and full -process chemotherapy management. In this context, the "medical community" specially planned medical voice · medical road series activities, and invited Professor Liu Ye from Handan City Hospital in Hebei Province and Professor Ren Haipng from the Weifang People's Hospital of Shandong Province to talk about them together with the patients. Anti -cancer story of combat.

Steady,

Elderly patients write anti -cancer miracles

Professor Liu Ye is a doctor in the Department of Internal Medicine of Handan Central Hospital. For nearly thirty years of medical treatment, patients who have treated various colors. Speaking of his common anti -cancer road with patients, in recent years, the most remembered by him is an elderly grandfather. Grandpa has another special identity- "Old Revolutionary Eighth Route Army". I am 93 years old. Faced with such an elderly patient, ordinary colds and fever will also make doctors particularly cautious, but Grandpa is diagnosed with advanced bowel cancer at this age, and every step of treatment is as thin as ice.

"Treatment is definitely necessary, but let the old man finish the end of his life in pain." Grandpa's family said. In the selection of initial treatment, Professor Liu had trouble. On the one hand, considering the patient's age, the physical score does not meet the standard. Barvarzumab, a major molecular targeting drug for antibroken, may have a greater impact on blood pressure. Based on the above -mentioned factors, Professor Liu chose to use a single medicine Karbin Binbin joint local radiation therapy. It is regrettable that after more than a year after the use of Kori Binbin, the patient progressed. In terms of the choice of second -line treatment schemes, based on the genetic test results of the previous patient: RAS wild type, the treatment plan has not been combined with chemotherapy, Professor Liu used Siciex monocular anti -single drug treatment for him. But unfortunately, just more than 7 months later, Grandpa's tumor progressed again.

In 2018, nearly 95 -year -old people have gone through the intestinal cancer anti -Japanese war for nearly two years. Grandpa is thinking: Is it almost the same? What else can I choose to choose? "Grandpa, we can also be regarded as comrades -in -arms with revolutionary friendship. Within the last moment, we will never abandon any comrade -in -arms." Professor Liu insisted.

Considering that the oral dose of Rigofini, which is treated in three lines, is 160mg, and Professor Liu found in the clinical use of many patients that many patients can tolerate the adverse reactions brought by drugs. At this time, with the announcement of the clinical data of FRESCO Study Phase III, the median OS (9.3 months VS6.6 months) in the median (PFS) (3.7 months VS1.8 On several important indicators such as the disease control rate (62.2%VS12.3%), it is significantly better than the placebo and good safety and controlling [3]. On September 5, 2018, Petinib was approved to be listed in China for advanced CRC in the third -tier treatment. On this basis, Professor Liu decided to try to apply cadoinib in the three -line treatment.

At that time, the local area could not buy cadinib. With the joint efforts of Professor Liu and the family members of the patient, it was finally allowed to be treated smoothly. Professor Liu said that Grandpa may be the first patient in Handan City to use cycitinib. Considering the age factor of the patient, Professor Liu made individualized adjustments to the dose of cymbinib. During the use, Grandpa did not have any adverse reactions. Professor Liu also joked humorously, "It is indeed an old revolutionary comrade, and the bones are really tough!" In addition, Professor Liu and the family members of the patients were surprised that Grandpa used the treatment of tumor control in the treatment of Tenni. The follow -up review of the follow -up follow -up review was not found for a year, and no signs of the progress of the tumor was found, and the PFS of the year was obtained.

Although in the end, because of the old age, Grandpa had not been able to continue treatment, and he died unfortunately. But Grandpa's children still have kept in touch with Professor Liu, mentioning the anti -cancer path that I have walked with Grandpa. In the last time, we have not been hospitalized. As a child, we can accompany it all the way. We have no regrets. "As Professor Liu's first patient with a third -line CRC for third -line therapy, the old man became a demonstration case of Professor Liu. Professor Liu said: "There are many patients in their eighties in the future ask me the efficacy and adverse reactions of this drug. I will take out the cases of the old man and give them confidence." Of course, the achievement of excellent efficacy and safety, The selection of personalized treatment schemes is inseparable. During the entire treatment process, Professor Liu and his team checked throughout the process. Professor Liu said: "On the one hand, it is necessary to control the relationship between the overall and local and local treatment. Based on the individual chemical treatment of patients, the appropriate treatment plan is selected according to their age, physical fitness, and basic diseases. "In order to control the effectiveness and safety of the drug, whether it is chemotherapy or targeted therapy, Professor Liu's drug and treatment plan Choice is particularly cautious. In the choice of three -line therapy, the dose of chimotinib has also been adjusted individually.

The success of this case is the result of the doctors working with patients and family members. The doctor is not afraid of challenges and moves forward bravely; patients and family members are not afraid of difficulties and never give up. On the road of anti -cancer, doctors and patients are always comrades -in -arms in the same trenches. They adhere to each other and work together. They have a answer to both doctors and patients.

Settling retreat,

Three -line treatment to re -ignition the fire of life

Professor Ren Haipeng is a doctor in the Department of Internal Medicine of the People's Hospital of Weifang City. Among the advanced CRC patients he had diagnosed and treated, the most impressive patient "Lao Li" (pseudonym) was a late micro satellite stability at the first diagnosis ( MSS) patients with intestinal cancer. Recalling the treatment process of Lao Li, Professor Ren said: "The first or second -line treatment schemes carefully selected for patients have not been able to get good results. First -line therapy chose Folfox (oxalibin+calcium villy, fluoropicidine) joint combination Bevarzab, 6 cycle evaluation patients' disease progress (PD). Second -line therapy used Folfiri's chemotherapy (Illi -Kang+Acaliated Calcium folic acid+fluoropicidine) combined with Bevarzab, 2 cycles patients with 2 cycles patients Fast PD. "

Lao Li responded very much during chemotherapy. Like most patients, he did not take long for his hair, but it was the gastrointestinal reaction that made him sleepy. Nausea and vomiting, dizziness and weakness, every time chemotherapy made him feel like a year. During the treatment, the bone marrow suppression was also serious. II degree and III degree of platelets were reduced. Regular blood tests often made his arm green and purple. I heard that the effect of chemotherapy is not good. Lao Li is almost desperate. "Professor Ren. I heard that the greater the chemotherapy response, the better the curative effect? ​​Chemotherapy can not kill my cancer cells. Did I not save it?" Lao Li, at this time, also red eyes. The pessimistic words of helplessness, disappointment, and frustration are not as good as the old thought at the moment.

On the one hand, Professor Ren appeases Lao Li's emotions and encourages him to regain his confidence in the treatment. On the other hand, he seek more active and effective treatment plan with the team. Affected by the results of the Regonivo research published by ASCO in 2019 at the time, the combined immunotherapy of tyrosine kinase (TKI) combined with immunotherapy obtained excellent effects in advanced colorectal cancer in MSS [4]. Professor Ren believes that combined immunotherapy of antemlodia production drugs may benefit Lao Li. After the team discussed, the treatment plan for the choseninib combined with the vinsiumab. After a few cycles, the miracle occurred, and Lao Li's tumor finally was effectively controlled.

After hearing the results of the review, Lao Li, who had not showed a smile in the past six months, was happy like a child at this moment, and the stone of Professor Ren finally fell to the ground. The results of the review again and again are not only the pronouncement of the patient, but also the consideration of the doctor's treatment plan. After the standard treatment of the first and second -tier standards is still progressing rapidly, the plan of antibrokers combined with immunotherapy has finally controlled the flood beast, and the ultimate disease is stable (SD). Two years have passed, and Lao Li is still taking orally. During the process, Lao Li appeared on the lesions of the lymph nodes and bone metastasis of the clavicle. For local widow metastasis, Professor Ren was treated with radiation therapy. The lesion was effectively controlled, and no recurrence and metastasis of other lesions appeared again. Lao Li also obtained PFS for more than 2 years in the third -line treatment plan, and has continued to benefit so far.

Lao Li is currently followed up in the outpatient clinic of Professor Ren. The two looked back at the anti -cancer path in recent years and intersect. Lao Li admitted: "The months of recalling the first few months of chemotherapy are a double test of physiology and psychology. Under the torture of chemotherapy, the tumor still grows crazy. Home oral medicines are not only convenient, but also small side effects, and tumors are also stable. "Professor Ren said:" For the treatment of patients, the overall is safe and controllable, and it has reached more than 2 years of PFS. As a result of the joint efforts of doctors and patients, the patient does not give up, and we can let it go. "

Wu Mengchao, a famous hepatobiliary surgeon, said: "Doctors treat the disease, as if they can carry the patients one by one." Sometimes, the river is turbulent and the reefs are dense. For the treatment effect, no one can predict that there is no risk on this common anti -cancer road. Only when the doctors and patients trust each other and work together can they be able to cross the difficulties and reach the other side. Stable and far away,

How to make patients live longer and live better

Professor Liu combined with his personal diagnosis and treatment experience that there are the following aspects for how to make patients the best benefit: First of all, CRC's first -line standardized treatment is still the basis for the benefit of the long survival of the patient. The key to the extension of the patient's OS is the initial initial First -line treatment. At the same time, the patient should be fully and effective. The survival benefits brought by each line of treatment should be precious. It can be seen from the wonderful case sharing he brought by him. Other coalition local radiation therapy brings a year of PFS to the patient. Secondly, it is individually given a precise treatment plan for patients. In response to the results of the patient RAS wild genetic testing, the treatment of Setccuca monoclonal anti -resistance also brought it 7 months of PFS. In addition, while the three -line treatment is extended, the quality of life needs to focus on the quality of life of patients. While living longer, it also lives better.

Professor Ren combined with his classic case of PFS for more than 2 years, and published his own diagnosis and treatment experience on CRC: First, the patient was a patient with KRAS mutations. This mutation uses EGFR inhibitors to produce resistance, clinical treatment difficulty, and poor prognosis [5]. Secondly, inspired by the research of Regonivo, the excellent effect of antibrokers' combined immunotherapy was well confirmed on the patient. At the same time, at the ASCO conference in 2021, a Phase IB research data of 呋喹 呋喹 同时 信 信 同时 同时 [6] was announced [6] to conduct related exploration of the MSS/mismatch repair function (PMMR) advanced CRC. For regulating tumor micro -environment, from immunosuppressive to immune support, that is, from "cold tumor" to "heat tumor", increasing the sensitivity of tumors to immunotherapy, antibodium production combined immunization treatment is to explore MSS/PMMR late CRC Provide subsequent research directions. Finally, the overall benefit of the patient is also based on individualized, precise treatment and full -process disease management. The management of subsequent CRC patients needs to adhere to this concept and strive for more patients to benefit from their treatment.

Regarding the future research outlook, Professor Liu said that the current treatment of patients with 呋喹 替 in the micro satellite instability (MSI-H) sees a good effect, but patients with intestinal cancer in MSS need to continue to explore. In the future, the discovery of the new CRC target, such as the antibody coupling drug (ADC) for HER2 targets may become a new hotspot of research. Professor Ren's outlook for the future also mentioned the hot spot of targeted therapy. At the same time, it affirmed that the second -generation sequencing (NGS) was a major key direction to support the more efficient and more accurate treatment in the future. For how MSS patients can copy the excellent curative effect of his classic case, it is necessary to conduct more in -depth exploration on the selection of advantageous people in the future.

On the road full of thorns, every patient, every story, and every journey left these anti -cancer warrior footprints. On this road, not only did cancer patients work hard, but also scientists explored the mystery of the tumor every night. Accompanying around day and night, patients encourage and support each other. When you look back, you will find that there is also a beautiful shimmer of light on this road, which can smooth the difficulty and suffering of the difficulty in the anti -cancer process, and give the light and hope on the anti -cancer road.

Expert Introduction

Professor Liu Ye

Chief Physician, Master Graduate Tutor

Head of Tumor Science, Handan Central Hospital

Director of the Third Department of Cancer Hospital Hospital Hospital

Deputy Chairman of the First Committee of the Cancer Branch of the Hebei Medical Association

Deputy Chairman of the First Tumor Professional Committee of the Hebei Anti -Cancer Association

Deputy Chairman of the Professional Committee of Lung Cancer Prevention and Rehabilitation of Hebei Province

Deputy Chairman of the Professional Committee of Gastrointestinal Tumor Precision Treatment of Beijing Cancer Prevention and Treatment Society

Standing Committee of the first Lung Cancer Professional Committee of the Beijing Oncology Society

Standing Committee Member of the Beijing Cancer Prevention Research Association

Standing Committee Member of the Hebei Provincial Anti -Cancer Association Tumor Radiation Treatment Professional Committee

Standing Committee Member of the Hebei Provincial Anti -Cancer Association Cancer Department

Standing Committee Member of the Hebei Provincial Anti -Cancer Association Cancer Rehabilitation and Passing Treatment Professional Committee

Secretary -General of Handan Clinical Oncology Association

Deputy Chairman of Handan Cancer Internal Medicine Quality Management and Control Center

Expert Introduction

Professor Ren Haipeng

Deputy Director of the Department of Internal Medicine of the People's Hospital of Weifang City, Director of the Third Words (Digestive Cancer Words)

Member of the Chinese Anti -Cancer Association Cancer Minimally Invasive Special Committee of the Training Branch

Standing Committee Member of the Shandong Provincial Research Hospital Association of Tumor Molecular A targeted therapy Branch

Executive Director of the Youth Council of the Shandong Anti -Cancer Association

Member of the Shandong Medical Association's liver cancer multidisciplinary branch

Member of the Chemotherapy Branch of the Shandong Anti -Cancer Association and the Gastrointestinal Tumor Branch

Deputy Chairman of the Weifang Medical Association of Multi -disciplinary Specialty Committee of Colomea Cancer

Deputy Chairman of the Weifang Medical Association of the Weifang Medical Association Tumor Sinica Treatment Specialist Committee

references:

[1] .sng h, flace j, siegel rl, et al. Global Cancer Statistics 2020: GLOBOCAN ESTImates of 249.

[2] .http://www.xinhuanet.com/2020-10/07/c_1126579813.htm.

[3].Li J, Qin S, Xu RH, Shen L, Xu J, et al. Effect of Fruquintinib vs Placebo on Overall Survival in Patients With Previously Treated Metastatic Colorectal Cancer: The FRESCO Randomized Clinical Trial. JAMA. 2018 Jun 26 ; 319 (24): 2486-2496.

[4].FukuokaS,HaraH,TakahashiN,etal.RegorafenibplusNivolumabinpatientswithadvancedgastric(GC)orcolorectalcancer(CRC):anopen-label,dose-finding,anddose-expansionphase1btrial(REGONIVO,EPOC1603).ASCO,2019,abstract2522.

[5]. Li Chunyi, Huang Xinen, Wang Ping. Research on target targets and targeted therapy of colorectal cancer [J]. Shandong Pharmaceutical, 2021,61 (17): 108-112. Doi: 10.3969/J.ISSNN .1002-266x.2021.17.030.

[6] .Ye Guo, Weijie ZHANG, JIEER YING, ET Al. Preliminary Results of a Phase 1B Study of Fruquintinib Plus Sintilimab in Advanced COLORECTAL CARORECER. 2021 ASCO ABSTRACT 2514.

*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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