【佳学基因靶向药物基因检测】基于突变的短期“新辅助”治疗可使 IVB 期和 C 期甲状腺间变癌实现可切除性

中国基因检测公司排名详解

讨论了肿瘤个体化药物研究路径做备注《Eur Arch Otorhinolaryngol》在 2023 Jan 13.发表了一篇题目为《》肿瘤靶向药物治疗基因检测临床研究文章。该研究由Elisabeth Maurer, F Eilsberger, S Wächter, J Riera Knorrenschild, A Pehl, K Holzer, A Neubauer, M Luster, D K Bartsch等完成。促进了肿瘤的精准治疗与个性化用药的发展，进一步强调了基因信息检测与分析的重要性。

肿瘤基因检测及靶向药物治疗研究关键词：

间变性甲状腺癌,基于突变的治疗,新辅助治疗。

肿瘤治疗检测基因临床应用结果

简介：很少有可用数据表明，基于突变的“新辅助”治疗晚期甲状腺未分化癌 (ATC) 可能会将最初无法切除的原发性肿瘤转化为可切除的，并优化局部肿瘤控制。我们在三名 ATC IVB 期和 C 期患者中评估了术前短期“新辅助”治疗与 BRAF 定向治疗，或者在 BRAF 非突变肿瘤的情况下，mKI/检查点抑制剂组合。佳学基因解码的途径：在尽快开始术前诊断、免疫组织化学 (IHC) 评估和基因分析。乐伐替尼抗血管生成治疗在 ATC 诊断后立即开始作为桥接治疗。在 BRAF 突变的 ATC 的情况下，dabrafenib 和曲美替尼联合治疗，在 BRAF 野生型 ATC 的情况下，给予 pembrolizumab 和 lenvatinib 的联合治疗 4 周。如果重新分期显示由于大小减少 > 50% 而产生显着的治疗反应，则重新考虑手术切除。首先进行了原发性肿瘤切除术。第二步，在甲状腺手术后大约 4 周切除了有限的远处转移。术后恢复后，继续进行靶向全身治疗。患者：2例BRAF野生型ATC IVC期患者，1例BRAF突变ATC IVB期患者。所有患者在诊断为 ATC 时均接受了外科、核医学和肿瘤学评估。靶向药物研究的客观数据：在所有三例中，“新辅助”治疗引起了显着的反应，并导致了主要不可切除的 ATC IVB 或 C 期的局部可切除性。我们有首次选择短期“新辅助”治疗期以降低由于潜在的快速肿瘤缩小而导致出血和/或瘘管的风险。仅经过短期“新辅助”治疗后的手术结果显示两个 R0 切除和一个 R1 切除。术后组织病理学结果证实我们患者的肿瘤坏死或退行性纤维化组织的范围在 60% 到 > 95% 之间。药物指导及病因判断的依据：短期基于突变的“新辅助”疗法可以在最初不可切除的 ATC IVB 期或 C 期实现局部可切除性。大约 4 周的新辅助治疗期似乎与至少 3 个月的治疗期表现出相似的反应。基于突变的治疗；新辅助治疗。

肿瘤发生与革命国际数据库描述：

Introduction: Few available data indicate that a mutation-based "neoadjuvant" therapy in advanced anaplastic thyroid carcinoma (ATC) might convert an initially unresectable primary tumor to resectable and optimize local tumor control. We evaluated a preoperative short-term "neoadjuvant" therapy with a BRAF-directed therapy or, in case of BRAF non-mutated tumors, an mKI/checkpoint inhibitor combination in three patients with ATC stage IVB and C.Methods: In the context of preoperative diagnostics, immunohistochemistry (IHC) assessment and genetic analysis was started as soon as possible. The antiangiogenetic therapy with lenvatinib was immediately after diagnosis of ATC started as bridging therapy. In case of a BRAF-mutated ATC, a combination therapy of dabrafenib and trametinib, in case of BRAF-wildtype ATC a combination of pembrolizumab and lenvatinib was given for 4 weeks. If re-staging has shown a significant therapy response due to a decrease in size of > 50%, surgical resection was reconsidered. A primary tumor resection was performed first. As a second step, limited distant metastasis have been resected approximately 4 weeks after thyroid surgery. After postoperative recovery, the targeted systemic therapy was continued.Patients: Two patients presented with BRAF-wildtype ATC stage IVC, one with BRAF-mutated ATC stage IVB. All patients were evaluated by surgery, nuclear medicine and oncology upon diagnosis of ATC.Results: In all three cases, the "neoadjuvant" therapy induced a dramatic response and led to local resectability in primarily non-resectable ATC stage IVB or C. We have chosen for the first time a short-term "neoadjuvant" treatment period to reduce the risk of bleeding and/or fistula due to potential rapid tumor shrinkage. The results of surgery after only short-term "neoadjuvant" therapy showed two R0 und one R1 resections. Postoperative histopathological findings confirmed an extent of tumor necrosis or regressive fibrotic tissue between 60 and > 95% in our patients.Conclusions: A short-term mutation-based "neoadjuvant" therapy can achieve local resectability in initially unresectable ATC stage IVB or C. A neoadjuvant treatment period of about 4 weeks seems to show similar response as a treatment duration of at least 3 months.Keywords: Anaplastic thyroid cancer; Mutation-based therapy; Neoadjuvant therapy.

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