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    Home > Active Ingredient News > Digestive System Information > NEJM: Pim monoantigen is used to treat advanced colorectal cancer with high instability of microsatellitons

    NEJM: Pim monoantigen is used to treat advanced colorectal cancer with high instability of microsatellitons

    • Last Update: 2020-12-14
    • Source: Internet
    • Author: User
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    Although colorectal cancer is clinically defined by its origin in the colon or rectum, it is actually a genetically classified heterogeneous disease.
    this well-known genetic difference is not reflected in the chemotherapy programme, which is largely uniform for colorectal cancer.
    Patients who are initially diagnosed with metastatic colorectal cancer can use treatments based on 5-fluorouracil (5-FU) alone, such as FOLFOX (5-FU, Osali platinum and folate) or FOLFIRI (5-FU, Iriticon and folate);
    the genetic phenomenon of misalmediation repair defects (dMMRs) in 15 per cent of colorectal cancer patients, 12 per cent of which were extrinsic and 3 per cent were genetic.
    80% of cases of extrinsic dMMR colorectal cancer are caused by methylation of MMLH1 gene initiaters, while more than 70% of hereditary cases are associated with lineage mutations in the MLH1 and MSH2 genes.
    cells are unable to recognize and repair spontaneous mutations, causing a high burden of tumor mutations and changes in microsatellite sequences, leading to high levels of microsatellite instability (MSI-H-dMMR).
    increasing evidence that MSI-H-dMMR tumors respond poorly to conventional chemotherapy, but so far there is no literature to support this argument, so chemotherapy remains the standard of treatment for patients with MSI-H-dMMR colorectal cancer.
    -1 (PD-1) blocking has become a new method for treating patients with MSI-H-dMMR metastatic colorectal cancer who are ineffective against standard chemotherapy programs.
    PD-1 inhibitors, Pym monoantigen and niguru monoantigen can produce a lasting response in patients who have already been treated.
    to compare the efficacy of PD-1 inhibitors with standard chemotherapy programs for colorectal cancer, Thierry André et al. conducted a randomized, open-label phase III trial that resulted in 307 previously untreated metastatic MSI-H-d cases MMR colorectal cancer patients were randomly assigned according to a 1:1 ratio, the monoantigen group received 200 mg of pim monotherapy every 3 weeks, and the chemotherapy group received 5-FU chemotherapy every 2 weeks (with or without beva monoanti or sytoxident).
    if patients in the chemotherapy group developed the disease, they could also receive Pym monotherapy.
    two main endpoints are progress-free lifetime and total lifetime.
    In the second interim analysis, the medium follow-up time (from random grouping to data cut-off) in the Pym mono-resistance group was 32.4 months (ranging from 24.0 to 48.3), and its progress-free survival was better than that of the chemotherapy group.
    (median is 16.5 vs. 8.2 months, the risk ratio is 0.60; the 95% confidence interval is 0.45 to 0.80; P is 0.0002).
    estimated that the average duration of the restriction after 24 months of follow-up was 13.7 months in the monoantial group (ranging from 12.0 to 15.4) and 10.8 months in the chemotherapy group (ranging from 9.4 to 12.2).
    to the data cut-off, 56 cases and 69 patients died in the Pym monoantial and chemotherapy groups, respectively.
    data on overall survival are still in the process (66 per cent of the necessary events occurred) and cannot be finalized until a final analysis is carried out.
    response (full or partial response) assessed using the 1.1 solid tumor response assessment criteria (RECIST) accounted for 43.8% and 33.1% of the Pym monoantigen and chemotherapy groups, respectively.
    in patients with overall remission, the Pym monoantial group was 83 percent, compared with 35 percent in the chemotherapy group, and the Pym monoantial group continued to remission at 24 months.
    22 percent of patients in the Pham monoantial group had treatment-related level 3 or higher adverse events, compared with 66 percent in the chemotherapy group (including one patient who died).
    data suggest another advance in biomarker-driven research for MSI-H-dMMR colorectal cancer.
    treatment can significantly prolong progression-free survival and reduce adverse events associated with treatment compared to chemotherapy.
    , for patients with MSI-H-dMMR metastatic colorectal cancer, the use of Pym monoantigen as an initial treatment option should be considered.
    Original Link: MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Mets Medical and are not reproduced by any media, website or individual without authorization, and must be reproduced with the words "Source: Mets Medicine".
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