Metastatik Kolon ve Rektum Kanseri
Özet
Metastatik kolorektal kanser oldukça sık görülen ve tedavi yelpazesi geniş bir tümördür. Önceleri 5- florourasil ve lökoverin ile başlayan, daha sonra oksaliplatin irinotekan sonrasında bevacizumab, setuksimab, panitumumab gibi biyolojik ajanların dahil olmasıyla sistemik tedavinin etkinliği artmıştır. Tedavi planı yapmadan önce; tümörün biyolojik özellikleri, yerleşim yeri, hastanın komorbiditesi, hastanın performans durumu, verilecek ilaçların yan etkileri ve tedavi hedefi mutlaka belirlenmelidir. Metastatik hatta tedavi çoğunlukla küratif olmayacak, daha çok palyatif olacaktır.
Bu hastalarda tedavinin amacı genel sağkalımı uzatmak ve yaşam kalitesini mümkün olduğunca uzun süre korumaktır. Ancak sınırlı metastatik hastalar; başlangıçta ya da tedaviyle cerrahiye uygun ise bu hastalarda beklenen yaşam süresi daha uzundur. Bu durumda; metastazları küçültme yeteneği, yani yanıt oranı daha kuvvetli ajanlarla kurtarma tedavileri/konversiyon denilen yoğun rejimler tercih edilmelidir. Ancak unrezektabl metastatik hastalarda tümör progresyonunun olabildiğince geciktirilmesi ve stabil hastalığı sağlamak en iyi tedavi yanıtı kabul edilebilir.
Metastatic colorectal cancer is a very common tumor with a wide range of treatment options. The efficacy of systemic treatment has increased with the inclusion of biologic agents such as bevacizumab, cetuximab, panitumumab, which started with 5-fluorouracil and leukoverin, then oxaliplatin and irinotecan. Before making a treatment plan, the biological characteristics of the tumor, its location, the patient's comorbidity, the patient's performance status, the side effects of the drugs to be administered and the treatment goal must be determined. In the metastatic line, treatment will mostly not be curative, but rather palliative. The aim of treatment in these patients is to prolong overall survival and maintain quality of life for as long as possible. However, if limited metastatic patients are suitable for surgery at baseline or with treatment, the life expectancy in these patients is longer. In this case, intensive regimens called salvage therapies/conversion with agents that have a stronger ability to shrink metastases, i.e. a stronger response rate, should be preferred.
However, in unresectable metastatic patients, delaying tumor progression as much as possible and maintaining stable disease may be considered the best treatment response.
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