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Kişiye Özel Kanser Tedavisi

Kişiye Özel Kanser Tedavisi

Kategori   | 1/30/2019

Kişiye Özel Kanser Tedavisi

Günümüzde kanser tedavisinde büyük umut verici gelişmeler olmaktadır. Özellikle hedefe yönelik tedaviler (targeting therapy) grubunda yeni ilaçların geliştirilmesi ve kullanıma girmesi tıbbi onkoloji uzmanlarının elini kuvvetlenmiş, kanserli hastanın iyileşme şansını arttırmıştır (1-3).

Her kişinin kanseri, kendi sağlıklı hücrelerinden gelişmekte olup sadece o kişiye özel genetik özellikler taşımaktadır. Bu nedenle kanser tipi aynı olsa da kanser tedavisinde elde edilen sonuçlar her kişi için farklı olmaktadır. Bu da kişiye özgü kanser tedavisinin önemini göstermektedir.

Kliniğimize başvuran hastalarda kanser dokusu örneğinde kişiye özel tedavi planlaması için ileri labaratuvar testleri yaptırılmaktadır. Kanserin yaşaması için gerekli enzim, mutasyon ve proteinler belirlenerek bunları engelleyen ilaçlar kullanılmaktadır. Sonuç olarak kanserde iyileşme şansı arttırılırken, daha az yan etki görülmektedir.

Günümüzde kanser tedavisinde kullanımı onaylanmış hedefe yönelik kanser ilaçları aşağıda hastalıklara göre listelenmiştir (4).

Agent

Target(s)

FDA-approved indication(s)

Ado-trastuzumab emtansine (Kadcyla)

HER2 (ERBB2/neu)

  • Breast cancer (HER2+)

Afatinib (Gilotrif)

EGFR (HER1/ERBB1), HER2 (ERBB2/neu)

  • Non-small cell lung cancer (with EGFR exon 19 deletions or exon 21 substitution (L858R) mutations)

Aldesleukin (Proleukin)

 

  • Renal cell carcinoma

  • Melanoma

Alectinib (Alecensa)

ALK

  • Non-small cell lung cancer (with ALK fusion)

Alemtuzumab (Campath)

CD52

  • B-cell chronic lymphocytic leukemia

Atezolizumab (Tecentriq)

PD-L1

  • Urothelial carcinoma

  • Non-small cell lung cancer

Avelumab (Bavencio)

PD-L1

  • Merkel cell carcinoma

  • Urothelial cancer

Axitinib (Inlyta)

KIT, PDGFRβ, VEGFR1/2/3

  • Renal cell carcinoma

Belimumab (Benlysta)

BAFF

  • Lupus erythematosus

Belinostat (Beleodaq)

HDAC

  • Peripheral T-cell lymphoma

Bevacizumab (Avastin)

VEGF ligand

  • Cervical cancer

  • Colorectal cancer

  • Fallopian tube cancer

  • Glioblastoma

  • Non-small cell lung cancer

  • Ovarian cancer

  • Peritoneal cancer

  • Renal cell carcinoma

Blinatumomab (Blincyto)

CD19/CD3

  • Acute lymphoblastic leukemia (precursor B-cell)

Bortezomib (Velcade)

Proteasome

  • Multiple myeloma

  • Mantle cell lymphoma

Bosutinib (Bosulif)

ABL

  • Chronic myelogenous leukemia (Philadelphia chromosome positive)

Brentuximab vedotin (Adcetris)

CD30

  • Hodgkin lymphoma

  • Anaplastic large cell lymphoma

Brigatinib (Alunbrig)

ALK

  • Non-small cell lung cancer (ALK+)

Cabozantinib (Cabometyx [tablet], Cometriq [capsule])

FLT3, KIT, MET, RET, VEGFR2

  • Medullary thyroid cancer

  • Renal cell carcinoma

Canakinumab (Ilaris)

IL-1β

  • Juvenile idiopathic arthritis

  • Cryopyrin-associated periodic syndromes

Carfilzomib (Kyprolis)

Proteasome

  • Multiple myeloma

Ceritinib (Zykadia)

ALK

  • Non-small cell lung cancer (with ALK fusion)

Cetuximab (Erbitux)

EGFR (HER1/ERBB1)

  • Colorectal cancer (KRAS wild type)

  • Squamous cell cancer of the head and neck

Cobimetinib (Cotellic)

MEK

  • Melanoma (with BRAF V600E or V600K mutation)

Crizotinib (Xalkori)

ALK, MET, ROS1

  • Non-small cell lung cancer (with ALK fusion or ROS1 gene alteration)

Dabrafenib (Tafinlar)

BRAF

  • Melanoma (with BRAF V600 mutation)

  • Non-small cell lung cancer (with BRAF V600E mutation)

Daratumumab (Darzalex)

CD38

  • Multiple myeloma

Dasatinib (Sprycel)

ABL

  • Chronic myelogenous leukemia (Philadelphia chromosome positive)

  • Acute lymphoblastic leukemia (Philadelphia chromosome positive)

Denosumab (Xgeva)

RANKL

  • Giant cell tumor of the bone

Dinutuximab (Unituxin)

B4GALNT1 (GD2)

  • Pediatric neuroblastoma

Durvalumab (Imfinzi)

PD-L1

  • Urothelial carcinoma

  • Non-small cell lung cancer

Elotuzumab (Empliciti)

SLAMF7 (CS1/CD319/CRACC)

  • Multiple myeloma

Enasidenib (Idhifa)

IDH2

  • Acute myeloid leukemia (with IDH2 mutation)

Erlotinib (Tarceva)

EGFR (HER1/ERBB1)

  • Non-small cell lung cancer (with EGFR exon 19 deletions or exon 21 substitution (L858R) mutations)

  • Pancreatic cancer

Everolimus (Afinitor)

mTOR

  • Pancreatic, gastrointestinal, or lung origin neuroendocrine tumor

  • Renal cell carcinoma

  • Nonresectable subependymal giant cell astrocytoma associated with tuberous sclerosis

  • Breast cancer (HR+, HER2-)

Gefitinib (Iressa)

EGFR (HER1/ERBB1)

  • Non-small cell lung cancer (with EGFR exon 19 deletions or exon 21 substitution (L858R) mutations)

Ibritumomab tiuxetan (Zevalin)

CD20

  • Non-Hodgkin's lymphoma

Ibrutinib (Imbruvica)

BTK

  • Mantle cell lymphoma

  • Chronic lymphocytic leukemia

  • Waldenstrom's macroglobulinemia

Idelalisib (Zydelig)

PI3Kδ

  • Chronic lymphocytic leukemia

  • Follicular B-cell non-Hodgkin lymphoma

  • Small lymphocytic lymphoma

Imatinib (Gleevec)

KIT, PDGFR, ABL

  • GI stromal tumor (KIT+)

  • Dermatofibrosarcoma protuberans

  • Multiple hematologic malignancies including Philadelphia chromosome-positive ALL and CML

Ipilimumab (Yervoy)

CTLA-4

  • Melanoma

  • Renal cell carcinoma

Ixazomib (Ninlaro)

Proteasome

  • Multiple Myeloma

Lapatinib (Tykerb)

HER2 (ERBB2/neu), EGFR (HER1/ERBB1)

  • Breast cancer (HER2+)

Lenvatinib (Lenvima)

VEGFR2

  • Renal cell carcinoma

  • Thyroid cancer

Midostaurin (Rydapt)

FLT3

  • acute myeloid leukemia (FLT3+)

Necitumumab (Portrazza)

EGFR (HER1/ERBB1)

  • Squamous non-small cell lung cancer

Neratinib (Nerlynx)

HER2 (ERBB2/neu)

  • Breast cancer (HER2 overexpressed/amplified)

Nilotinib (Tasigna)

ABL

  • Chronic myelogenous leukemia (Philadelphia chromosome positive)

Niraparib (Zejula)

PARP

  • Ovarian cancer​

  • Fallopian tube cancer​

  • Peritoneal cancer​

Nivolumab (Opdivo)

PD-1

  • Colorectal cancer (dMMR and MSI-H)

  • Head and neck squamous cell carcinoma

  • Hepatocellular carcinoma

  • Hodgkin lymphoma

  • Melanoma

  • Non-small cell lung cancer

  • Renal cell carcinoma

  • Urothelial carcinoma

Obinutuzumab (Gazyva)

CD20

  • Chronic lymphocytic leukemia

  • Follicular lymphoma

Ofatumumab (Arzerra, HuMax-CD20)

CD20

  • Chronic lymphocytic leukemia

Olaparib (Lynparza)

PARP

Olaratumab (Lartruvo)

PDGFRα

  • Soft tissue sarcoma

Osimertinib (Tagrisso)

EGFR

  • Non-small cell lung cancer (with EGFR T790M mutation)

Palbociclib (Ibrance)

CDK4, CDK6

  • Breast cancer (HR+, HER2-)

Panitumumab (Vectibix)

EGFR (HER1/ERBB1)

Panobinostat (Farydak)

HDAC

  • Multiple myeloma

Pazopanib (Votrient)

VEGFR, PDGFR, KIT

  • Renal cell carcinoma

Pembrolizumab (Keytruda)

PD-1

  • Classical Hodgkin lymphoma

  • Colorectal cancer (MSI-H/dMMR)

  • Gastric cancer

  • Melanoma

  • Non-small cell lung cancer (PD-L1+)

  • Head and neck squamous cell carcinoma

  • Urothelial cancer

  • Solid tumors (MSI-H/dMMR)

Pertuzumab (Perjeta)

HER2 (ERBB2/neu)

  • Breast cancer (HER2+)

Ponatinib (Iclusig)

ABL, FGFR1-3, FLT3, VEGFR2

  • Chronic myelogenous leukemia

  • Acute lymphoblastic leukemia (Philadelphia chromosome positive)

Ramucirumab (Cyramza)

VEGFR2

  • Colorectal cancer

  • Gastric cancer or Gastroesophageal junction (GEJ) adenocarcinoma

  • Non-small cell lung cancer

Regorafenib (Stivarga)

KIT, PDGFRβ, RAF, RET, VEGFR1/2/3

  • Colorectal cancer

  • Gastrointestinal stromal tumors

  • Hepatocellular carcinoma

Ribociclib (Kisqali)

CDK4, CDK6

  • Breast cancer (HR+, HER2-)

Rituximab (Rituxan, Mabthera)

CD20

  • Non-Hodgkin’s lymphoma

  • Chronic lymphocytic leukemia

  • Rheumatoid arthritis

  • Granulomatosis with polyangiitis

Rituximab/hyaluronidase human (Rituxan Hycela)

CD20

  • Chronic lymphocytic leukemia

  • Diffuse large B-cell lymphoma

  • Follicular lymphoma

Romidepsin (Istodax)

HDAC

  • Cutaneous T-cell lymphoma

  • Peripheral T-cell lymphoma

Rucaparib (Rubraca)

PARP

Ruxolitinib (Jakafi)

JAK1/2

  • ​Myelofibrosis

Siltuximab (Sylvant)

IL-6

  • Multicentric Castleman's disease

Sipuleucel-T (Provenge)

 

  • Prostate cancer

Sonidegib (Odomzo)

Smoothened

  • Basal cell carcinoma

Sorafenib (Nexavar)

VEGFR, PDGFR, KIT, RAF

  • Hepatocellular carcinoma

  • Renal cell carcinoma

  • Thyroid carcinoma

Temsirolimus (Torisel)

mTOR

  • Renal cell carcinoma

Tocilizumab (Actemra)

IL-6R

  • Rheumatoid arthritis

  • Juvenile idiopathic arthritis

Tofacitinib (Xeljanz)

JAK3

  • Rheumatoid arthritis

Tositumomab (Bexxar)

CD20

  • Non-Hodgkin's lymphoma

Trametinib (Mekinist)

MEK

  • Melanoma (with BRAF V600 mutation)

  • Non-small cell lung cancer (with BRAF V600E mutation)

Trastuzumab (Herceptin)

HER2 (ERBB2/neu)

  • Breast cancer (HER2+)

  • Gastric cancer (HER2+)

Vandetanib (Caprelsa)

EGFR (HER1/ERBB1), RET, VEGFR2

  • Medullary thyroid cancer

Vemurafenib (Zelboraf)

BRAF

Venetoclax (Venclexta)

BCL2

  • Chronic lymphocytic leukemia (with 17p deletion)

Vismodegib (Erivedge)

PTCH, Smoothened

  • Basal cell carcinoma

Vorinostat (Zolinza)

HDAC

  • Cutaneous T-cell lymphoma

Ziv-aflibercept (Zaltrap)

PIGF, VEGFA/B

  • Colorectal cancer

 

Kaynaklar

  1. Baudino TA. Curr Drug Discov Technol. 2015;12(1):3-20. Targeted Cancer Therapy: The Next Generation of Cancer Treatment.

  2. Pento JT. Monoclonal Antibodies for the Treatment of Cance. Anticancer Research 2017;37(11) 5935-5939.

  3. Allahyari H, Heidari S, Ghamgosha M, Saffarian P, Amani J. Immunotoxin: A new tool for cancer therapy. Tumour Biol. 2017 Feb;39(2):1010428317692226.

  4. https://www.mycancergenome.org/content/molecular-medicine/overview-of-targeted-therapies-for-cancer/