I. Chidule chaESMOMalangizo a 2025
Mu Ogasiti 2025, ESMO idatulutsa mwalamulo buku la Early and advanced non small cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow up, lofalitsidwa mu magazini yapamwamba ya oncology Annals of Oncology. Uwu ndi uthenga woyamba wokhudza kusintha kuyambira mu 2017 ndipo umapereka umboni wodalirika kwambiri kwa madokotala a khansa padziko lonse lapansi.
Khansa ya m'mapapo ili ndi chiwerengero chachikulu cha khansa padziko lonse lapansi komanso imfa zambiri kuposa khansa zina zilizonse. Chaka chilichonse, pali milandu yatsopano yoposa 2.2 miliyoni komanso imfa zoposa 1.8 miliyoni, zomwe zimapangitsa khansa ya m'mapapo kukhala chifukwa chachikulu cha imfa zokhudzana ndi khansa mwa amuna ndi akazi. Khansa ya m'mapapo yopanda maselo ang'onoang'ono (NSCLC) imayimira pafupifupi 80-85% ya odwala onse a khansa ya m'mapapo. Poganizira izi, kutulutsidwa kwa malangizo a 2025 kumabweretsa mphamvu zatsopano zasayansi m'machitidwe azachipatala, pomwe kusintha kwa njira zoyesera biomarker ndikofunikira kwambiri.
II. Kutanthauzira Zosintha za Malangizo Ofunika
2.1 Kuyesa kwa Biomarker: Kuchokera pa "Zosankha" kupita pa "Zofunika Kwambiri"
Malangizo a 2025 apanga kusintha kwakukulu pankhani yokhudza kuyezetsa kwa biomarker. Malangizowa amanena momveka bwino kuti kuyezetsa kwa biomarker ndikofunikira kwambiri posankha chithandizo kwa odwala omwe ali ndi gawo la IB-III NSCLC.
Malangizowa akuwonjezera mayeso a mamolekyu kuyambira pa nthawi yomwe ankayang'ana kwambiri odwala omwe ali ndi matenda opita patsogolo mpaka omwe angayambike kuchira. Cholinga chachikulu ndikuzindikira kusintha kwa majini oyambitsa matenda ndikupereka maziko asayansi ochizira molondola. Malangizowa akugogomezeranso kuti kuthekera kwa biopsy ndi njira yodziwira matenda kuyenera kutsimikiziridwa ndi gulu la akatswiri osiyanasiyana kutengera mawonekedwe a wodwala komanso chotupa.
Ponena za njira yeniyeni yoyesera, malangizowa amalimbikitsa momveka bwino kuti kuyezetsa majini kuchitike musanapange chisankho chochita opaleshoni, ndipo kuti kuyenera kuphimba EGFR ndi ALK. Lingaliro la "kuyezetsa pasadakhale" ili ndi tanthauzo lalikulu lachipatala pakupanga magulu enieni komanso chithandizo chapadera cha NSCLC yoyambirira - nthawi yake komanso kulondola kwa zotsatira za mayeso ndizomwe zimatsimikiza mwachindunji kusankha chithandizo chowonjezera chotsatira.
2.2 Kupita Patsogolo kwa Chithandizo mu NSCLC Yoyambirira Yabwino Yoyendetsa ndi Oncogene
Malangizo a 2025 akuphatikiza umboni wochokera ku maphunziro akuluakulu azachipatala kuti akhazikitse njira yolondola yochiritsira odwala omwe ali ndi NSCLC yoyambirira yokhala ndi driver-oncogene.
Odwala omwe ali ndi kachilombo ka EGFR:Kutengera ndi kafukufuku wodziwika bwino wa ADAURA, chithandizo cha adjuvant osimertinib pambuyo pa opaleshoni kwa zaka zitatu chakhala muyezo wapadziko lonse wa chisamaliro cha odwala omwe ali ndi EGFR exon 19 deletions kapena exon 21 L858R mutations. Kafukufuku wa ADAURA ndi kafukufuku wapadziko lonse lapansi, wokhudza malo ambiri, wosasankhidwa, komanso wolamulidwa wa gawo lachitatu lofufuza momwe adjuvant osimertinib imagwirira ntchito komanso chitetezo cha odwala omwe ali ndi gawo lochotsedwa kwathunthu la IB-IIIA EGFR-mutated NSCLC. Kafukufukuyu adawonetsa kuti osimertinib idasintha kwambiri moyo wopanda matenda komanso kupulumuka konse poyerekeza ndi placebo, ndikukhazikitsa osimertinib ngati muyezo watsopano wa chisamaliro cha anthu awa. Komabe, kusanthula kofufuza kwa kafukufuku wa ADAURA kudawonetsa kuti pafupifupi 36% ya kusiya chithandizo koyambirira kudachitika chifukwa cha zochitika zoyipa, ndipo ena 31% adachitika chifukwa cha chisankho cha wodwala. Kupeza kumeneku kukuwonetsa kufunikira koyesa koyambirira kolondola chithandizo chisanachitike kuti zitsimikizire kuti chithandizo cholunjika chikuperekedwa kwa odwala omwe angapeze phindu lokhazikika.
Odwala omwe ali ndi ALK:Kutengera ndi mayeso a ALINA, chithandizo cha adjuvant alectinib pambuyo pa opaleshoni kwa zaka ziwiri tsopano ndiye muyezo wa chisamaliro. Mu kusanthula koyamba kwa mayeso a ALINA open-label a gawo lachitatu, alectinib inawonetsa phindu lodziwika bwino la kupulumuka popanda matenda mu gawo la II-IIIA, ndi chiŵerengero cha zoopsa cha 0.24. Deta yosinthidwa kuchokera ku mayeso a ALINA omwe adaperekedwa ku msonkhano wa ESMO 2025 idawonetsa kuti patatha zaka ≥3 zotsatiridwa, phindu la DFS la alectinib linakhalabe "lokhazikika komanso lofunika kuchipatala," ndi chiŵerengero cha zoopsa cha 0.36 mu gawo la II-IIIA. Chiŵerengero chaposachedwa cha kupulumuka kwa zaka 4 chomwe chanenedwa chafika pa 98.4%, chiŵerengero cha DFS cha zaka 4 chinali 75.5%, ndipo DFS yapakati pa mitsempha yamagazi idawongoleredwanso, popanda zizindikiro zatsopano zachitetezo. Deta yolimba iyi imakhazikitsanso adjuvant alectinib ngati muyezo wa chisamaliro pambuyo pochotsa ALK-positive NSCLC ndikugogomezera kufunika koyesa molondola kuti mudziwe odwala otere.
Kusankha njira yoyesera:Malangizo a ESMO a 2025 amafotokoza momveka bwinoMayeso a multiplex RT-PCR panelpamodzi ndi NGS, IHC, ndi FISH zochokera ku RNA monga imodzi mwa njira zaukadaulo zomwe zimalimbikitsidwa kuti zidziwike za ALK fusion. Izi zikusonyeza kuti chofunikira chachikulu cha malangizowa ndikuchita mayeso kuti atsogolere zisankho zachipatala, m'malo molamula nsanja inayake yoyesera. Pazinthu za RT-PCR zomwe zimayang'ana pa kuzindikira kwa EGFR ndi ALK, njira yoyesera yosinthika iyi imapereka chifukwa champhamvu chogwiritsira ntchito malangizowa kuchipatala.
III. Mayankho Aukadaulo Oyesera Molondola
Malangizo a 2025 akupita patsogolo ku siteji yopanga zisankho asanachite opaleshoni, zomwe zimapangitsa kuti mayeso akhale olondola, omveka bwino, komanso osavuta kuwapeza. Zinthu ziwiri zodziwira matenda pogwiritsa ntchito RT-PCR zomwe zafotokozedwa pansipa zikugwirizana ndendende ndi zofunikira za malangizowo kuchokera pamalingaliro aukadaulo.
3.1 EGFR Mutation Detection Kit - Nsanja Yowonjezera ya Ukadaulo wa ARMS
Ukadaulo wapakati: Ukadaulo wowonjezereka wa ARMS umalola kukulitsa kwapadera kwa ma mutant ocheperako motsutsana ndi maziko apamwamba achilengedwe.
Chitetezo chaukadaulo zitatu:
-Ma ARMS Olimbikitsidwa → amawongolera kuzindikira kusintha kwa thupi
-Kukulitsa ma enzyme → kumagaya maziko achilengedwe ndikuwonjezera ma mutant sequences
-Kutseka kutentha → kumaletsa kukulitsa kosafunikira kwenikweni
Magwiridwe antchitoKuzindikira kwaMafupipafupi a allele osinthika a 1%
Kuletsa kuipitsidwa: Kuwongolera mkati komwe kwamangidwa + enzyme ya UNG imaletsa kuipitsidwa
Nthawi yosinthira: Ntchito yotseka chubu, pafupifupiMphindi 120
Kugwirizana kwa zitsanzo:Minofu/biopsy yamadzimadzizitsanzo → akufotokoza zofunikira "zoyesa pasadakhale"
Kuphimba:45 kusintha kwa zinthumu EGFR exons 18-21, madera ofanana bwino ndi malangizo (kuchotsedwa kwa exon 19 ndi exon 21 L858R)
Kugwiritsa ntchito kuchipatala: Amatsogolera mwachindunji chithandizo cha EGFR-TKI
3.2 MMT EML4-ALK Fusion Detection Kit – Yankho Lodziwira Fusion Lochokera ku RNA
-Nsanja yaukadaulo: RT-PCR yochokera ku RNA - imapereka ubwino wofanana ndi njira zozikidwa pa DNA zopezera fusion
-Ubwino wozikidwa pa RNA: Imazindikira mwachindunji zolemba zosakanikirana zomwe zafotokozedwa, ndikupewa bwino zolakwika zabodza
-Umboni wophunzirira: Mu ma ALK fusions ochepa, RT-PCR ndi yodalirika kwambiri kuposa mayeso ozikidwa pa DNA.
-Kuzindikira: Amazindikira kusakanikirana mpakaMakopi 20 pa yankho lililonse
-Kuphimba mitundu yosiyanasiyanaZikutoMitundu 12 yodziwika bwino ya EML4-ALK fusion(kuphatikiza mtundu 1 ~33%; mitundu 3a/3b pamodzi ~29%)
-Kugwira ntchito ndi kuletsa kuipitsidwa: Chubu chotsekedwa, ~ mphindi 120; zowongolera zomangidwa mkati + enzyme ya UNG imaletsa zotsatira zabodza
-Kugwirizana kwa zida: Imagwirizana ndi zida zosiyanasiyana za PCR zenizeni nthawi yeniyeni
-Kulinganiza malangizo: Zimagwirizana kwambiri ndi malangizo a ESMO
IV. Kugwirizana Pakati pa Mayeso ndi Malangizo Otsogolera
Zinthu ziwirizi zozindikirira zikugwirizana kwambiri ndi malangizo a ESMO 2025 oyambirira komanso apamwamba a khansa ya m'mapapo yopanda maselo ang'onoang'ono m'mbali zotsatirazi:
V. Mapeto
Malangizo a NSCLC a ESMO 2025 akuyamba ndi nthawi yatsopano yodziwira matenda molondola komanso chithandizo, makamaka pa "kuyesa pasadakhale, kulunjika molondola, komanso kukonza bwino chithandizo."EGFR Mutation Detection Kit ndi MMT EML4-ALK Fusion Detection Kit zimakwaniritsa zofunikira za malangizo okhudza zolinga, nthawi, ndi kulondola kudzera m'njira zosiyanasiyana zaukadaulo."
Kiti ya EGFR imagwiritsa ntchito ukadaulo wapamwamba wa ARMS pozindikira kusintha kwa majini m'zitsanzo zochepa, kuthandizira biopsy ya minofu ndi madzi kuti athe "kuyesa pasadakhale."
Kiti ya ALK imachokera ku RNA-based RT-PCR, zomwe zimapereka ubwino kuposa njira za DNA zodziwira fusion, mogwirizana ndi zomwe ESMO idapereka pa multiplex RT-PCR panels kuti ayesere ALK.
Pamodzi, zinthu ziwirizi zimapanga njira yoyesera molondola mogwirizana ndi malangizo a ESMO 2025, zomwe zimathandiza chithandizo chothandizira payekha cha NSCLC yoyambirira.
Maumboni:
- Zer A, Ahn MJ, Barlesi F, ndi ena. Khansa ya m'mapapo yoyambirira komanso yopita patsogolo m'deralo: Malangizo a ESMO Clinical Practice Guideline pozindikira matenda, chithandizo ndi kutsatira. Ann Oncol. 2025;36(11):1245-1262. doi:10.1016/j.annonc.2025.08.003
Nthawi yotumizira: Meyi-06-2026