Liječenje uznapredovalog karcinoma kolona

master's thesis

• Title (english): Treatment of advanced colon cancer
• Author: Ivona Peter
• Mentor: Neven Baršić (mentor)
• Committee member: Jasmina Marić Brozić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Neven Baršić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Kolorektalni karcinom je treći po učestalosti, a drugi po smrtnosti od svih malignoma u Hrvatskoj. Ako ga se otkrije u ranom stadiju, liječenje ima dobre ishode. Međutim, oko 20% pacijenata s kolorektalnim karcinomom u vrijeme otkrivanja ima metastaze, smanjujući mogućnost za izlječenje. Liječenje karcinoma kolona uključuje njegovu primarnu resekciju i resekciju metastaza te postoperativnu sistemsku kemoterapiju. Pošto je mali postotak metastaza inicijalno resektabilna, primjenjuje se kemoterapija kako bi se pokušale pretvoriti u resektabilne. Kemoterapeutici korišteni u prvoj i drugoj liniji liječenja uznapredovalog karcinoma kolona su fluoropirimidini (fluorouracil (5FU), kapecitabin, S-1), oksaliplatina i irinotekan. Razvoj lijekova koji djeluju izravno na molekule odabranog signalnog puta omogućio je liječenje određenog broja karcinoma kolona rezistentnih na kemoterapiju i poboljšao njihovo preživljenje. Također, prati se razvoj terapije koja pojačava bolesnikov upalni odgovor na rak kao učinkovita alternativa kemoterapiji. Tri opcije imunoterapije dopuštene su u posljednjih nekoliko godina za liječenje uznapredovalog kolorektalnog karcinoma s MMS-H/MMR-D: pembrolizumab, nivolumab i kombinacija nivolumaba s ipilimumabom. Kombinirana terapija imala je veće ukupne stope preživljenja, ali s češćim i težim nuspojavama. Zbog velikih razlika u prezentiranju bolesti i velikog spektra opcija za liječenje bolesnika s karcinomom kolona, važno je svakom bolesniku pružiti individualni pristup s pažljivim biranjem najbolje terapije za svakog bolesnika.

Abstract (english)

Colorectal cancer is the third most common and the second leading cause of death among all cancers in Croatia. If detected at early stage, treatment has good results. However, 20% of patients with colorectal cancer have metastases at the time of detection, reducing possibility of curative treatment. Treatment of colon cancer is based on it's primary resection with resection of metastases and adjuvant systemic chemotherapy. Fluoropyramidins (floururacil (5FU), capecitabine and S1), oxaliplatin and irinotecan are used as first and second-line of systemic chemotherapy for metastatic colorectal cancer. Since a small percentage of metastases are initially resectable, chemotherapy is given to try to convert them to resectable. The development of agents that directly target molecules of selected signalnig pathway allows the treatment of number of chemoresistant cancers. Moreover, agents enhancing patients inflammatory response to cancer are developing as an effective replecament for chemotherapy. Recently, three options of chemotherapy have been aprroved for the treatment of advanced colorectal cancer with MMS-H/MMR-D: pembrolizumab, nivolumab, and combination of nivolumab and ipilimumab. Combined therapy had higher overall survival rate, but side effects were more frequent and sever. Due to the large differences in disease presentation and wide rage of options for the treatment of a patient with colon cancer, it's important to have individual approach to each patient with careful selection of the best therapy for every patient.

• Keywords: karcinom kolona; metastaze; liječenje; resekcija; kemoterapija
• Keywords (english): colon cancer; metastases; treatment; resection; chemotherapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:866256
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-27 10:12:18