At this year’s American Society of Clinical Oncology Symposium on Gastrointestinal Tumors (ASCO-GI), "Cola" therapy has made the limelight, exploding 6 major types of solid cancer, especially in liver cancer. , Kidney cancer and endometrial cancer three cancer types have also obtained FDA breakthrough therapy designation.
What exactly is this "Coke" therapy?
"Cola" therapy is the abbreviation of the treatment plan formed by the immune drug Corrida (pembrolizumab, K drug) combined with the targeted drug Levima (lenvatinib), and its core treatment The idea is to inhibit PD-1 on the one hand to prevent immune escape, and on the other hand to synchronize anti-angiogenesis and cut off the nutrient supply of cancer cells.
In the 2020 ASCO meeting, KEYNOT 524 updated its research results, applying the cola combination as a first-line treatment to patients with advanced liver cancer, which can extend the median survival of to as long as 22 months. It can be described as a new high.
The magic combination of cola is inseparable from the two great heroes of pembrolizumab and lenvatinib.
1️⃣Pembrolizumab
Pembrolizumab is also known as the K drug, its principle is to combine our body's span T5_span CD8+span CD8+ PD-1 inhibits its immune function, thereby preventing tumor cells from escaping. Speaking of this, you must be confused. What is CD8+ T cell? What is PD-1?
This starts with our immune system.The immune system of our body is composed of immune organ, immune cells and immune active substances, which together protect the body from harm. CD8+ T cells are one of the immune cells, and PD-1 is one that grows on the surface of immune cells. This receptor, the full name of programmed death receptor 1, its role is to suppress the work of the immune system.
You may be wondering why there is such a thing on immune cells that suppresses itself ❓Isn’t the immune system stronger, the better❓
This is not the case.
We compare the immune cells to the police of the body. In normal conditions, the police perform their duties and catch the bad guys. However, once the police make a mistake in their judgment, they will attack themselves irrespective of their enemies and over-immune, causing autoimmune diseases, such as psoriasis, lupus erythematosus, etc. At this time, the body will activate PD-1. Suppressing the work of immune cells helps to set things right.
Cunning cancer cells use this mechanism. Under normal circumstances, when T cells see cancer cells, the first reaction is to lift the knife. However, cancer cells will express PD-L1 protein on the cell surface. This PD-L1 is like " daji", which charms the PD-1 on the T cells. After the two are combined, PD-1 is It will send out an inhibitory signal, telling the T cell: "This is a friendly army." As a result, T cells are like the bewitched "King King", slowly heading for destruction. The cancer cell smiled and escaped the immune system's pursuit, wantonly killing "Zhongliang", and continued to grow and grow.
At this time, pembrolizumab in the cola combination came forward and bound to PD-1 in front of the PD-L1 protein. The PD-L1 protein on the surface of cancer cells was useless and immune The cells will start to move again and hunt down the escaped cancer cells.
2️⃣ lenvatinib
lenvatinib is a family of vascular endothelial growth factor (VEGF) secreted by tumor cells that can be choked from the root,Reduce the possibility of its immune escape. At the same time, as a tyrosine kinase receptor inhibitor (TKI)), it can inhibit tumor pathological angiogenesis, thereby inhibiting tumor growth.
In fact, this is well understood, lenvatinib is a typical drug that starves cancer cells to death. A tumor is like a young adolescent boy who grows fast and eats a lot. Therefore, it must spontaneously promote the formation of new blood vessels, so that it has enough nutrients for it to "thrive." Many ultrasound doctors suspect that a nodule is malignant. One of the most important evidences is that there are many blood vessels in the nodule.
And lenvatinib looks like vascular endothelial growth factor, blood vessels see it no longer bind to the factor secreted by the tumor, but run to bind it, but lenvati Nitrile does not promote the growth of blood vessels, so if there are no blood vessels to feed the cancer cells, the cancer cells can only be starved to death. This is the magical effect of lenvatinib's competitive inhibition.
Therefore, pembrolizumab and lenvatinib are a match made in heaven. They can show their power in a variety of solid tumors , and enter multiple cancer treatment guidelines in one fell swoop. Among them, the "2020 CSCO Liver Cancer Diagnosis and Treatment Guidelines" clearly pointed out that in the first-line treatment of patients with liver function Child-PughA or better B (≤7 points), it is recommended to use "Cola therapy".
At present, in my country and internationally, the indications of the "cola combination" are in full swing. Pembrolizumab's original drug manufacturer , merck and lenvatinib's original drugs Factory Eisai also carried out a total of 12 clinical trials from LEAP001 to LEAP012. We believe that this therapy will surely be applied to more types of cancer and bring gospel and hope to more cancer patients.
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