Immunotherapy 101: Chimene Chiri ndi Momwe Zimagwirira Ntchito

by Lynne Eldridge, MD; Yofotokozedwa ndi Doru Paul, MD

Mmene Immunotherapy Ingathandizire Njira Zathu Zomwe Amatitetezera Kumadzi Timateteza Kanseri

Ngati mumasokonezeka ndi momwe matenda amathandizira kuchiza khansa, pali chifukwa chabwino. Immunotherapy si mtundu umodzi wokha wa mankhwala; M'malo mwake pali mitundu yambiri yochiritsira yomwe imakhala pansi pa mutuwu. Kawirikawiri kuti mankhwalawa amagwiritsira ntchito chitetezo cha mthupi, kapena mfundo za chitetezo cha mthupi, kuti athetse khansa.

Mwa kuyankhula kwina, mankhwalawa, omwe amatchedwa kuti biologic therapy, amagwiritsidwa ntchito posintha thupi la chitetezo cha thupi kapena kugwiritsa ntchito zinthu zopangidwa ndi chitetezo cha mthupi kuteteza khansa.

Nchifukwa Chiyani Immunotherapy Ndi Yosangalatsa Kwambiri?

Ngati mwakhala mukuwerenga nyuzipepala posachedwa, mwinamwake mwawona mitu ya nkhani yomwe ili ndi mauthenga achidwi monga "mankhwala akuyandikira" pamene akufotokoza za immunotherapy. Kodi ichi ndi chinachake chomwe chiyenera kukondweretsedwa, kapena kodi ndizowonjezereka chabe?

Pamene tikuyamba kuphunzira za mankhwalawa, ndipo ndithudi sagwira ntchito kwa khansa zonse, munda wa immunotherapy ndi chinthu chofunika kwambiri. Ndipotu, matenda a immunotherapy amatchedwa khansara ya 2016 yomwe imayambira chaka ndi American Society of Clinical Oncology. Kwa iwo amene akukhala ndi khansa, mundawu, pamodzi ndi kupita patsogolo kwa mankhwala monga chithandizo chamankhwala, ndi chifukwa chokhala ndi chiyembekezo cha chiyembekezo osati osati mtsogolo chabe, koma lero.

Mosiyana ndi maulendo ambiri omwe amapita patsogolo pa zamagetsi, zomwe zimapanga mankhwala oyamba, matendawa ndi njira yatsopano yothetsera khansara (osagwiritsa ntchito njira zoteteza mthupi monga interferon akhala ali pafupi zaka makumi angapo). Poyerekeza ndi mankhwala ena ambiri:

Zina mwa mankhwalawa zingagwiritse ntchito khansa mitundu (mwachitsanzo, mankhwala akhoza kugwira ntchito, kunena, khansa ya khansa ya khansa ya m'mapapo).

Zina mwa mankhwalawa zingagwire ntchito yopambana kwambiri komanso yovuta kwambiri yothetsera khansa (mwachitsanzo, zingakhale zothandiza khansa monga khansara yamapapo yapamwamba kapena khansara ya pancreatic).
Nthawi zina, zotsatira zimakhala zatha-zomwe oncologists amanena kuti ndi "yankho lokhazikika." Mankhwala ambiri okhudza khansa omwe amawopsa kwambiri, monga chemotherapy ndi mankhwala omwe amachititsa kuti mitundu yambiri yamoyo ikhale ndi khansa, ndi yochepa; maselo a khansa amatha kukhala osagwirizana ndi mankhwala. Ngakhale kuti palibe amene akudandaula kuti anene mawu akuti "machiritso" komabe pali chiyembekezo kuti kwa anthu ochepa omwe ali ndi ena mitundu ya khansa-mankhwalawa angapereke mwayi wathandizira kuti awononge khansa yawo nthawi yaitali.

Mbiri ya Immunotherapy

Lingaliro la immunotherapy lakhala likukhalapo kwa nthawi yaitali. Zaka zana zapitazo, dokotala wotchedwa William Coley adanena kuti odwala ena, omwe ali ndi kachilombo ka bakiteriya, amawoneka kuti amenyana ndi khansa zawo. Dokotala winanso wotchedwa Steven Rosenberg akudziwika kuti akufunsa mafunso okhudza chosiyana ndi khansa. Nthawi zambiri, khansa ikhoza kutha popanda mankhwala. Kukhululukidwa kwadzidzidzi kapena kuponderezedwa kwa khansara kwatchulidwa, ngakhale kuti sikuchitika kawirikawiri.

Malingaliro a Dr. Rosenberg anali akuti chitetezo chake cha mthupi la wodwalayo chinali chitagonjetsa ndi kuchotsa khansara.

Chiphunzitso Chotsatira Immunotherapy

Zomwe amakhulupirira zokhudzana ndi immunotherapy ndikuti chitetezo chathu cha mthupi chimadziwira kale momwe tingamenyane ndi khansa. Monga momwe matupi athu amatha kuzindikira, kutchula, ndi kukweza chitetezo cha mthupi motsutsana ndi mabakiteriya ndi mavairasi omwe amabwera matupi athu, maselo a khansa angatchulidwe ngati osadziwika ndi ochotsedwa ndi chitetezo cha mthupi.

Ndiye chifukwa chiyani machitidwe athu omenyana ndi chitetezo chathu sagonjetsa khansa yonse?

Kuphunzira za momwe zimakhalire ndi mankhwala osokoneza bongo kumabweretsa funso: "Ngati chitetezo chathu cha mthupi chitidziwa momwe tingamenyerekerere khansa, bwanji?

Kodi zimatheka bwanji kuti munthu mmodzi mwa amuna awiri ndi mmodzi mwa amayi atatu azikhala ndi khansa pa moyo wawo wonse? "

Choyamba, chitetezo chathu cha mthupi chimagwira bwino kwambiri poyeretsa maselo owonongeka omwe pamapeto pake angakhale maselo a khansa. Tili ndi majini angapo omwe amadziwika kuti DNA yathu, yotchedwa tumor suppressor genes , yomwe imapanga dongosolo la mapulotini omwe amakonza ndi kuchotsa maselo omwe awonongeka. Mwina funso loposa likhoza kukhala, "bwanji ife tonse sitimayambitsa khansa kawirikawiri?"

Palibe amene amadziŵa bwino chifukwa chake maselo ena a khansa amatha kutulukira ndi kuwonongeka ndi chitetezo cha m'thupi. Chimodzi mwa zifukwa, zimaganiziridwa, ndikuti maselo a khansa akhoza kukhala ovuta kuti azindikire kuposa mabakiteriya kapena mavairasi chifukwa amachokera ku maselo omwe amawoneka kuti ndi abwino mwa chitetezo chathu cha mthupi. Maselo apachimunthu amalinganizidwa kuti awonetsere zomwe amadziona ngati enieni kapena osadzikonda, ndipo popeza kuti maselo a khansa amachokera ku maselo oyenera m'thupi lathu, akhoza kutuluka mwachibadwa. Kuchuluka kwa maselo a khansa kungathandizenso, ndi chiwerengero cha maselo a khansa pachimake choposa mphamvu ya nambala yaing'ono ya maselo a chitetezo.

Koma chifukwa chake ndizovuta kwambiri kuposa kuzindikira kapena nambala-kapena, maselo a khansa ndi ovuta kwambiri. Kawirikawiri maselo a khansa amachititsa chitetezo cha mthupi mwa "kudziyesa" kuti awoneke ngati maselo achibadwa. Maselo ena a khansa atulukira njira zodzibisa okha, kuvala maski ngati mukufuna. Mwa kubisala mwa njirayi akhoza kuthawa kudziwika. Ndipotu, mtundu umodzi wa mankhwala ogwiritsira ntchito mankhwala ogwiritsira ntchito mankhwala amthupi umathandiza makamaka kuchotsa chigoba kuchokera ku maselo otupa.

Monga cholembera chomaliza, nkofunika kuzindikira kuti chitetezo cha mthupi chimakhala ndi malipiro abwino a macheke ndi miyeso. Kumbali imodzi ndikofunika kulimbana ndi adani othawa. Ku mbali inayo, sitikufuna kumenyana ndi maselo m'matupi athu, ndipo kwenikweni, matenda omwe amachititsa kuti thupi likhale ndi matenda a nyamakazi amagwirizana ndi "mawonekedwe a chitetezo cha mthupi."

Kulephera kwa Immunotherapy

Pamene mukuwerenga, ndikofunika kuzindikira zina mwa zolephera za immunotherapy pa gawo ili la chitukuko. Katswiri wina wamaphunziro a zachipatala anatchula izi motere: chithandizo cha khansa ndi matenda a khansa monga Wright Brothers oyendetsa ndege. Munda wa immunotherapy uli pachiyambi.

Tikudziwa kuti mankhwalawa sagwira ntchito kwa aliyense, kapena kwa anthu ambiri omwe ali ndi khansa. Kuonjezera apo, tilibe chidziwitso chowonekeratu cha omwe adzapindule ndi mankhwalawa. Kufufuzira zamakono, kapena njira zina zoyankhira funsoli, ndi gawo lochita kafukufuku pa nthawi ino.

Kubwereza Kwachidule kwa Njira ya Immune ndi Khansa

Kuti mumvetse pang'ono za momwe mankhwalawa amathandizira, zingakhale zothandiza kufufuza mwachidule momwe chitetezo cha mthupi chimagwirira ntchito polimbana ndi khansa. Thupi lathu la chitetezo cha m'thupi limapangidwa ndi maselo oyera a magazi komanso timisitiki ta maselo a mitsempha yotchedwa lymph nodes. Ngakhale pali mitundu yambiri ya maselo komanso maselo omwe amachititsa kuchotsa maselo a khansa, "mfuti zazikulu" mu khansara yolimbana ndi T-cell (T lymphocytes) ndi maselo achilengedwe . Bukuli lotsogolera kumvetsetsa chitetezo cha mthupi limapereka kukambirana mozama za zofunikira za kuyankhidwa kwa chitetezo cha mthupi.

Kodi chitetezo cha m'thupi chimalimbana bwanji ndi kansa?

Pofuna kuthana ndi maselo a khansa, pali machitidwe ambiri omwe chitetezo chathu cha mthupi chimayenera kuchita. Mwachidule, izi zikuphatikizapo:

Kuyang'anitsitsa: Chitetezo cha mthupi choyamba chiyenera kupeza ndi kuzindikira maselo a khansa. Maselo athu a chitetezo a m'thupi amayenera kufufuza maselo onse mkati mwawo ndikuzindikira kuti maselo a khansa ndi osakhala okha. Chifaniziro chikanakhala wogwira ntchito m'nkhalango akuyenda kudutsa m'nkhalango kufunafuna mitengo yodwala.
Kulemba: Pamene atulukira, chitetezo chathu cha mthupi chiyenera kusindikiza kapena kutchula maselo a khansa kuti awonongeke. Potsanzira kufanana kwake, wogwira ntchito m'nkhalango amafunika kuikapo kapena kutchula mitengo yodwalayo yomwe ili ndi utoto wa lalanje.
Kuwonetsa: Pamene maselo a khansa amadziwika, maselo athu amateteza mthupi, kutsegula maselo a chitetezo cha mthupi omwe amamenyana ndi khansa ku dera kumene amapezeka. Pitirizani kufanana, wogwira ntchito m'nkhalango ayenera kubwerera ku ofesi yake, foni, mauthenga, ndi imelo ntchito yamtengo kuti abwere ndi kuchotsa mitengo yodwalayo.
Kulimbana: Pamene maselo a khansa amadziwika ndi kuzindikiritsidwa, ndipo maselo a chitetezo amateteza ku alamu ndipo amasamukira kumalo ena, maselo a cytotoxic ndi maselo achilengedwe amaukira ndi kuchotsa maselo a khansa m'thupi. Pomaliza, mu fanizo, antchito ogwira ntchito amatha kudula ndi kuchotsa mitengoyo.

Nkhaniyi yokhudzana ndi momwe maselo a T amagwira ntchito polimbana ndi khansa imatchula njira zomwe izi zimayendera, ndipo nkhaniyi yokhudzana ndi matenda a chitetezo cha khansa imapereka zithunzi za njira iliyonse.

Kodi Maselo a Khansa Amabisa Bwanji Mphamvu Yachilengedwe?

Zingakhalenso zothandiza kudziŵa momwe maselo a khansa amatha kuteteza kapena kuyesedwa ndi ma chitetezo cha mthupi. Maselo a khansa akhoza kubisala ndi:

Kuchepetsa kutulutsa ma antigen pamwamba pa maselo. Izi zikhoza kufanana ndi mitengo yomwe imachotsa zizindikiro za matenda awo ku nthambi zawo kapena masamba.
Kuwonetsa zinthu pamwamba pa selo zomwe zimayambitsa chitetezo cha mthupi. Maselo a khansa angapangitse mamolekyu amene amachititsa kuti chitetezo cha mthupi chitetezeke. Pofananako, mitengo ikanachita kanthu kuti iwathamangitse antchito a m'nkhalango komanso ntchito yamtengo.
Maselo a khansa angayambitsenso maselo osagwidwa ndi khansa kuti asamawononge zinthu zomwe zimachepetsa mphamvu ya chitetezo cha mthupi. Njira imeneyi imatchedwa kusintha kwa microenvironment, dera lozungulira maselo a khansa. Poyesa kufanana kwake, mitengo yodwalayo idzafunsanso amayi ndi malaki kuti alowe nawo kuti athandize antchito a m'nkhalango kuchoka.

Ngati mumasokonezeka chifukwa cha kusiyana pakati pa maselo a kansa, ndi zomwe zimapangitsa maselo a khansa kukhala ofanana, nkhani zotsatila zikufotokoza zomwe zimapangitsa selo kukhala ndi khansa yambiri , komanso kusiyana pakati pa maselo a kansa ndi maselo obadwa .

Mitundu ndi Njira za Immunotherapy

Mwinamwake mwamvapo mankhwala omwe amatchulidwa ngati mankhwala omwe "amachititsa" chitetezo cha mthupi. Mankhwalawa ndi ovuta kwambiri kuposa kungopereka chitetezo cha mthupi. Tiyeni tiwone njira zina zomwe thupi limagwirira ntchito, komanso magulu omwe amagwiritsidwa ntchito masiku ano.

Njira za Immunotherapy

Njira zina zomwe ma ARV angapatsire khansa ndizo:

Kuthandiza chitetezo cha mthupi kumadwala khansa
Kuwongolera ndi kukulitsa maselo a mthupi
Kulimbana ndi khungu la khansa kumabisa (de-masking)
Kutsegula ndi microenvironment ya maselo a kansa mwa kusintha kansalu zamagetsi
Kugwiritsira ntchito mfundo za chitetezo chathu cha mthupi monga chithunzi cha kupanga kansa mankhwala

Mitundu ya Immunotherapy

Njira zamakono zomwe zimayesedwa kapena kuyesedwa m'mayesero a zachipatala ndi awa:

Mankhwala a monoclonal
Checkpoint inhibitors
Katemera wa khansa
Mankhwala othandizira odwala monga CAR T-cell mankhwala
Mavairasi oncolytic
Makina a Cytokines
Adjuvant immunotherapy

Ndikofunika kuzindikira kuti pali kusiyana kwakukulu pakati pa mankhwalawa. Mwachitsanzo, mankhwala omwe amagwiritsidwa ntchito monga checkpoint inhibitor angakhalenso antioclonal antibody.

Matenda a Monoclonal (Mankhwala Ochepetsa Matenda)

Mankhwala a monoclonal amagwira ntchito mwa kupanga maselo a kansa ndipo akhala akugwiritsidwa ntchito kwa nthawi yaitali, makamaka kwa khansa monga mitundu ina ya lymphoma.

Pamene chitetezo chathu cha mthupi chimakhudzana ndi mabakiteriya ndi mavairasi, mauthenga akutumizidwa omwe amachititsa kupanga mapangidwe a antibodies. Ndiye, ngati mdani yemweyo akuwonanso, thupi likonzekera. Mankhwala opatsirana monga chimfine amawombera ntchito powonetsa chitetezo cha mthupi chimafa ndi matenda a chimfine (kuwombera) kapena kachilombo koyambitsa matendawa (mankhwala amphongo) kotero amatha kupanga ma antibodies ndi kukonzekera ngati kachilombo koyambitsa matenda kamalowa m'thupi lanu.

Mankhwala othandizira odwala kapena ochepetsera thupi amachitanso mofananamo koma m'malo mwake ndi "man made" omwe amachititsa kuti awononge maselo a kansa m'malo mwa tizilombo toyambitsa matenda. Ma antibodies amagwiritsira ntchito ma antigen (mapuloteni) pamwamba pa maselo a khansa, ngati fungulo likhoza kulowa mulova. Pamene maselo a khansa amadziwika kapena kuikidwapo, maselo ena m'thupi laumunthu amachenjezedwa kuti awononge selo. Mungathe kuganiza za mankhwala omwe amachititsa kuti thupi likhale ndi matenda. Chizindikirocho ndi chizindikiro chakuti selo (kapena mtengo) iyenera kuchotsedwa.

Mtundu wina wa anti-monoclonal antibody angalowe m'malo mwa antigen pa selo ya khansa kuti athetse chizindikiro cha kukula kuti asapezeke. Pankhaniyi, zidzakhala ngati kuika fungulo muzitseko, kotero kuti chimzake china-chizindikiro cha kukula-sichingakhoze kulumikizana. Mankhwala Erbitux (ceuximab) ndi Vectibix (panitumumab) ntchito mwa kuphatikiza ndi kulepheretsa kulandira EFGR (antigen) pa maselo a khansa. Popeza kuti cholandira EGFR "chatsekedwa" chizindikiro cha kukula sichitha kugwirizanitsa ndikuuza khungu la khansa kuti ligawikane ndikukula.

Mankhwala otchedwa monoclonal antibody ambiri omwe amagwiritsidwa ntchito ndi mankhwala a Lymphoma Rituxan (rituximab). Mankhwalawa amamangiriza ku antigen yotchedwa CD20-chotupa chodziŵika chopezeka pamtundu wa ma lymphocytes a B odwala m'matumbo ena a B cell.

Mankhwala a monoclonal panopa amavomereza khansa zingapo. Zitsanzo zikuphatikizapo:

Avastin (bevacizumab)
Herceptin (trastuzumab)
Rituxan (rituximab)
Vectibix (panitumumab)
Erbitux (ceuximab)
Gazyva (obinutuzumab)

Mtundu wina wa antioclonal antibody ndi antipecific antibody. Mankhwalawa amamatira ku ma antigen awiri osiyana. Chimodzi chimatengera kansalu ya khansa ndipo ina imagwira ntchito yolemba T selo ndikubweretsa ziwirizo pamodzi. Chitsanzo ndi Blincyto (blinatumomab).

Matenda a Monoclonal Conjugated

Mankhwala a monoclonal pamwamba pa ntchito okha, koma ma antibodies angagwirizanenso ndi mankhwala a chemotherapy, mankhwala oopsa, kapena mankhwala othandizira mankhwala omwe amatchedwa antijacked monoclonal antibodies . Liwu loti conjugated limatanthauza "kumangirizidwa." Mkhalidwe uwu, "kulipira" kumaperekedwa molunjika ku selo ya khansa. Pokhala ndi anti antibody yogwirizana ndi antigen pa selo ya khansa ndikupereka "poizoni" (mankhwala, toxin, kapena radioactive particle) mwachindunji ku gwero, sipangakhoze kuwonongeka kwambiri ma tishu wathanzi. Mankhwala ena m'gulu lino omwe amavomerezedwa ndi FDA ndi awa:

Kadcyla (ado-trastuzumab): uyu ndi antioclonal antibody wothandizidwa ndi mankhwala a chemotherapy pofuna kuchiza khansa ya m'mawere
Adcetris (brentuximab vedotin ): wodwala uyu amathandizidwanso ndi mankhwala a chemotherapy
Zevalin (ibritumomab tiuxetan): wodwala wotereyu amamangiriridwa ndi tinthu tomwe timapanga tizilombo toyambitsa matenda
Ontak ( denileukin difitox ): mankhwalawa akuphatikizapo antioclonal antibody ndi poizoni kuchokera ku mabakiteriya omwe amachititsa kuti diphtheria

Zizindikiro Zowononga Mthupi

Zowonongeka kwa ma chitetezo cha m'madzi zimagwira ntchito pochotsa mabakiteriya pa chitetezo cha mthupi.

Monga taonera kale, chitetezo cha mthupi chimayang'anitsitsa ndiyeso kuti chisapitirire kapena kuperewera. Pofuna kuti likhale la overperforming-komanso liwope matenda omwe amachititsa kuti munthu asatengeke, pali zizindikiro zowonongeka motsatira njira ya chitetezo cha mthupi yomwe imayendetsedwa, monga mabekita amagwiritsidwa ntchito kuchepetsa kapena kuyimitsa galimoto.

Monga taonera kale, maselo a khansa akhoza kukhala achinyengo ndipo amanyenga chitetezo cha mthupi. Njira imodzi yomwe amachitira zimenezi ndi kudzera m'mapuloteni oteteza. Mapuloteni othamanga ndi zinthu zomwe zimagwiritsidwa ntchito kuthetsa kapena kuchepetsa chitetezo cha mthupi. Popeza maselo a khansa amachokera ku maselo abwino, amatha kupanga mapuloteniwa koma amawagwiritsa ntchito mwanjira yodalirika yopewera kudziwidwa ndi chitetezo cha mthupi. PD-L1 ndi CTLA4 ndi mapulotini otsegula omwe amasonyezedwa ochulukirapo pamwamba pa maselo ena a khansa. Mwachidule, maselo ena a khansa amapeza njira yogwiritsira ntchito "mapuloteni ozolowereka" m'njira yodabwitsa; mosiyana ndi wachinyamatayo amene angakhale ndi phazi lotsogolera pa galimoto yowonjezera, mapuloteniwa amapanga phazi lotsogolera pa mabaki a chitetezo cha mthupi.

Mankhwala otchedwa checkpoint inhibitors amatha kumanga mapuloteni oterewa monga PD-L1, makamaka kumasula mabaki, kotero chitetezo cha mthupi chikhoza kubwerera kuntchito ndikulimbana ndi maselo a khansa.

Zitsanzo za inhibitors zofufuzira zomwe zikugwiritsidwa ntchito zikuphatikizapo:

Opdivo (nivolumab)
Keytruda (pembrolizumab)
Yervoy (ipilimumab)

Kafukufuku tsopano akuyang'ana phindu la kuphatikiza mankhwala awiri kapena angapo m'deralo. Mwachitsanzo, kugwiritsa ntchito PD-1 ndi CTLA-4 inhibitors pamodzi (Opdivo ndi Yervoy) ndikuwonetsera lonjezo.

Kusamutsa Kagulu ka Adoptive ndi CAR T-Cell Therapy

Selo lovomerezeka ndi mankhwala a CAR T-cell ndi njira zomwe zimalimbitsa thupi lathu. Mwachidule, iwo amachititsa maselo athu okhudzana ndi khansa kukhala abwino kumenyana nawo powonjezera mphamvu zawo zankhondo kapena chiwerengero chawo.

Kusamutsira Kagulu Yokwatira

Monga tanenera kale, chimodzi mwa zifukwa zomwe chitetezo chathu cha mthupi sichimenyera zilakolako zazikulu ndikuti zimangopitirira mphamvu komanso zosawerengeka. Monga kufanana, mungaganize za kukhala ndi asirikari khumi pamzere kutsogolo kutsutsana ndi adani okwana zana (maselo a khansa). Mankhwalawa amapindula ndi ntchito yomenyana ndi asilikali koma kuonjezeranso asilikali kumbuyo.

Ndi mankhwalawa, madokotala amachotsa ma T cells anu kuchokera kumadera ozungulira chifuwa chanu. Momwe maselo anu T amasonkhanitsira, amakula mu labu (ndipo atsegulidwa ndi maginito). Pambuyo powonjezeka mokwanira, iwo amalowetsedwanso m'thupi lanu. Mankhwalawa athandiza anthu ena omwe ali ndi khansa ya khansa.

CAR T-cell Therapy

Kupitiliza ndi kufanana kwa galimoto kuchokera pamwamba, ARV T-cell mankhwala akhoza kuganiziridwa ngati chitetezo cha m'thupi "kuyimba." CAR imayimira chimeric antigen receptor. Chimeri ndilo mawu omwe amatanthauza "kugwirizana pamodzi." Mu mankhwalawa, anti-antibody amathandizidwa pamodzi ndi (kuphatikizidwa) ndi T-cell receptor.

Mofanana ndi maselo othandizira, T-maselo ochokera kumadera a chifuwa chanu amasonkhanitsidwa poyamba. Maselo anu T amasinthidwa kuti afotokoze mapuloteni omwe amatchedwa chimeric antigen receptor kapena CAR. Chotengera ichi pa ma T-maselo anu chimapangitsa kuti agwirizane ndi mapulogalamu opangidwa ndi maselo a khansa kuti awawononge. M'mawu ena, zimathandizira ma T-maselo pakuzindikira maselo a kansa.

Palibenso mankhwala a CAR T-cell omwe amavomerezedwa, koma akuyesedwa m'mayesero a zachipatala ndi zotsatira zolimbikitsa, makamaka motsutsana ndi khansa ya m'magazi ndi melanoma.

Katemera Wopereka Khansa

Katemera wa kansa ndi katemera omwe amagwira ntchito mwachangu poyambitsa matenda a khansa. Mungamve za katemera zomwe zingathandize kupewa khansa, monga chiwindi cha hepatitis B ndi HPV, koma katemera wothandizira khansa amagwiritsidwa ntchito ndi cholinga china-kuyambitsa khansayo kale.

Mukapatsidwa katemera, nenani, tetanasi, chitetezo chanu cha mthupi chikuwonekera pang'ono pokha kupha tetanasi. Poona izi, thupi lanu limazindikira kuti ndilolendo, limalankhula ndi B-cell (B-lymphocyte) yomwe imapanga ma antibodies. Ngati mwatuluka kachilomboka, ngati mutayirira msomali wodula, chitetezo chanu cha mthupi chimapangidwira ndikukonzekera.

Pali njira zingapo zomwe katemerawa amapangidwira. Katemera wa khansa angapangidwe pogwiritsa ntchito maselo otupa, kapena zinthu zopangidwa ndi maselo otupa.

Chitsanzo cha katemera wothandizira khansa yogwiritsidwa ntchito ku United States ndi Njira (spuleucel-T) ya kansa ya prostate. Katemera wa khansa pakalipano akuyesedwa kwa khansa zingapo, komanso kupeŵa kubwereka kwa khansa ya m'mawere.

Ndi khansa yamapapu, katemera awiri osiyana, CIMAvax EGF ndi Vaxina (racotumomab-alum), awerengedwa ku Cuba chifukwa cha khansa yaing'ono ya m'mapapo. Katemerawa, omwe apezedwa kuonjezera kupulumuka kwaufulu kwa anthu ena omwe ali ndi khansa ya m'mapapo yopanda maselo , akuyambanso kuphunzira ku United States. Katemerawa amagwira ntchito potenga chitetezo cha m'thupi kuti apange antibodies motsutsana ndi epidermal kukula factor receptors (EGFR). EGFR ndi mapuloteni pamwamba pa maselo omwe amawopsa kwambiri kwa anthu ena omwe ali ndi khansa ya m'mapapo.

Mavairasi oncolytic

Kugwiritsidwa ntchito kwa mavairasi oncolytic kutchulidwa mofanana ndi "dynamite ya maselo a kansa." Pamene tiganizira za mavairasi, timakonda kuganiza zolakwika. Mavairasi monga chimfine amachititsa maselo athu polowera maselo, kuchulukitsa, ndikumayambitsa maselo.

Mavairasi opangidwa ndi tizilombo toyambitsa matenda amagwiritsidwa ntchito "kupha" maselo a kansa. Mankhwalawa amawoneka kuti amagwira ntchito m'njira zingapo. Amalowa m'chipinda cha khansa, amachulukitsa ndikuchititsa kuti selo liwonongeke, komanso amamasula ma antigen m'magazi omwe amachititsa kuti maselo ambiri am'thupi azibwera.

Palibe mankhwala ochizira odwala omwe amavomerezedwa ku United States, koma akuphunziridwa m'mayesero a kachipatala kwa khansa zingapo.

Ma Cytokines (Immune System Modulators)

Ma chitetezo a chitetezo cha mthupi ndi mawonekedwe a immunotherapy omwe akhalapo kwa zaka zambiri. Mankhwalawa amatchulidwa kuti "osadziwika bwino a immunotherapy." M'mawu ena, amagwira ntchito kuthandizira chitetezo cha mthupi kumenyana ndi wowononga, kuphatikizapo khansara. Matendawa amatha kupangitsa kuti maselo a chitetezo a m'thupi asagwiritsidwe ntchito polimbana ndi khansa.

Zitsanzo zikuphatikizapo IL-2 ndi IFN-alpha zomwe zimagwiritsidwa ntchito pa khansa ya impso ndi khansa ya khansa pakati pa khansa zina.

Adjuvant Immunotherapy

BCG ndi mtundu wina wa adjuvant immunotherapy umene ukuvomerezedwa kuti uchitire khansa. BCG imayimira Bacillus Calmette-Guerin ndipo ndi katemera omwe amagwiritsidwa ntchito m'madera ena padziko lapansi monga chitetezo cha chifuwa chachikulu. Ikhoza kugwiritsidwanso ntchito pochiza khansara ya chikhodzodzo. Katemerayu, mmalo mwa kupatsidwa ngati katemera, amalowetsedwa mu chikhodzodzo. M'chikhodzodzo, katemerayu amapereka yankho losasamala lomwe limathandiza kulimbana ndi khansa.

Zotsatira Zotsatira

Chimodzi mwa ziyembekezo zakhalapo, chifukwa immunotherapy imayankhula khansa mwapadera, kuti mankhwalawa adzakhala ndi zotsatira zochepa kusiyana ndi mankhwala am'thupi. Mofanana ndi mankhwala onse a khansa, komabe mankhwala opatsirana pogonana angabweretse mavuto, omwe amasiyana malingana ndi gulu la immunotherapy komanso mankhwala enaake. Kwenikweni, njira imodzi yomwe zotsatirazi zimatchulidwira ndi "chirichonse chokhala ndi iris" - "itis" kukhala kutukuta kutanthauza kutentha.

Tsogolo

Munda wa immunotherapy ndi wokondweretsa, komabe tili ndi zambiri zoti tiphunzire. Mwamwayi, kuchuluka kwa nthawi yomwe akugwiritsira ntchito mankhwalawa kumagwiritsidwanso ntchito kwa anthu omwe ali ndi khansara ikukula, komabe m'mbuyomu pakhala nthawi yayitali pakati pa kupeza mankhwala ndi nthawi yomwe amagwiritsidwa ntchito kuchipatala. Ndi mankhwala monga awa, omwe mankhwala omwe amapangidwira akuyang'ana pazinthu zenizeni za khansa, nthawi yowonjezera nthawi zambiri ndi yochepa kwambiri.

Potero, kugwiritsa ntchito mayesero a zachipatala akusintha. M'mbuyomu, mayesero a magawo 1 - mayesero oyambirira omwe mankhwala atsopano amayesedwa kwa anthu-ankawoneka ngati "ntchito yotsiriza". Zidapangidwa monga njira yowonjezera chithandizo cha mankhwala kwa iwo mtsogolo osati momwe munthu akuyankhira. Tsopano mayesero omwewo angapatse anthu ena mwayi wokhawo wokhala ndi matenda awo. Tengani kamphindi kuti mudziwe zambiri za mayesero a zachipatala , komanso momwe anthu amapezera mayesero a kachipatala kwa khansa .

> Zotsatira:

> American Society of Clinical Oncology. Cancer.Net. Immunotherapy: Chithandizo cha Chithandizo cha Mchaka cha 2016 Chakale. 02/04/16.

> Farkona, S., Diamandis, E., ndi I. Mantha. Cancer immunotherapy: chiyambi cha kutha kwa khansa? . BMC Medicine . 2016. 14 (1): 73.

Kamat, A., Sylvester, R., Bohle, A. et al. Tsatanetsatane, Mfundo Zomalizira, ndi Zochitika Zokakamiza Zokakamiza Zomwe Zilibe Zovuta Zosakanikirana ndi Khansa Yachikhodzodzo: Zolangizidwa Kuchokera ku International International Cancer Group. Journal of Clinical Oncology . 2016. 34 (16): 1934-44.

> Lu, Y., ndi P. Robbins. Kuwongolera nthenda zogonana za khansa ya immunotherapy. Padziko Lonse . 2016 May 19. (Epub patsogolo pa kusindikiza).

> Mittendorf, E., ndi G. Anthu. Kuwongolera Chiyembekezo - Kubwereza za katemera wa khansa ya m'mawere. Oncology . 2016. 30 (5): pii: 217054.

> National Cancer Institute. CAR T-Cell Therapy: Maselo Opatsirana Oteteza Opaleshoni Kuti Apewe Khansa Zawo. Kusinthidwa 10/16/14. CAR T-Cell Therapy: Maselo Opatsirana Oteteza Opaleshoni Kuti Apewe Khansa Zawo

> National Cancer Institute. Immunotherapy. 04/29/15.

> National Cancer Institute. Immunotherapy: Kugwiritsira ntchito chitetezo cha Immune Kuti Chitani Khansa. Kusinthidwa 09/14/15.

> Parishi, C. Khansa Immunotherapy: Zakale, zamtsogolo komanso zamtsogolo. Immunology ndi Cell Biology . 2003. 81: 106-113.

> Redman, J., Hill, E., AlDeghaither, D., ndi L. Weiner. Njira zothandizira ma antibodies for the cancer. Mapuloteni a Immunology . 2015. 67 (2 Pt A): 28-45.

> Vilgelm, A., Johnson, D., ndi A. Richmond. Njira yogwirizana ndi khansa ya immunotherapy: mphamvu muzinthu. Journal of Biological Leukocyte . 2016 June 2. (Epub patsogolo pa kusindikiza).