Kodi Chithandizo Chofunika Kwambiri pa Gawo 4 Kodi HER2-Positve Khansa ya M'mimba?
Ngati mwapezeka kuti muli ndi khansa ya m'mawere ya HER2-positive, ndiye kuti zambiri zomwe mumapeza zimatanthawuza khansa yoyambirira kapena siteji ya khansa ya m'mawere. Kodi muyenera kudziwa chiyani za chithandizo cha khansa ya m'mawere 4 yomwe ili HER2 zabwino?
Matenda a Metastatic HER2 Posachedwapa khansa ya m'mawere
Mwinamwake mwaphunzira kuti muli ndi khansa ya m'mawere (masastatic) yapakati pa 4 pamene mudapezeka kuti muli ndi matendawa, koma mobwerezabwereza, mitsempha yayitali imakhala ngati chotupa chomwe poyamba chinali chotupa cham'mbuyomo kale.
Momwemonso, matendawa amatuluka mochititsa mantha ndipo amatha kumva kuti ndi oopsa.
Sizizindikiro zokhazokha pamene khansa ya m'mawere imafalikira, koma lingaliro la kupita kuchipatala lingathe kukugwetsani kukhumudwa. Ngakhale pulogalamu ya 4 HER2 yabwino khansa ya m'mawere isachiritsidwe, imachiritsidwa, ndipo mankhwala omwe akukonzekera kuti HER2 apitirize kukulitsa ndi kusintha. Mankhwalawa amakhalanso ndi zotsatira zochepa kuposa mankhwala a chemotherapy.
Pafupifupi asanu mwa khansa ya m'mawere ndi khansa ya m'mawere ya HER2 . Izi zikutanthawuza kuti ma khansa ena a m'mawere ali ndi majeremusi a H22 omwe amapanga mavitamini a HER2. Mapuloteni ameneŵa amamanga maselo a kansa ya m'mawere, ndipo amachititsa kukula kwa ziwalozi. Kawirikawiri, zilonda zamabere za HER2 zimakula kwambiri komanso zimakula mofulumira.
Mpaka chaka cha 1998, pamene Herceptin adavomerezedwa, HER2 zotupa zabwino zinkakhala zovuta kwambiri, makamaka kwa iwo omwe anali ndi mitsempha yotchedwa estrogen ndi progesterone receptor.
Kuchokera nthawi imeneyo mankhwala ena omwe adakakamizidwa apangidwa omwe amawongolera HER2, kusiya zosankha ngakhale pamene mankhwala amodzi, kapena awiri, alephera.
Zosintha Zomwe Zikugwirizana
Anthu ambiri amadabwa kuona kuti malo omwe amalandira khansa yawo atasintha atabwereranso. Ngati mutakhala ndi chotupa chotchedwa estrogen receptor chithokomiro mukapezeka kuti muli ndi khansa ya m'mawere oyambirira, kubwereranso kwa mayendedwe ka estrogen kumakhala kosayenera.
Chimodzimodzinso, ngati mutakhala ndi chifuwa chachikulu cha HER2 / neu poyamba, zikhoza kukhala zoipa tsopano komanso mosiyana.
Ichi ndichifukwa chake chikhalidwe cha obwelera chowunika ndi chofunika kwambiri ngati muli ndi matenda obwereza kutali.
General Management
Kafukufuku wambiri wa khansa ya m'mawere imakhala yodabwitsa kwa omwe akhala akutha msinkhu atangoyamba kumene khansa ya m'mawere m'mbuyomu. Poyamba, khansa ya m'mawere imayamba kuchepa. Cholinga cha nkhanza ndi opaleshoni, chemotherapy, mankhwala opatsirana, ndi / kapena ma radiation ndikuteteza kubwereza ngati n'kotheka.
Pokhala ndi kansa ya kansa ya m'mawere, njira yochiritsira imakhala yosiyana, ndipo anthu ambiri amadzifunsa chifukwa chake njirayi si yowopsya (ndipo imakhala ndi nkhawa chifukwa cha izi). Cholinga cha khansa ya m'mawere ndikumagwiritsira ntchito mankhwala ocheperako kuti athetse matendawa. Kawirikawiri, kupweteka kwambiri pamsana wa khansa ya m'mawere sikumapangitsa kuti munthu apulumuke koma kumawonjezera zotsatira zake. Izi zikutanthawuza kuti kawirikawiri mtundu umodzi wa chithandizo pa nthawi umagwiritsidwa ntchito (ngati ukulepheretsa kukula kwa khansa) kusiyana ndi njira zingapo kuphatikizapo matenda oyambirira.
Njira Zothandizira
Njira yoyamba yothandizira khansa ya m'mawere imakhala yaikulu kwambiri, ndipo ngati ili yobwereza, maere estrogen ndi progesterone ndi oyenerera ndi HER2 / neu ayenera kuyesedwa (monga taonera pamwamba, izi zingasinthe.)
Ngati chotupa chanu chiri cholandira chithandizo cha estrogen ndipo HER2 chithandizo choyambirira, chithandizo choyamba chingaphatikizepo mankhwala otchedwa hormonal therapy , mankhwala opatsirana a HER2, kapena onse awiri. Zosankhazi zidzadaliranso ndi mankhwala omwe munapatsidwa musanabwererenso (ngati khansara yanu yayitali kwambiri kusiyana ndi chotupa chomwe chiri pulogalamu ya 4 panthawi ya kuchidziwitso.) Chemotherapy ingagwiritsidwe ntchito kwa miyezi inayi kapena isanu ndi umodzi .
Ngati simunapangidwepo ndi mankhwala ozunguzidwa ndi HER2, mankhwala amayamba ndi Herceptin (trastuzumab) kapena Perjeta (pertuzumab). Kwa iwo omwe anachiritsidwa kale ndi Herceptin, mankhwala ena omwe amawotchedwa HER2 angagwiritsidwe ntchito, monga Perjeta (pertuzumab). Ngakhale anthu omwe adapitabe patsogolo pa HER2 zogwiritsa ntchito mankhwala osokoneza bongo, mankhwala omwe amachititsa trastuzumab emtansine (TDM1) amatha kukhala ndi moyo woposa momwe ovomerezeka amasankhira mankhwala ena (kuphatikizapo mankhwala enaake a mankhwala) mu phunziro limodzi.
Ngati khansa yapita patsogolo pa Herceptin kapena mkati mwa miyezi 12 yothetsa mankhwalawa, T-DM1 (trastuzumab emtansine) ndi njira yosankhidwa yachiwiri.
Zosankha zachitatu zidzasiyana malinga ndi chithandizo cham'tsogolo. Kwa iwo omwe sanayambe kuchitidwa ndi T-DM1, izi ndi njira. Perjeta ingathenso kugwiritsidwa ntchito kwa iwo omwe sanalandirepo kuphatikizapo Herceptin. Kwa anthu amene anachiritsidwa ndi Perjeta ndi T-DM1 ndipo adakalipobe, zotsatira zake zikuphatikizidwa ndi Xeloda (capecitabine) ndi Tykerb (lapatinib), mankhwala otchedwa hormonal therapy kwa omwe ali ndi zotupa zotchedwa estrogen, ndi zina zotchedwa chemotherapy pamodzi ndi HER2 mankhwala osokoneza.
Chithandizo cha Metastasis-Specific Treatment
Chithandizo chachikulu cha matenda ochepetsa khansa ya m'mawere kumalo aliwonse omwe amapezeka amapezeka nthawi zambiri ndi mankhwala osokoneza bongo, HER2 zabwino zothandizidwa, kapena chemotherapy. Izi zingasokoneze anthu ena. Kodi n'chifukwa chiyani maselo a khansa m'mapapu amatha kuchiritsidwa ndi mankhwala am'thupi?
Ndikofunika kuzindikira kuti pamene khansa ya m'mawere imafalikira kwa ziwalo zina, monga mafupa, ubongo, chiwindi, ndi mapapo, ndi khansa ya m'mawere ya khansa yomwe imafalikira mu ziwalo zimenezo.
Mankhwala omwe ali "ofanana ndi metastasis" akhoza kugwiritsidwanso ntchito. Awa ndi mankhwala omwe amalingalira makamaka malo a metastases, monga metastases ya fupa. Chiwindi ndi ubongo wa metastases ndizofala kwambiri kwa amayi omwe ali ndi khansa ya m'mawere ya HER2 / neu yabwino kuposa omwe ali olakwika HER2.
Bone Metastases
Matenda a metastases ndi khansara ya m'mawere ndi ofala kwambiri, amapezeka pafupifupi 70 peresenti ya anthu omwe ali ndi matenda a metastatic. Kuphatikiza pa njira zothandizira odwala khansa ya m'mawere yokha, mankhwala amtundu wa masastases amatha kuchepetsa kupweteka komanso kusintha kupulumuka, ndipo mitsempha ya mafupa imakhala ndi ubwino wambiri kusiyana ndi malo ena odwala matendawa. Chodziwikiratu ndi chakuti mavuto a mafupa a metastases, monga kupweteka kwa thupi, amakhala ofunika kwambiri monga mankhwala opatsirana khansa ya m'mawere angapangitse mafupa.
Zosankha zikuphatikizapo:
- Mavitamini osokoneza mafupa kuphatikizapo bisphosphonates, monga Zometa (zoledronic acid) akhoza kuchepetsa mavuto monga kupweteka komanso kukhala ndi zotsatira zotsutsana ndi zotupa. Xgeva (denosumab) ndi njira ina yomwe ikuwoneka kuti ili ndi zotsutsana ndi khansa.
- Thandizo la ma ARV lingachepetse ululu ndipo lingachepetse ngozi
- Ma Radiopharmaceuticals angathandize anthu omwe ali ndi mafupa ambiri a mitsempha, monga timadzi ta tizilombo ta tizilombo toyambitsa matenda timene timayikidwa m'magazi ndipo timatengedwa kupita ku mafupa onse.
Matenda a Chiwindi
Matenda a chiwindi kuchokera ku khansa ya m'mawere ndi malo achiwiri otchuka a metastase ndipo amapezeka kawirikawiri pakati pa anthu omwe ali ndi zotupa zabwino za HER2. Mankhwalawa amagwiritsidwa ntchito pophatikizapo mankhwala ena a khansa. Mankhwala ena monga kupangidwanso angagwiritsidwe ntchito.
Ngati pali malo ochepa chabe a metastasis (oligometastase) kuchotsa opaleshoni kapena thupi la radiotherapy lingathandize kupulumuka. Matenda a chiwindi amachititsa kuti ascites (kutupa m'mimba) ndi paracentesis (kuchotsa madzi m'mimba kudzera mu singano yayitali yaitali) nthawi zambiri amafunika kuchepetsa kuvutika. Kuyamwa kumakhalanso kofala ndi metastases ya chiwindi ndi chithandizo cha kuyabwa kungapangitse ubwino wa moyo.
Matenda a ubongo
Ngakhale metastases kuchokera ku khansa ya m'mawere nthawi zambiri imatengedwa ngati gawo la mankhwala opatsirana khansa ya m'mawere, ubongo wa metastases ukhoza kukhala ndi vuto lapadera. Mitsempha ya ubongo wa ubongo ndi mndandanda wa ma capillaries olimba omwe amaletsa mankhwala ambiri, kuphatikizapo mankhwala ambiri a chemotherapy, kuti asalowe mu ubongo. Zikondwerero, mankhwala ena amatha kuwoloka barr
Kupenda kwa 2017 kafukufuku amene Herotin (trastuzumab) akuwunikira kumapangitsa kuti anthu omwe ali ndi kansa ya bere ya H3 yabwino ndi ubongo wa metastases. Trastuzumab emtansine (T-DM1) ndi Perjeta (pertuzumab) akulonjezeranso. Mosiyana ndi zimenezo, Tykerb (lapatinib) ikuwoneka kuti ilibe mphamvu pa ubongo wa metastases (monga maphunziro a 2017) ndipo ali ndi mbiri yapamwamba ya poizoni. Pamene lapatinib ikuphatikizidwa ndi mankhwala a chemotherapy, komabe, mayeso omvera ndi abwino.
Lung Metastases
Matenda a khansa ya khansa ya m'mawere amathandizidwa ndi njira zambiri zothandizira khansa ya m'mawere, monga mankhwala a mahomoni, mankhwala osokoneza bongo a HER2, ndi chemotherapy, osati mankhwala enaake. Pamene masastases angapo alipo, kuchiza izi ndi opaleshoni kapena SBRT kungaganizidwe, koma maphunziro sanawonetsebe kuchuluka kwa kupulumuka kwa chizoloŵezi ichi.
Ma Metastases Osiyana
Khansara ya m'mimba ikhoza kufalikira kumadera ena akutali a thupi, kuphatikizapo khungu, minofu, mafuta, mafupa, ndi zina. Nthawi zambiri madera oterewa amachiritsidwa ndi mankhwala ambiri omwe amachititsa khansa yabwino ya HER2, koma pamene masitima amatha kupezeka, zosankha monga opaleshoni kapena mankhwala opatsirana pogwiritsa ntchito mankhwalawa zingaganizidwe.
Kulimbana
Kulimbana ndi khansa ya m'mawere ndizovuta ngakhale zili zosiyana bwanji. Ngati mwalandira chithandizo chamankhwala kuchipatala msinkhu ndipo khansara yanu imabwereranso, njira yeniyeni yothetsera khansa ya m'magazi ikhoza kusokoneza poyamba, popeza cholinga chanu nthawi zambiri chimagwiritsidwa ntchito ngati chithandizo chothetsera matenda, m'malo mozunza inu mwina anali ndi kansa ya m'mawere oyambirira.
Mawu oti "amatenga mudzi" sakanakhala oyenera kuposa momwe angakhalire ndi khansa yapamwamba. Pali magulu ambiri othandizira komanso khansa ya m'mawere ya pa intaneti yomwe ikupezeka, koma anthu ambiri omwe ali ndi kansa ya m'mawere amasankha magulu omwe akuphatikizapo omwe ali ndi kansa ya khansa ya m'ma 4 m'malo mwa anthu omwe ali ndi khansa ya m'mawere.
Ngati ndi wokondedwa wanu amene akukhala ndi khansa ya m'mawere 4, khalani ndi kamphindi kuti mudziwe zinthu zomwe simuyenera kunena kwa munthu yemwe ali ndi khansara ya m'mawere .
Mawu Ochokera
Kachilombo ka HIV kamene kanali ndi kansa ya m'mawere ingapangidwe ndi mankhwala ochizira (omwe ali ndi estrogen receptor positive) ndi chemotherapy, koma njira yogwiritsira ntchito HER2 zokhudzana ndi chithandizo imapanganso zina mwazimenezi.
Matenda okwana HER2 amatha kufalikira ku ubongo ndi chiwindi kuposa matumbo a HER2 oipa. Pamene metastase izi zimachitika, mankhwala onse ndi mankhwala ochiritsira matenda a metastasis angaganizidwe. Mwamwayi, ndipo mosiyana ndi mankhwala ambiri, Herceptin ndipo mwinamwake pertuzumab akuwoneka kuti akuwoloka malire a ubongo kuti athetse bwino metastases awa.
> Zotsatira:
> Dieras, V., Miles, D., Verma, S. ndi al. Trastuzumab Emtansine Potsutsana ndi Capecitabine Plus Lapatinib Odwala Amene Anayamba Kuchita HER2-Positive Advanced Matenda a Khansa ya M'mimba (EMILIA): Kusanthula Kufotokozera kwa Zotsatira Zosatha Zomwe Zidasinthika Kuchokera M'ndandanda Wosasinthika, Wotsegulidwa, Gawo 3. Lancet Oncology . 2017. 18 (6): 732-742.
> Krop, I., Kim, S., Martin, A. et al. Trastuzumab Emtansine Mosiyana ndi Chithandizo cha Dokotala Chosankha Kwa Odwala Kale Ankachitira Kachilombo ka HIV Kachibadwa ka Matastatic Breast (TH3RESA): Zotsatira Zowonjezera Zonse Kuchokera ku Zosintha Zowonjezera Zowonjezera Gawo 3. Lancet Oncology . 2017. 18 (6): 743-754.
> Laakmann, E., Muller, V., Schmidt, M. et al. Njira Zothandizira Mankhwala a Kachilombo ka Kachilombo ka Kachilombo ka HIV Kachilombo ka Breast Patients with Brain Metastases Beyond Trastuzumab: Ndemanga Yomaliza. Care Care . 2017. 12 (3): 168-171.