Kusamalira EGFR Positive Lung Cancer
Kodi kusintha kwa EGFR ndi chiyani ndipo n'kofunika ndi khansara yamapapo? Kodi izi zimayesedwa bwanji ndipo zimachizidwa bwanji? Ndani nthawi zambiri ali ndi kusintha kwa EGFR ndipo zimatanthauzanji pokhudzana ndi matendawa?
Mwachidule
Khansa ya EGFR yabwino yamapapo imatchula khansa ya m'mapapo yomwe imayesa kusintha kwa EGFR kusintha. EGFR imaimira epithelial kukula factor receptor, mapuloteni omwe alipo pamwamba pa maselo a khansa ya khansa yapachibadwa monga maselo a kansa yamapapo.
Zosintha za EGFR zimafala kwambiri kwa anthu omwe ali ndi mapapu adenocarcinoma (mawonekedwe a kansa yaing'ono ya m'mapapo ya khansa), amapezeka kwambiri ndi khansa ya m'mapapo mwa osuta fodya , ndipo amapezeka kwambiri mwa amayi kuposa amuna.
Kusintha kwa jini yokopa kwa EGFR ndi kusintha kwabwino kwa anthu omwe ali ndi khansara yamapapu, kutanthauza kuti ndiwowonjezera kusintha kwa majini komwe kuli mankhwala omwe amapezeka makamaka m'maselo a khansa ya m'mapapo. Kupititsa patsogolo kwapadera kwapangidwe ka mankhwala a khansa ya m'mapapo ndi maselo ena omwe ali ndi zaka zaposachedwapa. Kuyambira pa chivomerezo cha Iressa (gefitinib) mu 2003-panthawi yomwe sitinkadziŵa pang'ono za EGFR-pafupifupi theka la mankhwala atsopano omwe amavomereza kuti adziwe khansa ya m'mapapo pomwe 2016 idzayang'anitsitsa mbiriyi.
Kodi Mtheradi wa EGFR ndi chiyani?
Kusintha kwa EGFR kumatanthauza kusintha kwa gawo la DNA mu kansa yamapapu yamapapu yomwe imatenga "Chinsinsi" popanga mapuloteni a EGFR (epidermal growth factor receptor).
Pakati pa maselo athu ali ndi DNA yathu, yomwe imapangidwa ndi majini. Zamoyo zimenezi zimakhala mapulani a mapuloteni onse opangidwa m'matupi athu. Mwa kuyankhula kwina, majini athu ali ngati mawu mu bukhu lophunzitsira kulongosola momwe tingamangire zigawo zonse za thupi lathu.
Zina mwa mapuloteni omwe amapangidwa pogwiritsa ntchito maelementi amtunduwu akuphatikizidwa pakukonzekera kukula ndi kupatukana kwa maselo.
Pamene jini yomwe imanyamula malangizo opanga EGFR imasokonezeka-imasinthidwa kukhala mapuloteni osadziwika.
Pachifukwa ichi, mapuloteni ovuta kwambiri omwe amapezeka ku epithelial receptor (EGFR). Mapuloteni osalimbawa amachitanso "ntchito yodabwitsa" poyendetsa kukula kwa selo. Pali njira zingapo zomwe jini imeneyi ingasinthire (onani m'munsimu).
Kodi Kwenikweni Ndi EGFR?
Maselo athu ali ndi maantijeni ambiri (mapuloteni apadera) pamwambapa. EGFR (Epidermal Grow factor receptor) ndi imodzi mwa mapuloteni omwe amapezeka pamwamba pa maselo a khansa komanso maselo obadwa. EGFR ikhoza kuganiziridwa ngati chosinthika. Pamene zizindikiro zokula (pakali pano tyrosine kinases) zimagwirizanitsa ndi EGFR kunja kwa selo, zimatulutsa chizindikiro chomwe chimatumizidwa ku khungu la selo kuti likulitse ndikugawaniza.
Mu maselo ena a khansa, mapuloteniwa ndi owopsa kwambiri. Chotsatiracho chikufanana ndi kusinthana kosasunthika komwe katsalira pa "pa" pa malo, kuwuza selo kuti ipitirize kukula ndikugawanitsa ngakhale ikayenera kuima. Mwanjira iyi, kusintha kwa EGFR nthawi zina kumatchedwa "kusintha kwa thupi."
Tsopano tili ndi mankhwala omwe amagwiritsidwa ntchito ndi tyrosine kinase inhibitors-omwe amawombera "mapuloteni "wa mu maselo ena a khansa.
Mankhwalawa amaletsa zizindikiro zomwe zimafika mkati mwa selo, ndipo kukula kwa selo kumasiya.
Zinthu Zoopsa ndi Kukula
Kusintha kwa EGFR kulipo pafupifupi 15 peresenti ya anthu omwe ali ndi khansa ya m'mapapo ku United States, ngakhale chiwerengero ichi chikuwonjezeka mpaka 35 mpaka 50 peresenti mwa anthu a ku East Asia.
Kawirikawiri amapezeka mwa anthu omwe ali ndi khansa ya m'mapapo yopanda maselo yotchedwa lung adenocarcinoma. (Khansa imeneyi imatchedwanso "khansayi yopanda khansa yapakhungu yochepa). Pakadali pano pafupifupi 85 peresenti ya khansa ya m'mapapo ndi khansa yaing'onoting'ono ya mapuloteni, ndipo izi, zopitirira 50 peresenti ndi mapapu adenocarcinomas.
Kusintha kwa EGFR ndi:
- Ambiri mwa amayi kuposa amuna. (Pali kusiyana kwakukulu pakati pa khansara yamapapu mu kansa ya amayi ndi mapapo mwa amuna ,)
- Ambiri mwa anthu omwe ali ndi mapapu adenocarcinoma (koma angapezeke mwa anthu omwe ali ndi magawo ena a khansa yaing'ono yopanda maselo.)
- Kawirikawiri mumapezeka osuta fodya kapena anthu omwe amasuta mophweka. (Wosuta fodya amadziwika ngati munthu yemwe wasuta ndudu 100 kapena zochepa pa moyo wawo.) Ngakhale kuti 15 peresenti ya khansa ya m'mapapo yonse ikufotokoza EGFR, khansa ya m'mapapo mwa osasuta ndizovuta kwambiri kusintha.
- Zowonjezeka kwambiri kwa achinyamata achikulire omwe ali ndi khansa ya m'mapapo. (Kusintha kwa EGFR kulipo pafupifupi 50 peresenti ya khansa ya m'mapapo mwa achinyamata .)
- Ndizofala kwambiri ku Asiya, makamaka anthu a ku East Asia cholowa.
- Osawerengeka kwambiri mu Afirika Achimerika kuposa a Caucasus.
Gene Testing
Tsopano tikulimbikitsidwa kuti Aliyense amene ali ndi khansa yamapapu yopanda mapapu, makamaka mapapu adenocarcinoma, amakhala ndi majekesitomu (kuyesera kwa jini) pochita ziwalo zawo kuti ayang'ane kupezeka kwa zovuta zamtundu wa maselo a khansa ya m'mapapo.
Zingakhale zotsutsana kuti mumve za kusintha kwa majini mumaselo anu a kansa ndi zokamba za majeremusi ndi khansa ya m'mawere. Mosiyana ndi kusintha kwa majini, zamoyo zomwe mumabereka kuchokera kwa kubadwa, komabe kusintha kwa maselo komwe kumapezekanso kumaphatikizapo kusintha kwa majeremusi (somatic mutations). Kusinthaku sikulipo panthawi yoberekera koma kumakhala m'moyo mtsogolo selo kukhala kansera ya khansa.
Selo la khansa lingasinthe kwambiri, koma ndi ochepa okha omwe amachita nawo kansalu. Kusintha kumeneku kumabweretsa kupanga mapuloteni osalimba omwe amatsogolera kukula ndi kukula kwa selo ya khansa. Mapuloteni osalongosoka "amayendetsa" kukula ndi kufalikira kwa khansara ndipo chifukwa chake kusintha kwa maselo omwe amachititsa kupanga kwawo amatchedwa "kusinthasintha kwa khansa." Zina, koma sizinthu zonse zomwe zimasinthika ndi kusintha kwa galimoto komanso kusintha kwamasinthidwe omwe amatanthauza kuti akhoza kugwiritsidwa ntchito ndi mankhwala.
Zikuoneka kuti kusintha kwa magetsi kumakhalapo 60 peresenti ya anthu omwe ali ndi mapapu adenocarcinoma, ndipo nambalayi, komanso kusintha kwa kayendetsedwe ka khansa m'magulu ena a kansa ya m'mapapo, ikuyembekezeka kukula pamene kumvetsa kwathu kwa chilengedwe cha khansa kumawonjezeka. Kusintha kwachitsulo kamodzi kumaphatikizapo:
- Zosintha za EGFR
- ALK rearrangements
- ROS1 rearrangements
- MET kukulitsa
- Kusintha kwa KRAS
- Kusintha kwa H22
Zambiri mwazimenezi, mankhwala ochiritsira amapezeka tsopano. Mankhwalawa amawunikira maselo a khansa makamaka ndipo nthawi zambiri amakhala ndi zotsatira zochepa kuposa mankhwala omwe amachititsa kuti maselo onse akukula mofulumira.
Kuonjezera apo, mayesero a zachipatala ali m'malo mwa kusintha kwa mitundu ina ndi kusintha kwa majini komanso mitundu ina ya khansa ya m'mapapo. Kawirikawiri, nthawi zambiri anthu sakhala ndi kusintha kosintha. Mwachitsanzo, sizosatheka (koma sizosatheka) kwa wina yemwe ali ndi kusintha kwa EGFR kuti akhalenso ndi kusintha kwa ALK kapena kusintha kwa KRAS m'maselo awo a khansa yamapapo.
Kudziwa
Zosakaniza zamatenda
Kuti zowonongeka kwa jini zizichitika, chitsanzo cha chotupa chanu chiyenera kupezeka. Nthaŵi zambiri, kuyezetsa kumafuna zitsanzo za minofu yomwe imapezeka panthawi yamapapu . Izi zikhoza kuchitika kupyolera mu singano ya singano, nthawi ya bronchoscopy, kapena kupyolera mu mapulogalamu otseguka. Nthawi zina kuyezetsa kumachitika pa chotupa chomwe chachotsedwa kwathunthu pa opaleshoni ya khansa ya m'mapapo.
Zamadzimadzi
Mu June 2016, kuyezetsa kusintha kwa EGFR kunayambanso kuyesedwa kwatsopano. Mosiyana ndi zovuta zowonongeka, izi zimayesedwa mwa kuyesa magazi mosavuta. Pakalipano, mayeserowa adakali ofunika kufufuza ndikusagwiritsidwa ntchito payekha kuti athe kutsogolera ndi kuchiza khansa yamapapo, koma kupereka lonjezo lalikulu. Tikuyembekeza kuti mayeserowa adzakupatsani mwayi wotsogolera anthu ndi khansa yabwino ya EGFR mu nthawi yeniyeni. Pakali pano, timangophunzira kuti chotupa chakhala chosagonjetsedwa ndi mankhwala omwe akugwiritsira ntchito EGFR pamene silingayankhe (ayamba kukula kapena kufalikira) pamapangidwe a mapapo. Zamadzimadzi zamadzimadzi zimapatsa madokotala mwayi wophunzira chotupa chakhala chosagonjetsedwa-ndipo motero amasintha kupita kuchipatala mofulumira kuposa momwe zingathere.
Genetic Changes in Cancer Maselo
Kuti mumvetse bwino kufotokozera kwa maselo ndi njira zochiritsira za khansa ya m'mapapo, ndizothandiza kufotokozera mfundo zochepa zomwe zimayambitsa ma genetic. Pali mitundu yambiri ya kusintha kwa majini yomwe ingabwereke m'maselo a khansa. Izi zikuphatikizapo:
- Kusinthika - Kusinthika ndi kusintha kwa ma DNA omwe amapanga jini.
- Zokonzanso - Muzokonzanso, dongosolo la DNA likonzedwanso.
- Translocations - Kusintha uku kumachitika pamene gawo la jini pa chromosome imodzi imasamukira kudera lina la DNA.
- Gene fusion - Geni ya "fusion" imapezeka pamene translocation imabweretsa magulu awiri omwe sali pamodzi.
- Kutsindika kumatanthawuza kupanga mapepala angapo a jini ndipo amapezeka m'maselo a khansa.
Palinso mitundu yosiyanasiyana ya kusintha. Zina mwa izi, mophweka, zimaphatikizapo:
- Kusintha kwamasinthasintha - Mfundo yosinthika imatanthawuza kusinthika kumene maziko amodzi amalowetsamo wina.
- Kuchotsedwa - Mu kuchotsedwa, chidutswa cha majini amatayika kapena kuchotsedwa ku jini
- Kuikapo - Powonjezerapo, gawo la jini limaphatikizidwa ku jini.
Mitundu
Kusinthika kwa EGFR sikukutanthauza kuti pali mitundu yosawerengeka ya jini. M'malo mwake, pali mitundu yosiyanasiyana ya kusintha kwa EGFR yomwe imasiyana mosiyana ndi mtundu wa kusintha kwa thupi (monga momwe tafotokozera pamwambapa) komanso pamene pali kusintha kwa jini. Mwa kuyankhula kwina, pali njira zambiri zomwe EGFR ikhoza kusinthidwa
Kusintha kwa EGFR kumachitika m'malo osiyanasiyana kuyambira pa 18 mpaka 21. Zosintha zambiri za EGFR (pafupifupi 90 peresenti) ndizoponyedwa kunja (zosowa za genetic) kapena kusintha kwamasamba 21 L858. (Onani kusintha kwa T790 pansipa komwe kawirikawiri kumachitika ndi kukana.)
Chithandizo
Pakalipano pali mankhwala atatu ovomerezeka a FDA omwe amapezeka kuti athetse EGFR yabwino mapapu adenocarcinoma, komanso imodzi ya squamous cell carcinoma komanso imodzi ya EGFR khansa ya m'mapapo yosagwira mtima. Mankhwalawa amatchedwa tyrosine kinase inhibitors. Amaletsa ntchito ya mapuloteni a EGFR.
Mankhwala omvomerezeka a mapapu adenocarcinoma ndi awa:
- Tarceva (erlotinib)
- Gilotrif (afatinib)
- Iressa (gefitinib)
Mankhwala omvomerezeka a kusintha kwa T790 ndi awa:
- Tagrisso (osimertinib)
Mungamve nkhani yanu ya oncologist za "mibadwo" ya mankhwalawa. Tarceva ndi mbadwo woyamba wa EGFR inhibitor, Gilotrif ndi mbadwo wachiwiri, ndipo Tagrisso, mbadwo wachitatu wa EGFR inhibitor.
EGFR Inhibitors kwa Lung Adenocarcinoma
Ndi mankhwala atatu omwe akuyambira pa EGFR yabwino mapapu adenocarcinoma, madokotala amatha kusankha chiyani mwa tyrosine kinase inhibitorsyi yomwe ingagwire ntchito yabwino kwa khansa yanu yeniyeni?
Kusankha kwa EGFR inhibitor inayake kumadalira makamaka zomwe mukukonda (ndi malo anu) Pali kusiyana kochepa . Iressa amadziwika kuti ali ndi zotsatira zochepa kwambiri ndipo angaganizidwe kukhala woyamba kwa wina yemwe ali ndi mankhwala ena akuluakulu kapena okalamba. Mosiyana ndi zimenezo, Gilotrif akhoza kukhala ndi zotsatira zoopsa (makamaka zilonda zam'thupi) koma akhoza kukhala ndi phindu lalikulu la kupulumuka. Gilotrif ingagwiritsenso ntchito bwino kwa anthu omwe ali ndi matenda osokoneza bongo exon 19. Komabe, pali zina zambiri zomwe ovomerezeka anu akufuna kuziganizira ndi khansara yanu.
EGFR ndi Squamous Cell Carcinoma M'mapula
Njira ya EGFR ingathandizenso anthu omwe ali ndi squamous cell carcinoma m'mapapo omwe alibe EGFR kusintha, koma mwa njira zosiyanasiyana.
Mmalo mwa kusintha kwa EGFR kuyendetsa khansa izi, kukula kumalo kumayenderana ndi kukulitsa kwa EGFR . Ndipo mmalo mogwiritsa ntchito tyrosine kinase inhibitors pofuna kulondolera kusintha kwa EGFR, anti-EGFR antibodies ndi gulu la mankhwala ogwiritsira ntchito EGFR kunja kwa selo (mu khansa yomwe ilibe kusintha kwa EGFR) kusokoneza njira yolankhulira.
Mapulogalamu (necitumumab) adavomerezedwa mu 2015 pamodzi ndi mankhwala a chemotherapy kwa anthu omwe ali ndi squamous cell carcinoma m'mapapo omwe sanalandire chithandizo cham'mbuyo. Mazira a antioclonal antibody ( anti- man-made antibody) omwe amaletsa ntchito ya EGFR. Mankhwala othandizira anti-EGFR monga mankhwala a Erbitux (ceuximab) ndi Vectibix (panitumumab) -gwiritsidwa ntchito ndi khansa zina.
Mosiyana ndi mankhwala ogwiritsidwa ntchito pa adenocarcinoma pamwambapa omwe amaperekedwa pamlomo, anti-EGFR mankhwala opangira mankhwalawa amaperekedwa mwachindunji.
Kukana kwa Chithandizo
Mwamwayi, ngakhale khansa ya m'mapapo ingayankhe bwino kwa tyrosine kinase inhibitors poyamba, iwo nthawizonse amakhala osagonjetsedwa pakapita nthawi. Komabe, nthawi yambiri isanayambe kukana, imakhala yosiyana kwambiri. Ngakhale nthawi yapakatikati pakati pa kuyamba kwa mankhwala ndi chitukuko cha kukana ndi miyezi 9 kapena 13, mankhwalawa akhala akugwira ntchito kwa anthu ena kwa zaka zambiri.
Pakali pano, nthawi zambiri timapeza kuti chotupa chakhala chikulimbana ndikuyamba kukula kapena kufalikira. Kubwereza kotsatizana, kutsatiridwa ndi kufotokoza kwa maselo kumachitika nthawi imeneyo. Monga tafotokozera pamwambapa, tikuyembekeza kuti zizindikiro zamadzi zidzakhala njira yodziwira kuti chotupa chidzakhala chotani m'tsogolomu.
Kuchiza kwa EFFR Yotsutsa Lung Cancer
Monga momwe pali mitundu yambiri yosiyanasiyana ya kusintha kwa EGFR, pali njira zingapo zomwe khansa ikhoza kugonjetsedwa. Maselo a khansa amasintha nthawi zambiri, ndipo nthawi zambiri amasintha zinthu zomwe zimapangitsa kuti asagwiritsidwe ntchito ndi mankhwalawa.
Pafupifupi theka la anthu, kusintha kwachiwiri-kuchotsa exon 20 yotchedwa EGFR T790 ikukula. Kusintha kumeneku kumakhudza dera la EGFR yomwe tyrosine kinase inhibitors (monga Tarceva) yoyamba ndi yachiwiri imamangiriza, kupanga mankhwala onse atatu pamwamba (Tarceva, Gilotrif, ndi Iressa) opanda ntchito. Kwa anthu omwe ali ndi kansa ya EGFR T790 yokhala ndi mavitamini osagwidwa ndi khungu, mankhwala a Tagrisso kapena AZD9291 (osimertinib) amavomerezedwa tsopano. Komabe, monga momwe kukana kumayambira ndi mankhwala a mbadwo woyamba, anapeza kuti mankhwalawa amatha kukhala a tyrosine kinase inhibitors. Tikuyembekeza, mankhwala osokoneza bongo adzapitirizabe kupangidwa kuti asakanike, kotero kuti anthu ambiri akhoza kukhala ndi khansa ya m'mapapo ngati mawonekedwe a matenda osachiritsika osati ochiritsidwa, koma olamulidwa ndi mankhwalawa.
Lumikizani kwa Bra mu Metastases
Mwamwayi, chifukwa cha kukhalapo kwa magazi-ubongo wa mitsempha-malo amodzi ogwirizana kwambiri omwe amachititsa ma capillaries mu ubongo-ambiri mwa mankhwalawa sangathe kufika ku maselo a khansa omwe apita ku ubongo. Mitsempha ya ubongo ya ubongo imapangidwira kuchepetsa mphamvu ya poizoni kuti ifike mu ubongo, koma mwatsoka, imateteza mankhwala a chemotherapy ndi mankhwala ochiritsira kuti afike ku ubongo. Popeza khansara yamapapu imakonda kufalikira ku ubongo, izi zakhala vuto lalikulu kwa iwo omwe ali ndi kansa ya m'mapapo ndi ubongo wa metha .
Mankhwala amodzi omwe akuphunziridwa m'mayesero a kachipatala - AZD3759 adapangidwa kuti aloŵe kupyolera muzitsulo za ubongo, ndipo akuyembekeza kuti mankhwalawa, kapena ena akuyesedwa, angathandize omwe ali ndi khansa ya m'mapapo ya kusintha kwa EGFR omwe ali ndi matenda a ubongo kapena leptomeningeal .
Zotsatira Zochiza Chithandizo
Zotsatira zofala kwambiri za tyrosine kinase inhibitors, zomwe zilipo pafupifupi 80 peresenti ya anthu, ndizophulika khungu. Pang'ono ndi pang'ono, kutsekula m'mimba kumatha kuchitika.
Tarceva (erlotinib) ziphuphu zamphuno (ndi ziphuphu zina za tyrosine kinase inhibitors) zikufanana ndi acne, zikupezeka pamaso, pamutu ndi kumbuyo. Malinga ndi mbali ya kutukudzika, ngati palibe mitu yoyera, pamakhala mankhwala odzola kwambiri (hydrocortisone kirimu). Ngati mitu yoyera ilipo ndipo kutukukaku kumawoneka kuti ndi kachilomboka, mankhwalawa amagwiritsidwa ntchito. Nthawi zina mlingo wa mankhwala uyenera kuchepetsedwa.
Mayesero Amakono
Monga tanenera kale, patsogolo podziwika za kusintha kwa majini ndi khansara yamapapu komanso mankhwala ochiritsira kuti athetse kusintha kumeneku. Pali zovuta zambiri zachipatala pakalipano poyang'ana mankhwala ena ochiza khansa ya m'mapapo ya EGFR, komanso mankhwala ena a kusintha kwa maselo a khansa.
Malinga ndi National Cancer Institute, anthu omwe ali ndi khansa ya m'mapapo ayenera kulingalira nawo mbali pa mayesero a zamankhwala. Mankhwala ambiri omwe tsopano akugwiritsidwa ntchito amapezeka kokha ngati gawo la mayesero a zachipatala kanthawi kochepa. Mabungwe angapo a khansa yamapapo agwira ntchito pamodzi kuti apange mayeso a kansa yamapapo a mapapo akufanana ndi wina aliyense ali ndi khansara yamapapo. Pogwiritsa ntchito ntchitoyi yaulere, madokotala amatha kufanana ndi khansara yanu yamapapo m'mayesero am'chipatala akuchitika kulikonse padziko lapansi.
Thandizo ndi Kulimbana
Ngati mwapezeka kuti muli ndi khansara yamapapo, mukuchita chimodzi mwa zinthu zabwino kwambiri zomwe mungachite - kutenga nthawi yophunzira za khansa yanu. Nazi malingaliro angapo a momwe mungapezere uthenga wabwino wa khansa pa intaneti, komanso zina mwazoyamba zomwe mungachite pamene mwatenga kumene .
Kuwonjezera pa kuphunzira za khansara yanu, kuphunzira momwe mungadziwonere nokha ngati wodwala matenda a khansa ikupanga kusiyana kwa ambiri. Ngakhale kuti mwakhala mukudziwika ndi zibisole za pinki kusiyana ndi mabala a khansa yoyera, mapepala a chithandizo cha kansa yamapapo, ndi amphamvu komanso amphamvu. Anthu ambiri amawona kuti ndi zothandiza kukhala nawo mbali m'magulu othandizirawa komanso m'midzi osati njira yopezera chithandizo kuchokera kwa wina yemwe "wakhalapo" koma monga njira yodziwiritsira ndi kufufuza kwatsopano pa matendawa.
Mankhwalawa-komanso mapulogalamu oyendetsa mosangalala-khansa ya m'mapapo ikukula, ndipo pali chiyembekezo chochuluka. Panali mankhwala atsopano ovomerezedwa pakati pa 2011 ndi 2015 kusiyana ndi zaka 40 zisanafike 2015. Komabe, khansara ndi mpikisano wothamanga, osati sprint. Ngati mukulimbana ndi khansa, yesetsani kubanja lanu ndi abwenzi anu ndikuwalola kuti akuthandizeni. Kukhala ndi maganizo abwino ndi khansara kumathandiza nthawi zina, koma onetsetsani kuti muli ndi abwenzi apamtima omwe mungathe kutseguka ndikutulutsa maganizo anu omwe sali oyenera komanso owopsa. Ngati ndi wokondedwa wanu yemwe watulukirapo, yang'anani maganizo awa pa zomwe zimakhaladi kukhala ndi khansa .
Zotsatira:
Greenhalgh, J., Dwan, K., Boland, A. et al. Chithandizo choyamba cha epidermal growth factor receptor (EGFR) kusintha kwa kansa kamene sikakhala kakang'ono kamene kali ndi kansa ya m'mapapo. Dongosolo la Cochrane la Zosintha Zogwirizana . 2016. 5: CD010383.
Hasegawa, T., Ando, M., Maemondo, M. et al. Udindo wa kusuta fodya kusapulumuka kwa anthu osapitirira angapo a khansa ya m'mapapo yambiri ya m'mapapo. Kugwiritsa ntchito epidermal kukula factor receptor (EGFR) kusintha mthupi loyamba kulandira mzere woyamba wa EGFR tyrosine kinase inhibitor kuphatikizapo platinum doublet chemotherapy: meta-analysis of potential random trials . Oncologist . 2015. 20 (3): 307-15.
Tan, C., Cho, B., ndi R. Soo. Kachilombo kameneka epidermal kukula factor receptor tyrosine kinase inhibitors mu epidermal kukula factor receptor -mutant osati yaying'ono kansalu ya khansa ya mapapo. Khansa Yam'mimba . 2016. 93: 59-68.
Tan, D., Yom, S., Tsao, M. et al. Bungwe la International Association for the Study of Lung Cancer kulengeza mgwirizano wa kukonzetsa kasamalidwe ka EGFR mutation yabwino kansalu yaing'ono ya m'mapapo ya khansa: udindo mu 2016. Journal of Thoracic Oncology . 2016 May 20. (Epub patsogolo pa kusindikiza).
Vanderbilt Cancer Center. MyCancerGenome.org. EGFR mu Can-Small Cell Lung Cancer (NSCLC). Kusinthidwa 06/18/15. https://www.mycancergenome.org/content/disease/lung-cancer/egfr/