Kodi sizingakhale zabwino ngati madokotala angayang'ane khansara yanu, yang'anani pa njira zatsopano zochiritsira zomwe zikuchitika, ndikudziwitsanso kuti ndi njira ziti zomwe zingapambane?
Ngakhale kuti oncologists akhoza, nthawi zambiri, ali ndi zipangizo zabwino ndi deta kuti athe kuyerekeza ndi kuyerekeza mankhwala osiyanasiyana, posachedwapa mankhwala omwe angoyamba kumene angakhale ovuta kufotokozera, popanda kukhala ndi chithandizo chamankhwala.
Kupita patsogolo pa chidziwitso kumachokera ku mayesero a zachipatala, kumene odwala amavomereza kuti alowe maphunziro ndi mankhwala ofukufuku omwe asonyeza lonjezo; koma, monga mawu akuti 'kuyesedwa' amatanthawuza, nthawi zonse kumakhala kokayikira kwambiri za momwe mankhwala amachitira bwino ndi omwe adzapindule kwambiri-ndiko kuti, mitundu iti ya odwala ndi khansa yoyenera.
Kodi Khansara Imayambitsa Bwanji?
Cancer immunotherapy ndi mankhwala omwe amaphatikizapo mbali zina za chitetezo cha m'thupi kuti chiteteze malignancy. Chitsanzo chimodzi cha immunotherapy ndi kugwiritsa ntchito ma antibodies monoclonal monga rituximab ndi obinutuzumab . Mankhwala a monoclonal ndi ma antibodies opangidwa ndi anthu, kapena mapuloteni a chitetezo cha m'thupi. Mankhwalawa amatha kumenyana ndi mbali yeniyeni ya khansa yomwe imatchedwa kuti mankhwala othandiza .
Mitundu ina ya khansa yotchedwa immunotherapy imaphatikizapo chitetezo cha m'thupi chitetezo cha mthupi , chomwe chimatulutsa 'mabaki' ku chitetezo cha mthupi kuti chiwathandize kuzindikira ndi kuwononga maselo a khansa.
Dziko la khansa ya immunotherapy silimangokhala zitsanzo zoposazi, komabe, ndi malingaliro atsopano ogwiritsira ntchito chitetezo cha thupi lanu kumenyana ndi maselo a khansa akupitiliza kukonzedwa ndi kuyesedwa.
Kodi Immunotherapy Amagwira Ntchito Khansa Yonse?
Munthu aliyense ndi wapadera, ndipo khansa ya munthu aliyense ndi yapadera; si onse omwe amachitanso chimodzimodzi kuti azikhala ndi thupi limodzi.
Kuyeza bwino, anthu omwe angayambe kuchitapo kanthu kuti athandizidwe ndi immunotherapy angakhale opindulitsa kuchokera m'magulu angapo. Kwa wodwalayo, ikhoza kupulumutsa nthawi yofunikira, yomwe ingatanthauzire ku chipatala.
Mwa kuyankhula kwina, simungataya nthawi yanu kapena zotsatira zoopsa zanu kuyesera chinthu chomwe chingakhale chochepa pokha pakhoza kukhala 'mfuti yaikulu' kapena mankhwala othandiza kwambiri. Koma kodi munthu angadziwe bwanji chinthu ichi pasadakhale? Nkhani imodzi yokhudzana ndi momwe ocologists ndi akatswiri a khansa akuchitira izi zikuyamba ndi zina zotchedwa neoantigens.
Neoantigens: Achilles a Cancer Achiritsidwa?
Maselo a khansa angakhale osokonezeka. Kawirikawiri amakhala ndi kusintha kosiyanasiyana m'magazi awo, ena mwa iwo angagwirizane ndi kuthekera kwawo kuchita zinthu zoipa zomwe maselo abwino, thanzi labwino sangathe. Zina mwa kusintha kumeneku kumabweretsa kusiyana kwa thupi kapena kunja kwa maselo a kansa omwe angapezeke ndi chitetezo cha mthupi. Mbali izi za maselo a khansa omwe chitetezo cha mthupi chingakhoze kuzindikira kuti ndi chachilendo chotchedwa "neoantigens."
Neo, kutanthauza zatsopano, chifukwa zimachokera ku maselo athu, zimakhala ndi khansara , mosiyana ndi asayansi omwe nthawi zambiri amafotokoza za matenda opatsirana.
Antigens nthawi zonse angapezeke kunja kwa mabakiteriya, kapena maselo omwe ali ndi kachilombo ka HIV. Mosiyana ndi zimenezo, neoantigens ali ngati mbendera zofiira zomwe zikhoza kusonyeza mawonekedwe a chitetezo cha mthupi kuti maselo athu ali osasamala.
Neoantigens amachititsa kuti maselo oyera amagazi amadziwika kuti T-maselo -asilikali a chitetezo cha mthupi. Msilikaliwa T-maselo amayenda mitsempha ya mitsempha, mofanana ndi misewu yambiri ya ku Roma, kuti afike pa malo a maselo osalongosoka, alowetsa chotupacho ndikuthandiza kuchepetsa chiwerengero cha maselo oipa.
Choncho, neoantigens ndi imodzi mwa mafungulo othandizira kuteteza khansa.
Izi zinati, kupambana nkhondoyo kaŵirikaŵiri kumaphatikizapo kuteteza thupi laumunthu yekha, ndipo njira yowonjezera yowonjezera ndiyofunika; Mankhwalawa amagwiritsidwa ntchito pogwiritsa ntchito cytotoxic chemotherapy ndi / kapena zina zotere, malinga ndi malungo ndi wodwalayo .
Kodi Immunotherapy Idzagwira Ntchito Kwa Ine?
Ili ndi funso lofunika kwambiri pa zamakono zamakono, ndi omwe akugwira ntchito mwakhama. Pamapeto pake, zizindikiro ziwiri za maselo anu a khansa zingathandize madokotala kuti adziwitse momwe magwiritsidwe ntchito a immunotherapi amathandizira: TMB ndi MSI.
Kusokonezeka kwa thupi, kapena TMB , kungalingalire ngati ndondomeko ya zonsezi zomwe zimayambitsa majini mumaselo omwe ali ndi khansa omwe ali ndi majeremusi, mwachitsanzo, omwe amagwiritsidwa ntchito kulembera zinthu zonse zomwe maselo amafunikira-koma Zasintha kapena kusintha kusintha kwa maselo a khansa. Nthaŵi zina TMB imatchulidwa kuti ndikuthamangitsidwa kwathunthu.
Matenda omwe ali ndi TMB apamwamba amakhulupirira kuti ali ndi neoantigens ambiri ndipo amatha kuyankha bwino kwa immunotherapy. Maselo a kansa amatha kukhala ndi TMB yapamwamba kupyolera mu zowonongeka zogwirizana ndi khansa, kuphatikizapo fodya kapena kuwala kwa UV. Njira ina ndi kupyolera mu microsatellite, kapena MSI , mawu ofunika omwe amatanthawuza vuto ndi thupi la thupi lanu lokonzanso DNA-vuto lomwe limapangitsa kuti kusintha kwakukulu kosasinthasintha kobwerezabwereza kwa DNA.
Kampani imodzi yotchedwa Foundation Medicine tsopano ikupereka ma polojekiti oyambirira ogwirizana, ogwirizanitsidwa ndi TMB monga gawo la FoundationOne testay, yomwe ingathandize kuthana ndi momwe munthu angayankhire pa immunotherapy.
Vincent Miller, MD, yemwe ndi dokotala wamkulu wa Foundation Medicine, akufotokoza kuti: "Mankhwala olakwika amachititsa kuti anthu onse azidwala khansa. "Kupweteka ndi chiwerengero chachikulu cha kusintha kwa thupi kumakhala kosavuta kupanga mapuloteni atsopano, omwe amachititsa kuti mapuloteni asatuluke. Chitetezo cha mthupi chimazindikira kuti ma neoantigens awa ndi achilendo ndipo amatha kukhala ochenjera, kuyambitsa njira zovuta zowononga chotupacho. "
Kodi Chitetezo cha M'madzi Chomwe Sichidzandigwire?
Chiwembuchi chimakhudza kwambiri kuti khansa zina zakhala ndi njira zowonongeka zowononga chitetezo cha mthupi-popanga mapuloteni omwe amachititsa kuti mitundu ina ya maselo anu a chitetezo cha thupi asamangidwe . Chipangizo chopangira biologic , ngati mukufuna.
Pofuna kupewa matenda a khansa kuti asadziteteze mwa njira imeneyi, maselo ena aumunthu amatha kupewera mapuloteni oteteza thupi lawo. Mankhwalawa, omwe amatchedwa immune checkpoint inhibitors , amaphatikizapo otchedwa anti-PD1 ndi anti-PDL1 antibodies . Ndipo, mofanana ndi mitundu ina ya immunotherapy, pali umboni umene umasonyeza kuti mapangidwe apamwamba a neoantigens mu maselo a khansa amathandizidwa ndi mayankho abwino kwambiri pa chitetezo cha mthupi chodziletsa.
Yankho la ma check inhibitors likusiyana ndi pafupifupi 20 peresenti mu khansa ya m'mapapo mpaka 80 peresenti mu Hodgkin lymphoma. Chifukwa chake zotupa zina zimayankhidwa pazitsulo zowonongeka ndi zina zomwe sizikuwonekera.
Kufunika Kudzala Mtengo Wopereka Udokotala
Zida zowonongeka izi ndi zokambirana pa msonkhano wa chaka chino wa American Society of Clinical Oncology, kapena ASCO.
TMB yatsimikiziridwa kuti inaneneratu mwayi waukulu wa kuyankha ndi kuchitapo kanthu kwa nthawi yaitali ku khansa ya immunotherapies kwa odwala khansara ya chikhodzodzo, kansa ya m'mapapo, khansa ya khansa ndi khansa zina zamakono. Kuphatikiza pa TMB, FoundationOne imayambanso kusagwirizana kwa microsatellite, yomwe imayesa mayesero amodzi kuti athe kutsata njira zothandizira zochiritsira, zovuta zachipatala komanso matenda a khansa yovomerezeka ya FDA pogwiritsa ntchito njira imodzi yokha.
"Cancer immunotherapies ndi patsogolo pa chithandizo cha khansa, ndipo njira zatsopano zowonetsera zowonongeka zimayenera kufotokozera zam'chipatala mayankho ogwira ntchitoyi, komanso ochiritsa," anatero Dr. Miller.
"Kukhoza kulingalira molondola amitundu yambirimbiri panthawi imodzi, kuphatikizapo TMB ndi MSI, ndi chitukuko chofunika kwambiri pamtunda wa khansa ya immunotherapy, ndi imodzi yosiyana ndi Foundation Medicine," anatero mtsogoleri wa pulogalamu ya atcology ya Thomas George, MD, GI, Florida. . "Maziko a Maseti a Foundation omwe akutsogolera maulendo apadera ndi machitidwe apadera kwambiri amandipatsa mwayi wopita kuchipatala kwa odwala anga kamodzi, ndikuthandiza kupulumutsa nthawi ndi minofu."
"Tinalimbikitsidwa ndi zomwe zapezeka ku ASCO, kuphatikizapo mwayi wodziwitsa odwala omwe angapindule ndi checkpoint inhibitor immunotherapy," anatero Dr. Miller. "Cholinga chathu ndi kupereka mphamvu kwa madokotala ndi odwala omwe ali ndi mauthenga osiyanasiyana ogwira ntchito, ndipo timasangalala kupereka njira yathu yodziŵira TMB ndi MSI panthawi imodzimodzimodzi komanso molondola kwambiri, pothandizidwa ndi ndondomeko zamakono komanso zozikika m'maganizo kuchokera ku chidziwitso chathu FoundationCORE. Ichi palibe chinthu china chotsatira chomwe chimapereka mapepala. "
Odziimira okhazikika pa FoundationOne ndi FoundationOne Heme, Foundation Medicine imaperekanso kuyesa kwa ma polojekiti PD-1 ndi PD-L1, kupereka, kuphatikizapo mayesero a FoundationOne, omwe akutsatiridwa ndi khansa ya immunotherapy ya oncologists.
Mawu Ochokera
Ngakhale kuti izi ndi malo odalirika, sayansi ikupitirizabe ndipo mayesero osiyanasiyana adakalipo ndikuphunziridwa. Zonse zamakono zotsatila zowonongeka kwa chithandizo cha kuchipatala kuti azindikire njira zotetezera ndizofukufuku okha ndipo pakalipano palibe mayesero ovomerezeka a FDA omwe anganeneratu molondola yankho lake poyang'ana malo otsekemera.
> Zotsatira:
> Foundation Medicine imapereka deta yatsopano ku ASCO 2016 yomwe ikusonyeza kuti FoundationOne ikhoza kuthandizira kufotokozera zomwe zimachitika ku khansa ya immunotherapy m'magazi osiyanasiyana apamwamba.
Ansell SM, Lesokhin AM, Borrello I, et al. PD-1 Blockade ndi Nivolumab mu Lobphoma ya Hodgkin kapena yobwezeretsedwa. N Engl J Med. 2015; 372 (4): 311-319.
Pardoll DM. Kutetezedwa kwa chitetezo cha mthupi ku khansa ya immunotherapy. Kan Rev Cancer. 2012; 12 (4): 252-64.