Mankhwala omwe amaletsa njira zonyenga za khansa
Khansara ya sepamisoni ya mutu ndi khosi ndi khansara yachisanu ndi chimodzi yowonongeka kwambiri padziko lapansi ndipo imawerengetsa pafupifupi 1 mpaka 2 peresenti ya onse akufa. Vuto limodzi lalikulu likupezeka pochiza anthu omwe ali ndi khansara yamutu ndi ya m'khosi, yomwe nthawi zambiri imakhala yosauka.
Nkhani yabwino ndi yakuti kafufuzidwe ikupita, ndipo madokotala akuyamba kugwiritsa ntchito ma immunotherapi mu chiwerengero cha odwala.
Immunotherapy ndi mankhwala achichepere omwe amawoneka otetezeka ndipo amathandiza zizindikiro komanso ngakhale nthawi yopulumuka kwa anthu ena, pogwiritsa ntchito kafukufuku wamasayansi oyambirira.
Kumvetsetsa Mfundo Zenizeni za Mutu ndi Khansa ya Khanda
Musanazindikire momwe maginitowa amagwira ntchito, ndi bwino kupeza chogwiritsira ntchito pazinthu zomwe "mutu ndi khosi" zina zimatanthauza.
Kodi Cell Squamous N'chiyani?
Maselo a squamous ndi maselo ofooka, omwe amakhala pamwamba pa khungu, timapepala ta m'mimba komanso mapewa, ndi ziwalo zina m'thupi.
Zitsanzo za malo omwe squamous cell carcinoma (khansa) ikhoza kukhazikitsa ndi malo awa:
- Mutu ndi khosi
- Khungu
- Chotsitsa
- Vagina
- Mphungu
- Anus
Kodi Malignant Amatanthauza Chiyani?
Chotupa choopsya (mosiyana ndi chotupa chochititsa manyazi, chomwe sichili khansa) pamutu ndi m'khosi kumalo akutanthauza kusonkhanitsa kwa maselo a khansa omwe akukula mosasinthasintha ndipo akhoza kapena sanafikepo minofu yathanzi.
Immunotherapy ndi mankhwala ena monga chemotherapy amagwiritsidwa ntchito pochizira zilonda zoopsa, chifukwa izi ndizovulaza ndipo zingathe kupha.
Kodi Mutu ndi Khansa Yamphongo Ali Kuti?
Mawu oti "mutu ndi khosi" angakhale ododometsa, chifukwa amadziwa malo akuluakulu. Mwa kuyankhula kwina, mungadabwe chomwe chimatanthauza pamene munthu amapezeka ndi mtundu uwu wa khansara.
Khansara yamutu ndi ya khosi imatchula zivomezi zomwe zimakhala m'modzi mwa malo awa:
- Mlomo / pakamwa
- Kubwerera pakamwa kapena pamtima (wotchedwa oropharyx)
- Gawo la pammero lomwe liri kumbuyo ndi pafupi ndi bokosi la mawu (lotchedwa hypopharynx)
- Pamwamba pammero kumbuyo kwa mphuno (yotchedwa nasopharynx)
- Bokosi la mawu (lotchedwa larynx)
Kodi N'chiyani Chimayambitsa Khansa ya Mutu ndi Khanso?
M'mbuyomu, chitukuko cha khansa ya mutu ndi khosi chinagwirizanitsidwa ndi fodya komanso kugwiritsa ntchito mowa. Koma zaka khumi zapitazo, kukula kwa khansa ya mutu ndi khosi yakhala ikugwirizanitsidwa ndi matenda ndi mitundu ina ya mapiromaviruses a anthu ( HPV ). Mwachitsanzo, deta ya sayansi yasonyeza kuti mtundu wa HPV wotchedwa HPV-16, womwe umayambitsa khansara ya chiberekero ndi khansara ya abambo mwa amuna ndi akazi, umagwirizanitsidwa ndi khansa ya oropharyx.
Kutenga ndi HPV kumakhala kofala kwambiri, komabe pokhapokha peresenti ya anthu imakhala ndi khansa. Ichi ndi chifukwa chakuti ma chitetezo a anthu ambiri amachotsa matendawa.
Chochititsa chidwi kwambiri kuposa kupeza kugwirizana pakati pa HPV ndi khansara ya mutu ndi khosi, ndiko kupeza kuti chiwerengero cha khansa ya mutu ndi khosi yotchedwa HPV yakula. Komabe, zotsatira za khansa ya mutu ndi khosi zomwe zimachitika chifukwa cha fodya ndi kugwiritsa ntchito mowa zachepa. Chifukwa chiyani kusintha uku? Akatswiri akuganiza kuti zingakhale chifukwa cha kusintha kwa chikhalidwe cha kugonana-makamaka, kugonana kwa m'kamwa kwafala kwambiri.
Pakalipano, pali chidwi kwambiri pa momwe angaperekere kansalu ka khansa ndi mutu wa HPV, monga biology yawo imasiyana ndi zotupa za HPV. Chifukwa cha zimenezi, akatswiri akuyang'ana njira zosiyanasiyana zothandizira anthu kuti athetse khansa.
Kodi Ndondomeko Zotani Zomwe Zimatetezedwa?
Zizindikiro za ma chitetezo a m'thupi ndi mapuloteni omwe amapezeka pamaselo a chitetezo cha munthu (otchedwa T maselo). Maselo a T ali ngati apolisi kufunafuna mavuto (kansa kapena matenda) mkati mwa thupi. T cell ikakumana ndi selo lina, imayesa maselo ogwiritsira ntchito mapuloteni omwe ali pamtunda kuti aone ngati selo ndilo "labwino" kapena "losazolowereka." Ngati sizinali zachilendo, T cell ikhoza kuyambitsa selo.
Koma panthawiyi, kodi maselo abwino, odwala amakhala otetezeka bwanji? Apa ndi pamene mapuloteni otha kuyang'ana amayamba. Mapuloteni otchedwa Checkpoint ali pamwamba pa maselo T ndikuonetsetsa kuti maselo wathanzi amasiyidwa okha.
Khansa ndi yonyenga chifukwa imapanga mapuloteni oterewa (a copycat weniweni) kuti asagwiritsidwe ndi chitetezo cha m'thupi. Puloteni imodzi yowonongeka pamwamba pa maselo a khansa kuti igwidwe ndi chitetezo cha m'thupi ndi PD-1.
Koma tsopano asayansi apeza kuti akhoza kuletsa PD-1 pa maselo a kansa, kotero kuti kansa imawoneka ndi chitetezo cha munthu. Izi ndi zomwe zimathandiza kuti thupi limatetezedwe, ndipo mankhwalawa otetezedwa ndi PD-1 amatchedwa immune system checkpoint inhibitors.
Immunotherapy Kutenga Mutu ndi Khansa Yamphaka
Pali ziwalo ziwiri zomwe zimapangitsa kuti FDA ivomerezedwe mu 2016 pochiza anthu omwe ali ndi mutu ndi mutu wa squamous cell carcinoma.
Khansara ya Metastatic imatchula khansara ya mutu ndi khosi yomwe yafalikira kumadera ena a thupi, pamene khansara ya mutu ndi ya m'khosi imatanthawuza khansara yomwe yapita patsogolo ngakhale kuti imakhala ndi mankhwala a platinum-chemotherapy regimen (mwachitsanzo, cisplatin).
Magulu awiri otchedwa immunotherapies amatchedwa Keytruda (pembrolizumab) ndi Opdivo (nivolumab).
Pembrolizumab
Kafukufuku oyambirira amasonyeza kuti pembrolizumab ali ndi mbiri yabwino ya chitetezo ndipo ingakhale yothandiza pakuchepetsa khansa ya anthu ena.
Mu phunziro limodzi lachiwiri, anthu 171 omwe ali ndi khansara ya mutu ndi khosi yomwe idapitabe ngakhale kuti anachitidwa kale ndi chemotherapy ndi cetuximab (a monoclonal antibody therapy ) adalandira kulowetsedwa kwa pembrolizumab milungu itatu iliyonse.
Mliri wonse wa kuyankhidwa unali 16 peresenti, ndipo nthawi yayitali ya yankho inali miyezi 8. Kuyankha kwa chiwerengero kumatanthauza chiwerengero cha anthu omwe khansara imatha kapena imatha chifukwa cha mankhwala.
Ponena za chitetezo, 64 peresenti ya ophunzirawo adakumana ndi zotsatira zovuta zokhudzana ndi chithandizo, koma 15 peresenti yokha anawona zochitika zitatu kapena zinayi zovuta (zoopsa kapena zowopsya).
Zotsatira zovuta kwambiri zinali:
- Kutopa
- Hypothyroidism (chithokomiro chopanda mphamvu)
- Nausea
- Kuwonjezeka kwa chiberekero cha chiwindi
- Kutsekula m'mimba
Zonsezi, zokhudzana ndi machitidwe okhudzana ndi chitetezo cha m'thupi ndi hypothyroidism, hyperthyroidism, ndi pneumonitis.
Pachifukwa chotsatira, chitetezo cha mthupi chimakhala chodetsa nkhaŵa kwambiri ndi ma immunotherapies, popeza pali nkhawa kuti chitetezo cha mthupi cha munthu chidzaukira osati maselo a khansa komanso minofu yathanzi. Pankhani ya pneumonitis, mapapo a munthu amawongolera, omwe angapangitse kupuma kukhala kovuta.
Chithunzi chachikulu ndi chakuti kulandira immunotherapy ndi wosakhwima, monga thupi ndi mankhwala amagwirira ntchito pamodzi kuti adziwe zoipa (khansa) ndi zomwe ziri zachibadwa ndi zathanzi.
Phunziro la Gawo III la pembrolizumab liripobe. Phunziro lachitatu limatanthauza kuti pembrolizumab idzafaniziridwa motsutsana ndi muyezo wa mankhwala osamalidwa kuti awone momwe izo zikuyendera, ngati ziri bwino kapena ayi.
Nivolumab
Mu phunziro lachitatu, anthu oposa 350 omwe ali ndi mutu wambiri ndi mutu, omwe matenda awo anali atapita mkati mwa miyezi isanu ndi umodzi atalandira mankhwala otchedwa platinum (chemotherapy), anadziwitsidwa kuti alandire nivolumab milungu iwiri iliyonse (kuperekedwa monga kulowetsedwa kudzera mu mitsempha) kapena mankhwala othandiza (methotrexate, docetaxel, kapena cetuximab ).
Zotsatira zinawonetsa kuti anthu omwe adalandira nivolumab ndi omwe adalandira chithandizo choyenera (kupulumuka kwa pakati pa 7.5 ndi miyezi 5.1, mwachindunji).
Kuonjezerapo, chaka chokhacho chinali kupitirira 36 peresenti mu gulu la nivolumab motsutsana ndi 16.6 peresenti mu gulu lachidziwitso. Mwa kuyankhula kwina, kuchuluka kwa chaka chimodzi kwapitirira kuchulukitsa.
Ponena za chitetezo, zotsatira za m'kalasi 3 kapena 4 zinachitika mu 13 peresenti ya gulu la nivolumab motsutsana ndi 35 peresenti ya gulu lachidziwitso. Mu gulu la nivolumab zomwe zimawopsya kwambiri zinali:
- Kutopa
- Nausea
- Rash
- Kuchepetsa kudya
- Kuyabwa
Kawirikawiri, zotsatira zovuta zokhudzana ndi chithokomiro zinali zofala kwambiri mu gulu la nivolumab (7,6 peresenti linapanga hypothyroidism ndi 0.9 peresenti muyezo wothandizira gulu).
Pneumonitis inapezeka mu 2.1 peresenti ya anthu omwe anachitidwa ndi nivolumab, ndipo anthu awiri adafa (imodzi kuchokera ku pneumonitis ndi imodzi kuchokera ku ma kashiamu okwera m'magazi). Munthu mmodzi mu gulu lachidziwitso amafa ndi matenda a mapapu okhudzana ndi chithandizo choperekedwa.
Chochititsa chidwi n'chakuti, mafunso omwe adawonetsa umoyo wa moyo kumapeto kwa phunziro, sanapeze kuchepa kwakukulu kwa moyo pambuyo pa chithandizo ndi nivolumab. Komabe, kuchepa kwakukulu kwa umoyo wa moyo kumadera ambiri (mwachitsanzo, kupweteka, kugwiritsidwa ntchito kwa thupi ndi chikhalidwe, mavuto a maganizo) pambuyo mankhwala ndi chemotherapy.
Mawu Ochokera
Immunotherapy yayamba kale kusintha nkhope ya kansa. Ndizovomerezeka, "zimakhala zomveka," ndipo zimalonjeza.
Kumbukirani kuti, kusamalira khansara ya mutu ndi khosi ndi njira yovuta. Pali zifukwa zambiri zomwe zimapangitsa kuti adziwe momwe dokotala akufuna kuchitira chotupa chanu, monga mbiri yanu ya mankhwala asanamwalire, kaya muli ndi mavuto ena azachipatala, ndi toxicities okhudzana ndi mankhwala ena.
Khalani wothandizira pa matenda a khansa yanu mwa kupeza chidziwitso. Ulendowu ndi wautali komanso wovuta, koma yesetsani kufunafuna chitonthozo ndi chimwemwe panjira.
> Zotsatira:
> Bauml J et al. Pembrolizumab kwa platinum- ndi khansa ya mutu ndi khansi yotsutsana ndi izi: Zotsatira kuchokera ku mkono umodzi, kuphunzira gawo lachiwiri. J Clin Oncol . 2017 May 10; 35 (14): 1542-49.
> Brockstein BE, Vokes E. Kuchiza khansa ya mutu ndi ya m'kati ya mthupi. Mu: UpToDate, Posner MR (Ed), UpToDate, Waltham, MA.
> Economopoulou P, Perisanidis C, Giotakis EI, Psyrri A. Kutuluka kwa thupi la thupi ndi khosi squamous cell carcinoma (HNSCC): anti-tumor immunity and applications. Ann Transl Med. 2016 May; 4 (9): 173.
> Ferris RL et al. Nivolumab kawirikawiri squamous-cell carcinoma ya mutu ndi khosi. N Engl J Med . 2016 Nov 10; 375 (19): 1856-67.
> National Cancer Institute. (2017). Mutu ndi Khansa ya Khanda. Health Professional Version: Kafukufuku.