Kuzindikira ndi Kuyesera kwa HER2 Posachedwapa Khansa ya M'bwere

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

Mitundu ya kuyesedwa, kulondola, ndi kusintha kwa kuyesa kwa HER2

Ngati mwakhala ndi chiopsezo kapena opaleshoni ya khansa ya m'mawere mumamva kuti chotupa chanu chiri HER2 chabwino kapena choipa. Ngati simunamvepo, muyenera kufunsa wanu oncologist za zotsatira za mayesowa. Ndikofunika kumvetsa kuyesa kwa HER2 ndi zotsatira, ngakhale ngati chotupa chanu chiri HER2 cholakwika.

Maziko a HER2 + Khansa

Mapuloteni a HER2 amapezeka pamwamba pa maselo a m'mawere, kaya ndi khansa kapena yachibadwa.

A gene (ndi HER2 kapena ERBB2 gene) tonsefe timanyamula malangizo kapena mapulani kuti tipange mapuloteniwa. Selo lirilonse liri ndi makope awiri a jini. Ngati pali zowonjezera za jiniyi (HER2 amplification) zotsatira zake ndi chiwerengero chowonjezeka cha mapepala a HER2 pamwamba pa selo la m'mawere (HER2). Ngakhale maselo a m'mawere amatha pafupifupi mamiliyoni awiri a mapepala ameneŵa, maselo a kansa ya mawere a HER2 abwino amakhala oposa 100 ambiri.

Mwachidule, pamene thupi likukula kuzipatala zowonjezera, zimasonyeza kuti selo ligawidwe ndipo limatulutsa kukula kwa maselo a m'mawere omwe timatcha khansa.

Pafupifupi 25 peresenti ya anthu omwe ali ndi khansa ya m'mawere adzakhala HER2 abwino. M'mbuyomu, kukhala HER2 zabwino kunkagwirizanitsidwa ndi matenda osayenera. Tsopano kuti tadwala mankhwala (monga Herceptin (trastuzumab) ) omwe alipo, omwe angasokoneze mapepala awa, zomwe zimatengera khansa ya m'mawere ya HER2 ndi bwino kwambiri.

Kufunika Koyesedwa

Ndikofunika kukhala ndi zotsatira zolondola za HER2 kuti mulandire njira zabwino zothandizira khansa yabwino ya HIV . Izi zimaphatikizapo mwayi wa mankhwala ochiritsidwa monga Herceptin (trastuzumab), Perjeta (pertuzumab), Tykerb (lapatinib), ndi Nerlynx (neratinib).

Mitundu ya chemotherapy ya khansa ya m'mawere yomwe imagwira ntchito bwino ingakhalenso yosiyana ndi HER2.

Maonekedwe oyenera a HER2 ndi ofunika kwambiri pakuchipata khansa yabwino ya khansa ya m'mawa . Chitsanzo cha metastases, komanso chithandizo cha malo enieni a metastases, akhoza kusintha mogwirizana ndi udindo wa HER2.

Nthawi Yoyesedwa

Aliyense yemwe ali ndi mtundu uliwonse wa khansa ya m'mawere (inviltive) yowonongeka ayenera kukhala ndi chifuwa chake kuyesedwa kwa HER2. "Khansa yosavuta" ya khansa imatchedwa khansara iliyonse yomwe ilibe malo 0 kapena carcinoma in situ . Zigawo zina zonse za khansa ya m'mawere, kuyambira pa siteji yoyamba kupita ku gawo la IV, ziyenera kuyesedwa pa nthawi ya HER2 panthawi yomwe akudziwiratu komanso asanayambe kulandira chithandizo.

Mitundu ya mayesero

Pali mitundu yosiyanasiyana ya mayeso omwe angachitidwe pa chotupa kuti adziwe ngati ali HER2 zabwino. Izi zikuphatikizapo:

HER2 Immunohistochemistry (IHC) : IHC ndiyeso ya chiŵerengero cha HER2 mapuloteni otengera pamwamba pa maselo a khansa ya m'mawere kapena "HER2"
Kufiira (ISH) : ISH ndiyeso ya kuchuluka kwa makope a HER2 pa selo iliyonse ya khansa ya m'mawere kapena "HER2 kukulitsa." Pali mitundu iwiri yosiyanasiyana ya mayeso a ISH: fluorescence (Nsomba) ndi munda wa ISH.

Pali kutsutsana pazomwe mayesero aliri olondola.

Akatswiri ena amakhulupirira kuti FISH ISH ndi yolondola, koma IHC imachitika ku United States. Popeza kuti derali likusintha mofulumira kwambiri, ndi kofunika kulankhula ndi a oncologist wanu za mayeso omwe mwachita ndi chifukwa chake njirayi ingasankhire.

Zotsatira Zoyesedwa

Malingana ndi malangizo a ASCO / CAP a 2013, ngati mayeso a HER2 akubwera monga malire kapena oyenerera, "kuyembekezera kwa" reflex "kumachitika ndi njira ina. Mwachitsanzo, ngati IHC inapereka zotsatira zowonjezera malire, ISH iyenera kuchitidwa chimodzimodzi, ndipo ngati ISH ndi borderline, iHC iyenera kuchitidwa zisanachitike zotsatirazo.

Nthawi zina zotsatira za mayesero osiyanasiyana a HER, mwachitsanzo, HCI ndi FISH ISH zidzakhala malire, osadalirika, kapena osagwirizana. Panopa sitili ndi malamulo omwe angapite ngati zili choncho, ndipo inu ndi a oncologist mukufunika kukambirana momwe mungapitirire.

Kuyesera Zofooka

Kuphatikiza pa kukhala ndi zotsatira zoyezetsa zomwe si zabwino kapena zoipa koma mmalo mwake kapena mosiyana, palinso zolephera zina mwa kuyezetsa kwake. Izi zikuphatikizapo:

Zolakwika: Ndi mtundu uliwonse wa mayeso a labotale nthawi zonse amakhala ndi vuto la zolakwika.
Kulephera kubwereza mayesero ngati zotsatira zake ndi malire, osadalirika, kapena osagwirizana: Ngati mayeso ayambiranso ngati malire, ayenera kubwerezedwa.
Chizindikiro: Lingaliro la kupweteka kwa chiphuphu ndilolondola komanso lingasokoneze. Popeza maselo a khansa amakhala osasintha, pangakhale ziwalo zina zomwe zimayesa HER2 zabwino ndi ziwalo zina zomwe zimayesa HER2 zoipa. Izi ndizomveka kumvetsetsa pamene tikuzindikira kuti mitundu yosiyanasiyana ya chotupa ikhoza kukhala ndi mitundu yosiyanasiyana ya selo pansi pa microscope.
Sintha: Mamimba amatha kusintha mtundu wina wa HER2.

Kusintha kwa HER2 Mkhalidwe

Timakonda kuganizira za khansa monga chigwirizano cha selo limodzi losauka lomwe maselo onse ali ofanana, koma izi siziri choncho. Tikudziwa kuti maselo a khansa akupitiriza kusintha kusintha kwatsopano. Mbali zosiyana za chotupa chimodzi chingakhale ndi maselo a khansa omwe ali ndi makhalidwe osiyanasiyana (chithokomiro chogwirizanitsa) ndipo kusintha kumeneku kungakhale koonekera kwambiri pamene chotupa chikupitirira, monga kubwereza kapena matenda opatsirana.

Sikuti ndi HER2 yokha yomwe ingasinthe. Ethorogen receptor (ER) ndi progesterone receptor (PR) chikhalidwe chingasinthe pamene chotupa chimayambiranso kapena chiwonetseratu, ndipo kusintha kumeneku mu malo ovomerezeka kumatchedwanso "kusagwirizana." Chotupa chingasinthe chifukwa chokhala ndi chitsimikiziro choipa cha imodzi mwa mapulogalamuwa, kapena, mosiyana, kuchoka ku cholakwika.

Kodi zotupa zimasintha kangati? Mpata wosagwirizana pakati pa chotupa choyambirira ndi mitsempha yoyamba kapena yachiwiri (mwina kuchokera ku chithunzi cholakwika kapena kuchokera ku zabwino mpaka choipa) ndi izi:

ER: 20.7 peresenti
PR: 40.7 peresenti
HER2: 19.6 peresenti

Mu phunziro ili, pafupifupi 20 peresenti ya zotupa zinasintha chikhalidwe kuchokera kwa HER2 zabwino kuti zikhale zoipa kapena zoipa. Kudziwa ngati chotupa chasintha ndi chofunikira kwambiri posankha njira zabwino zothandizira,

Kodi ndi zabwino kapena zoipa ngati mkhalidwe wa reception HER2 ukusintha? Malingana ngati kusintha kukupezeka (poyesa kubwereza) kotero kuti njira zabwino zothandizira zikhoza kulangizidwa, sizikuwoneka kuti kusintha kwa malo ovomerezeka kumawathandiza kwambiri. Mu zotupa zaphunziro izi zomwe zinali zosagwirizana ndi HER2 (zosinthidwa kuti zikhale zabwino kapena zoipa) zinali zofananako zofanana ndi zotupa zomwe sizinasinthe udindo wa HER2.

Phunziroli linapeza kusagwirizana pakati pa metastase yoyamba ndi mitsempha yoyamba kapena yachiwiri, koma kusagwirizana kumachitika pakati pa masewera oyambirira ndi achiwiri.

Bwerezaninso kuyesedwa

Kuphatikiza pa kuyesera kwa HER2 komwe kuli koyenera kuchitidwa kwa aliyense pa nthawi yowunika, pali nthawi yomwe mayeso amayenera kubwerezedwa. Izi zikuphatikizapo:

Pa nthawi yobwereza , kaya ndi chigawo chapafupi, chigawo, kapena chikhalidwe.
Ngati khansara ya m'mawere ikufalikira komanso ndi masewasesedwe atsopano.
Ngati inu ndi oncologist mukuwona kuti mayeso a HER2 omwe mwakhala mukuwachita sali olondola monga mayesero atsopano.

Kusokoneza maganizo

Kodi chimachitika nchiyani ngati malo anu a HER2 sakuzindikira? Ngati chotupa chanu chiridi HER2 chotsimikizika koma mutapeza zotsatira zolakwika za HER2, simungalandire chithandizo chamankhwala. Komabe, ngati chikhalidwe chanu cha HER2 sichinali choipa koma mutapeza zotsatira zabwino za HER2, mumayesetsa kuwonetsa zotsatira za mankhwala ochiritsidwa ndi HER2 popanda phindu (ngakhale kuti anthu ena omwe ali ndi vuto la HER2 ali ndi zotupa zomwe zavomera izi zochiritsidwa).

Mawu Ochokera

Kuyeza kwa HER2, pamodzi ndi mayeso a estrogen ndi progesterone receptor, ziyenera kuchitidwa pazirombo zonse zapakati pa stage (stage I kupita ku stage IV) panthawi yomwe akudziwiratu ndipo musanayambe kuchiritsidwa (nthawi zina kupatulapo opaleshoni).

Kuyesera kuyeneranso kubwerezedwa ngati mutakhala ndi mayeso omwe adabwereranso ngati indeterminate, ngati a oncologist akuwona mayesero osiyanasiyana ndi olondola, kapena khansara yanu ikafalikira kapena ikufalikira. Maonekedwe a HER2 a chotupa akhoza kusintha pakapita nthawi, ngakhale m'madera osiyanasiyana a chotupa chimodzi.

Kukhala ndi chikhalidwe choyenera cha HER2 ndi chofunikira posankha njira zabwino zothandizira khansa yanu pothandizira kuti zotsatira za mankhwala zisawonongeke. Pali kutsutsana pa mayesero abwino a HER2, ndipo mayesero atsopano ndi osinthidwa akuyesedwa lero. Izi zikutanthawuza kuti ndikofunika kufunsa mafunso ndikukhala wovomerezeka pa kansa yanu.

> Zotsatira:

> American Society of Clinical Oncology. Chitani ndi Zitsogozo. Khansa ya m'mawere. Zolinga za Kukula kwa Edzi Kukula kwa Edzi M'mimba Kuyezetsa 2 Kuyezetsa Khansa ya M'thupi. http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9751

> Lim, T., Lim, A., Thike, A., Tien, S., ndi P Tan. Malingaliro a Maphunziro a American American Society of Clinical Oncology / College of American Pathologists Malangizo Othandizira pa Kugonjetsedwa kwa Anthu Edzi Edzi Kugwiritsa Ntchito Immunohistochemistry ndi Fluorescence Pachikhalidwe Chotsitsa Khansa ya M'thupi. Archives of Pathology ndi Lab Medicine . 2016. 140 (2): 140-7.

> Lower, E., Khan, S., Kennedy, D., ndi R. Baughman. Kutayika kwa Mlandizi wa Estrogen ndi HER-2 / neu mu Khansara Yamatumbo Kuchokera Pachilombo Chachikulu kufika ku Malo Oyambirira ndi Achiwiri Achimake. Khansa ya m'mawere (Medical Dove Press) . 2017. 5: 515-520.