Mankhwala osangalatsa kwa omwe ali ndi khansa ya m'mapapo yapamwamba
Ngakhale chemotherapy zolinga zamaselo monga maselo a khansa omwe akugawanika mofulumira m'thupi, imagwiritsira ntchito chitetezo cha mthupi cha munthu, kulimbikitsa kuti lizindikire ndi kulimbana ndi maselo a khansa yokha. Mwa kuyankhula kwina, kumathandiza kuti munthu agwiritse ntchito chida chake chabwino kwambiri (thanzi lawo la chitetezo chakumadzi) kuti athetse khansa.
Kwa anthu omwe ali ndi khansara yapamwamba yopanda maselo (NSCLC), uthenga wabwino ndi wakuti ma immunotherapies amodzi akhala akupitilizidwa ndi asayansi.
Mankhwalawa, ndithudi, samachiza kansa yapakhungu yamapiko, koma akhoza kukuthandizani kapena wokondedwa wanu kumverera bwino ndikukhala ndi moyo wautali.
Matenda a khansa ya m'mimba
Musanayambe kugwiritsira ntchito mankhwala opatsirana pogwiritsa ntchito chithandizo chapamwamba cha NSCLC, nkofunika kufotokozera mawu pang'ono okhudzana ndi khansa ya m'mapapo.
Kodi Nkhumba Yopanda Kulimbana ndi Cell (NSCLC) ndi chiyani?
Pali mitundu iwiri ya khansa ya m'mapapo : Khansa yaing'ono ya mapapu ya khansa ndi khansara yaing'ono yamapapu ya m'mapapo, omwe alibe khungu kakang'ono kwambiri. Ndipotu, pafupifupi 80 mpaka 85 peresenti ya khansa ya m'mapapo ndi khansa yaing'ono ya mapapo.
Mukamva mawu akuti "khansa ya m'mapapo" amagwiritsidwa ntchito, munthu nthawi zambiri amagwiritsa ntchito khansa ya m'mapapo yopanda mapapo, ngakhale kuti izi siziri zoona nthawi zonse.
Kodi Nthendayi Yopanda Kulimbana ndi Nkhumba (NSCLC) Yotani?
Mu khansara ya m'mapapo ya m'mapapo, maselo oopsa (khansa) amakula mofulumira komanso mosasinthasintha kuti apange chotupa m'mimba mwa mapapo. Pamene khansayo ikukula, ikhoza kuyamba kufalikira ku maselo am'mimba, komanso kumalo akutali mkati mwa thupi monga ubongo, mafupa, chiwindi, kapena mapapo ena.
Malingana ndi mayesero angapo (mwachitsanzo, chidziwitso cha zithupsa ndi zojambula zojambula ngati CT scan), siteji ya NSCLC imatsimikiziridwa. Zakale zapamwamba NSCLC nthawi zambiri imatchula kanjira ya IIIb kapena kansa ya kanayi ya IV , zomwe zikutanthawuza kuti khansara yafalikira ku maselo enaake ndi / kapena malo akutali (otchedwa metastasis ).
Kodi Ndondomeko Zotani Zomwe Zimatetezedwa?
Pofuna kumvetsetsa kuti munthu ali ndi kachilombo ka HIV, nkofunika kumvetsa lingaliro la momwe zidziwitso za mthupi zimatetezera, monga izi ndi mamolekyu amene khansa ya m'mapapo imayambitsa matenda a khansa.
Ma chitetezo a chitetezo cha m'mthupi amapezeka pamaselo aumunthu a munthu, ndipo amachititsa kuti chitetezo cha mthupi chiteteze ma maselo abwino, achilendo, maselo achilendo, osadziwika (monga maselo omwe ali ndi kachilombo).
Komabe khansa ndi yodetsa nkhaŵa chifukwa njira imodzi yomwe imapeŵera kumenyedwa ndi chitetezo cha munthu ndi kupanga ndi kufotokoza mapuloteni oterewa. Koma khansa yotchedwa immunotherapies imayesetsa kupewa ma checkpoints kuti thupi lizindikire kuti khansara ndi yachilendo ndipo imayambitsa chiwonongeko.
Immunotherapy kwa Khansa Yam'mimba: PD-1 Antibody
Chimodzi mwa machitidwe a chitetezo cha chitetezo cha mthupi omwe amachitidwa ndi NSCLC immunotherapies ndi imfa 1 (PD-1), yomwe imapezeka pa maselo T koma imatha kupangidwa ndi kufotokozedwa ndi maselo a kansa yamapapo.
Kawirikawiri, mawonekedwe a chitetezo cha chitetezo cha mthupi amafika pa malo a chifuwa cha m'mapapo, kotero chitetezo cha mthupi chimapewa kumenyana ndi khansa. Koma ndi mankhwala omwe amaletsa PD-1, chitetezo cha mthupi chingayankhe ndikuukira maselo a khansa.
Pakalipano pali mankhwala awiri omwe ali PD-1 antibodies (kapena PD-1 checkpoint inhibitors), ndipo ali a FDA omwe amavomerezedwa kuti athetse NSCLC.
Mankhwalawa onse amaperekedwa monga infusions (kupyolera mu mitsempha) masabata awiri kapena atatu. Mankhwalawa ndi awa:
- Nivolumab
- Pembrolizumab
Chidule cha Nivolumab
Monga PD-1 antibody, nivolumab yawerengedwa m'mayesero angapo kwa anthu omwe ali ndi NSCLC. Mwachitsanzo, gawo limodzi la magawo atatu la 2015 la New England Journal of Medicine linagwirizanitsa mankhwala ndi nivolumab motsutsana ndi mankhwala ndi docetaxel mwa anthu omwe NSCLC yawo yapamwamba idapita patsogolo kapena pambuyo pake pokhala ndi dipatimamu ya chemotherapy regimen. Zotsatira zimasonyeza kuti omwe analandira nivolumab akhala ndi moyo nthawi yaitali kuposa omwe adalandira docetaxel-kupulumuka kwa miyezi 9.2 mu gulu la nivolumab motsatira miyezi 6 mu gulu la docetaxel.
Monga mbali, Taxotere (docetaxel) ndi mankhwala a chemotherapy omwe amaperekedwa kwa anthu omwe athandizidwa kale ndi NSCLC, kotero phunziro ili likufanizira chithunzithunzi cha immunotherapy pamtundu wamakono wa mankhwala ochizira.
Kuphatikiza pa phindu lopulumuka, nivolumab inkaonedwa kuti ndi yotetezeka kusiyana ndi docetaxel mu phunziroli-zomwe ziri zabwino, chifukwa chodetsa nkhaŵa kwambiri ndi ma immunotherapies ndikuti chitetezo cha munthu chidzaukira osati kokha maselo a khansa koma ziwalo zathanzi.
Chimodzi mwa mavuto aakulu omwe madokotala amadandaula nawo ndi khansa ya mankhwala ndi pneumonitis, yomwe ndi pamene mankhwala amachititsa kuti kutupa kutentha (osati matenda, omwe mukuwona ndi chibayo). Madokotala amakayikira kwambiri za pneumonitis chifukwa zimakhudza mapapu, zomwe zatha kale mu khansa ya m'mapapo. Mu phunziro ili, pneumonitis inayamba nthawi zambiri mu gulu la nivolumab ndipo inali yochepa kwambiri pamene iyo inkachitika.
Izi zinati, zotsatira zina zoipa (kupatulapo pneumonitis) zogwirizana ndi nivolumab zomwe madokotala amaziyang'ana monga:
- Matenda a khungu (mwachitsanzo, kuthamanga ndi kuyabwa)
- Matenda a m'mimba (mwachitsanzo, kutsegula m'mimba)
- Zosazolowereka zimayesedwa magazi a enzyme
- Matenda a chithokomiro
- Zotsatira zokhudza kulowetsedwa
Chidule cha Pembrolizumab
Pembrolizumab ndi FDA yovomerezeka kuti ichite NSCLC yapamwamba kwa anthu omwe alibe chibadwa chosabadwa cha kansa yawo yamapapu ( kusintha kwa EGFR kapena translocation ALK ) ndipo amene pafupifupi theka la maselo awo amtunduwu ali ndi mwayi kwa PD-L1. PD-L1 ndi mapuloteni omwe amamangiriza PD-1 pa maselo T, kuwaletsa kuti asawononge maselo a khansa.
Pembrolizumab yavomerezedwa kuti ichite NSCLC ( lung adenocarcinoma ) yophatikizapo limodzi ndi chemotherapy, mosasamala kanthu kuti maselo otupa amawononga PD-L1.
Mu phunziro la 2016 ku New England Journal of Medicine , anthu omwe ali ndi mawu apamwamba a NSCLC ndi PD-L1 pafupifupi 50 peresenti ya maselo awo otupa amakhala ndi kupulumuka kwapadera kwa nthawi yaitali (10.3 miyezi kupitirira miyezi 6) popanda zovuta zochepa ( otetezeka) kusiyana ndi anthu omwe anali ndi chikhalidwe cha mankhwala a platinum .
Mwachindunji, kupulumuka kwapanda pang'onopang'ono kunatanthauzidwa ngati nthawi imene odwala anali atapangidwanso kuti adzalandire pembrolizumab kapena chemotherapy, panthawi yomwe matenda awo adayendayenda kapena kufa.
Mu phunziroli, zotsatira zoopsa kwambiri zinapezeka mu 27 peresenti ya anthu omwe amalandira pembrolizumab poyerekeza ndi 53 peresenti ya omwe amalandira mankhwala a chemotherapy.
Kwachidziwikire, zotsatira zowononga kwambiri kwa omwe akudwala ndi pembrolizumab anali:
- Kutsekula m'mimba
- Kutopa
- Fever
Pneumonitis inapezeka mu gulu la pembrolizumab pamlingo wapamwamba kusiyana ndi mankhwala a chemotherapy (5,8 peresenti poyerekeza ndi 0.7 peresenti).
Immunotherapy kwa Khansa Yam'mimba: PD-L1 Antibody
Atezolizumab ndi mankhwala a FDA omwe amavomerezedwa kuti athetse anthu a NSCLC omwe matenda awo akupitirizabe kuwonjezereka panthawi yomwe akudwala mankhwala a platinum kapena atatha mankhwalawa .
Atezolizumab ndi yosiyana kwambiri ndi nivolumab kapena pembrolizumab chifukwa ndi anti-PD-L1. Mwachilankhulo china, zimalowera PD-L1, mapuloteni omwe amamangiriza PD-1 (a receptor T cells), kuwaletsa kuti asagwidwe ndi maselo a khansa. Monga mankhwala ena awiri, atezolizumab amaperekedwa ngati kulowetsedwa.
Mu kafukufuku wa 2017 ku Lancet, anthu omwe adalandira kale mankhwala a dipatimamu a chemotherapy a NSCLC apamwamba adasankhidwa kuti adzalandire atezolizumab kapena docetaxel.
Zotsatira zina zomveka zasonyeza kuti anthu omwe adalandira dietzolizumab ndi docetaxel, ngakhale kuti maselo otupa kapena maselo a chitetezo m'thupi mwawo anali abwino kwa PD-L1 (pakati pa miyezi 13.8 ndi atezolizumab ndi 9.6 miyezi ndi docetaxel ).
Kuphatikizansopo, zotsatira zoopsa zokhudzana ndi chithandizo zinawonetsedwa m'magulu a atezolizumab, poyerekeza ndi gulu la docetaxel (15 peresenti peresenti 43 peresenti).
Izi zati, zotsatira zofala kwambiri zomwe anthu omwe amalandira atezolizumab anali:
- Kutopa
- Nausea
- Kuchepetsa kudya
- Kufooka
Pneumonitis inapezeka pa 1.6 peresenti ya odwala m'magulu a atezolizumab, omwe ali otsika, ndipo osachepera 1 peresenti anali ndi matenda aakulu (a 3 kapena 4) a pneumonitis.
Immunotherapies pa Horizon
Ndikofunika kuzindikira kuti pali ziwalo zina zambiri zomwe zimayambitsa matenda a immune. Chinsinsi chodziwitsa udindo wawo pakuchiza iwe kapena khansa ya m'mapapo yapakhungu ikufotokozedwa bwino momwe mankhwalawa amachitira mu maphunziro a gawo lachitatu.
Mwachitsanzo, imodzi mwa imayipi yotchedwa ipilimumab yapezeka kuti ipitirize kupulumuka kwa anthu omwe ali ndi khansa yotchedwa metastatic melanoma . Mankhwalawa amachititsa kuti tizilombo ta T-lymphocyte antigen 4 (CTLA-4), yomwe ndi yoyang'anira momwe maselo a T amagwirira ntchito m'thupi. Ipilimumab ikuwerengedwa ngati chithandizo cha NSCLC yapamwamba kuphatikizapo chemotherapy.
Mawu Ochokera
Sizodabwitsa kuti khansa zina (monga kansa ya m'mapapo) sizingangokulirakulira koma mosalekeza koma zimatha kupeweratu, kutanthauza, chitetezo cha mthupi.
Izi zinati, akatswiri a khansa tsopano akutsogoleredwa ndi kutulukira kwa immunotherapies-chinthu chosinthika chomwe chidzapitiriza kusintha momwe timachitira khansa m'tsogolomu.
Pamapeto pake, kudziwa momwe mungaperekere kansa yanu yamapapu ndi yovuta komanso yokhometsa msonkho, ndipo nthawi zina, mankhwala ambiri sali yankho lolondola. Chonde onetsetsani kukambirana zofuna zanu, mantha anu, ndi nkhawa zanu ndi banja lanu ndi dokotala.
> Zotsatira:
> American Cancer Society. (2017). Immunotherapy kwa Khansa Yachilombo Yopanda Kulowetsa.
> Gettinger S. (June 2017). Kachilombo ka kansa kamene kali kochepa kamene kali ndi kansalu koyambitsa chitetezo cha m'thupi. Mu: UpToDate, Jett JR, Lilenbaum RC, S SEld (Eds), UpToDate, Waltham, MA.
> Reck M et al. Pembrolizumab motsutsana ndi chemotherapy kwa PD-L1 Kachilombo kochepa kamene kamakhala kosalekeza. N Engl J Med . 2016 Nov 10; 375 (19): 1823-33.
> Rittmeyer A et al. Atezolizumab motsutsana ndi docetaxel kwa odwala omwe ali ndi khansa yapakhungu yopanda mapira (OAK): gawo lachitatu, lotseguka, mayesero ochuluka omwe amachitidwa mosavuta. Lancet . 2017 Jan 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. Nivolumab ku NSCLC: zowonjezera zowonjezera komanso zowonjezera. Adv Med Med . 2015 Mar; 7 (2): 85-96.