Immunotherapy ikuthandizira kuthetsa matenda, makamaka matenda omwe ndi ovuta kuchiza. Ndi khansa ya immunotherapy , chitetezo cha mthupi chimayesedwa kuti chilimbana ndi zotupa m'njira zatsopano. Njira zowonongeka za thupi zimatha kupangitsa chitetezo cha mthupi kuteteza thupi lanu kapena kupatsa chitetezo cha m'thupi ndi mapuloteni opangira thupi, kapena kuti ma antigen , kuti chitetezo cha mthupi chitetezeke pamatenda.
Katemera wothandizira khansa ndi mawonekedwe a immunotherapy ogwiritsidwa ntchito pochiza khansa yomwe ilipo kale. Kawirikawiri, katemera wothandizira khansa ndi biologics, kapena biopharmaceuticals. Zamoyo zina zimaphatikizapo zigawo zikuluzikulu za magazi, mankhwala opatsirana, majeremusi, ndi zina.
Pakalipano, katemera wokhawokha omwe FDA amavomereza umatchedwa "Provenge" kuti uchite khansa ya prostate .
Katemera Wopereka Khansa
Antigeni ndi zinthu zomwe zimayambitsa machitidwe a chitetezo cha mthupi. Amankhwala ambiri opatsirana khansa mu chitukuko amapereka ma antigen omwe amagwiritsidwa ntchito ndi khansa ku maselo osakaniza. Maselo oterewa ndi maselo osamadzimadzi omwe amapezeka mwachindunji pa jekeseni (dermis) ndikupanga antigen. Kuwonjezera apo, ma molekyulu am'thupi amapezeka mu katemera wodwalayo, kapena kuti apangidwe, ma molekyulu omwe amafunika kuti agwirizane ndi maselo a T. Zindikirani, ma antigen omwe amagwiritsidwa ntchito ndi khansa akhoza kukhala enieni kapena mtundu umodzi wa khansara kapena gulu la khansa zingapo.
Maselo opangidwa ndi dendritic ameneŵa amasamukira ku ma lymph node, omwe amakhala ochepa kwambiri a minofu yomwe imapezeka m'thupi lonse. Pamene maselo opangidwa ndi dendriticwa amachititsa kuti maselo a mitsempha ayambe kudwala, amachititsa kuti maselo a T cell azikhala ndi khansa. Maselo opatsirana a T omwe amayenda mu thupi lonse ndikuwongolera maselo a khansa omwe ali ndi antigen ndi lyse, kapena akutha, kansalu ya khansa.
(Mwachidziwitso, ma CD4 + T opangidwa ndi maselo amachititsa ma cytokines omwe amachititsa kusasitsa kwa maselo a CD 8, omwe atatha kusasitsa thupi lonse.
Malinga ndi a FDA, katemera ambiri omwe ali ndi chithandizo pakadali pano akugwiritsa ntchito mabakiteriya, mavairasi, kapena yisiti monga magalimoto, kapena vector , kutumiza antigen. Mabakiteriya, mavairasi, yisiti ndi zina zotero zimakhala zozizwitsa komanso zimachititsa kuti thupi lawo lisamadziwe; Komabe, amasinthidwa kuti asayambitse matenda.
Momwemonso, katemera wothandizira khansa angapangidwe pogwiritsira ntchito DNA kapena RNA code kwa antigen. Izi zowonongeka zimaphatikizidwa mu maselo omwe amabala ma antigen. Chiyembekezo ndi chakuti maselo ena a thupi osinthidwa amatha kubereka ma antitigeni okhudzana ndi khansara kuti apange mphamvu yowononga chitetezo cha mthupi kuti aphe maselo otupa.
Potsirizira pake, ziyenera zitatu kuti ziwonongeke kuti maselo a chotupa awonongeke ndi katemera:
- maselo ambiri okhudzana ndi chitetezo cha mthupi ndi ovomerezeka ndi maselo a kansa ayenera kupanga
- maselo a T ameneŵa ayenera kulowa mkati mwa chotupacho
- maselo a T amenewa ayenera kuyamba kugwira ntchito pamalo otupa kuti awononge malo omwe akukhalapo
Kodi Katemera Wathandi Amathandiza Bwanji?
Pazaka zingapo zapitazo, mazana ambiri a katemera (dendritic-cell) katemera ayesedwa.
Komabe, kuchuluka kwa ma katemerawa ndi otsika kwambiri-pafupifupi 2,6 peresenti. Ndipotu, mitundu ina ya immunotherapy yatsimikizirika kukhala yothandiza kwambiri, yomwe yakhudza akatswiri ambiri kuti azikayikira katemera wathu wodwalayo "obsession".
Kotero ngati katemera odwala katemera sakhala ogwira ntchito kwambiri kwa anthu, n'chifukwa chiyani tikupitirizabe kugulitsa ndalama ndi nthawi kuti tizilombo toyambitsa khansa? Pali zifukwa zosachepera zitatu zomwe zikufotokozera chidwi chathu mwa njirayi.
Choyamba, katemera wakhala akugwira ntchito popewera khansa, ndipo izi zakhala zikupitirira kuchiza khansa ndi katemera.
Mwa kuyankhula kwina, ntchito yomwe tapanga kukhala ndi katemera yoteteza matenda a khansa yatiphunzitsa zambiri za momwe thupi limayendera matenda a khansa ndipo yakhala ikutsogolera chithandizo cha chithandizo cha khansa. Pakalipano pali katemera awiri omwe amapewa khansa: katemera wa chiwindi cha hepatitis B chimateteza khansa ya chiwindi, ndipo katemera wa munthu wa papillomavirus (HPV) amaletsa khosi, chiberekero, anal ndi khansa zina.
Chachiwiri, katemera wodwala katemera ndi osavuta kupereka ndipo amachititsa mavuto pang'ono.
Chachitatu, ochita kafukufuku nthawi zambiri amayesetsa kutanthauzira zotsatira za mayesero okhudzana ndi khansa ya katemera, yomwe imayambitsa matendawa. Mwachindunji, ofufuza amayamba kuganizira za matupi ake osasintha, kapena maselo, kusintha kwa thupi ndi ma lymphocyte (T cell) kulowa m'mimba m'malo moganizira kusintha kwenikweni : kuchepetsa kukula kwa chifuwa kapena kusintha kwa zizindikiro za matenda.
Kuwonjezera apo, ofufuza akuluakulu akuyesa katemera wa khansa nthawi zambiri amagwiritsa ntchito mafotokozedwe olakwika ndi mawu omwe amasonyeza zotsatira, monga "zizindikiro zimatha," "kukula kwa kanthawi kochepa," "tumor necrosis" komanso "kupulumuka kwadzidzidzi kwa nthawi yaitali." Popanda tsatanetsatane, mawuwa amatanthauza pang'ono.
Pazinthu zowonjezereka, kafukufuku wochuluka wa katemera wagwiritsidwa ntchito pazikulu za sayansi ya zachipatala pogwiritsa ntchito zitsanzo za zinyama. Ntchentche, monga momwe zingathekere kuchokera ku kukula kwake, makhalidwe ndi maonekedwe aubweya, ndi osiyana ndi anthu. Motero, kupambana kulikonse komwe timawawona pochiza nyamazi ndi katemera wodwala katemera sikutanthauzira kwa anthu.
Zowonjezera, ngakhale kuti katemera wa khansara watsimikiziridwa kukhala wothandiza pa zinyama, ndizosatheka kupeza zotsatira zoterozo mwa anthu. Mwachindunji, pali kokha kamodzi katemera ka mankhwala omwe amavomerezedwa ndi FDA pofuna kuchiza khansara mwa anthu: Perekani. Komabe, pali katemera wina wa khansa ya prostate yomwe ili mu mayesero a Phase 3 omwe atsimikiziridwa kukhala othandiza: Prostvac.
Tisanayang'ane pa Provenge ndi Prostac, tiyeni tizitsuka pang'ono podziwa kwathu khansa ya prostate .
Kansa ya Prostate
Kupatula khansara ya khungu, kansa ya prostate ndiyo khansa yowopsa kwambiri yomwe imakhudza amuna a ku America. Ngakhale kuti pafupifupi amodzi mwa amuna asanu ndi awiri a ku America amapanga kansa ya prostate, amafa ndi matenda (pafupifupi 1 mwa 39). M'malo mwake, amuna amafa ndi matenda ena poyamba, monga matenda a mtima. Komabe, mu 2016, panali anthu 26,120 omwe anafa ndi khansa ya prostate.
Chifukwa cha kuyesa kwa prostate-specific (PSA) antigen, chidziwitso cha khansa ya prostate, tatha kuzindikira kansa ya prostate poyamba, pamene khansayo imangokhala ku prostate, Kawirikawiri, amuna ali ndi khansa ya prostate zomwe zasintha kapena zimafalitsidwa mafupa ndipo zimakhala zakupha.
Zinthu zomwe zimachulukitsa chiopsezo cha khansa ya prostate ndizolamba, azungu wa ku America ndi mbiri ya banja.
Anthu ambiri omwe ali ndi kansa ya prostate safuna thandizo la mankhwala ndipo m'malo mwake amawonedwa ndi madokotala awo. Chithandizo cha kansa ya prostate chingaphatikizepo kuyang'anira (kuyang'anitsitsa), opaleshoni (prostatectomy kapena kuchotsa prostate), radiotherapy ndi androgen, kapena mahomoni ogonana, kunyansidwa.
Perekani
Kupatsa kapena kupopera mankhwalawa-T ndi katemera wa maselo a dendritic omwe adavomerezedwa ndi FDA mu 2010. Chopereka ndi chomwe chimadziwika kuti autologous cell immunotherapy ndipo chimagwiritsidwa ntchito pochiza matenda omwe sali kufalikirabe (pang'ono). Komanso, Perekani khansa ya prostate yomwe imakhala yosamalitsa mahomoni (hormone refractory).
Zotsatira zina, mahomoni amatsenga khansa amayankha mankhwala osokoneza mahomoni, kapena mankhwala osokoneza bongo ndi orrogens, kapena mahomoni ogonana (kuganiza zachipatala).
Kupereka kumakonzedwa pogwiritsa ntchito maselo oyera a magazi (pulogalamu ya magazi mononuclear cells) ndi puloteni yotchedwa granulocyte-macrophage-colony-stimulating factor (GM-CSF) ndi prostatic acid phosphatase, kapena PAP, khansa ya prostate ya antigen.
Chifukwa chomwe GM-CSF imaperekera ndi antigen PAP ndichifukwa chakuti ochita kafukufuku amakhulupirira kuti GM-CSF imathandizira kuwonetsera kwa antigen. Dziwani kuti, magazi omwe amapezeka m'magazi amatha kukhala ngati maselo a dendritic omwe antigen akuwonekera.
Mwamwayi, Chidziwitso chimapatsa moyo kwa miyezi inayi yokha. Komabe, nthawi ino ikhoza kulola munthu kuti azichita zinthu zake mwadongosolo ndikukhala ndi nthawi yayitali ndi banja lake.
Zotsatira zoipa zazinthu ndizo zotsatirazi:
- malungo
- zovuta
- kutopa
- ululu wammbuyo
- mutu
Pakati pa zochitika zachipatala za Provenge, amuna ochepa adakumana ndi mavuto aakulu kuphatikizapo kupuma kupuma, kupweteka pachifuwa, kupweteka kwa mtima, kutengeka kwa chifuwa komanso kusinthasintha kwa magazi. Choncho, anthu omwe ali ndi vuto la mtima ndi mapapu ayenera kukambirana izi ndi chithandizo chawo chaumoyo.
Prostvac
Njira ya Prostvac imasiyana ndi Mapangidwe.
Prostvac ili ndi pexvirus (fowlpox) vector, prostate-specific antigen (PSA) ndi complex cosmulatory yotchedwa TRICOM. Katemera wa PSA-TRICOM amachititsa maselo a antigen-presenting akuwachititsa kufotokoza mapuloteni a prostate-specific antigen pamwamba pawo. Maselo a antigen omwewa amapezeka pamaselo a T ndipo amawaphunzitsa kuti awononge maselo a khansa ya prostate.
Mayankho a Prostvac Phase 2 anaphatikizapo anthu 82 omwe 42 analandira Prostvac. Prostvac anatambasula moyo mu gulu loyesera ndi mtengo wapakati wa miyezi 8.5. Pakalipano, Prostvac ali m'mayesero a matenda a Phase 3, ndipo ochita kafukufuku sakuyesera kutsimikizira kupulumuka kwa mankhwala koma akuyesetsanso kudziwa ngati GM-CSF iyenera kuwonjezeredwa ku katemera.
Pakati pa mayesero a maphunziro a Phase 2, zotsatira za Prostvac zinaphatikizapo zotsatirazi:
- malingaliro a malo ojambulidwa (ululu, kutupa, kufiira ndi zina zotero)
- kutopa
- malungo
- kutupa
- zovuta
- ululu wophatikizapo
- chizungulire
- kunyoza
- kusanza
- kutsekula m'mimba
- kudzimbidwa
Katemera wa khansa ya prostate sikutanthauza kugwiritsidwa ntchito ngati mankhwala oyamba a kansa ya prostate. M'malo mwake, amaperekedwa kuwonjezera pa chemotherapy.
Kodi Imlygic Ndi Chiyani?
Mu 2015, a FDA amavomereza Imlygic, katemera wa oncolytic kuti mankhwala kapena mankhwala oopsa a melanoma omwe sangathe kugwira ntchito. Ngakhale kuti sikuti ali ndi katemera wa chithandizo cha khansa, imlygic ili ndi zotsatira zofanana ndi khansa ya katemera.
Tizilombo toyambitsa matenda ndi mtundu wa immunotherapy komwe tizilombo toyambitsa matenda timayambira mwachindunji mu tumatu tomwe timayambitsa matenda a melanoma ndi lyses kapena timaphwanya maselo otupa. Kuwonjezera pa kuphwanya maselo, mavairasiwa amakhala ndi zotsatira zowonjezereka zomwe zimapangitsa kuti antitumor athandizidwe mofanana ndi katemera wa antiticancer.
Katemera wodwala katemera ndi ine
Pakalipano, kugwiritsa ntchito katemera wa khansa m'makonzedwe a chipatala ndi ochepa. Kuonjezera apo, monga tanenera poyamba, zakhala zovuta kupeza katemera wa khansara zomwe zimakhudza anthu omwe akugwira nawo ntchito. Sitikudziwa kuti tidzawona katemera wa khansa yogwiritsidwa ntchito pochiza khansa zosiyanasiyana posachedwa.
Komabe, katemera wa khansa amaimira kukula kwa chitetezo cha mthupi komanso munda wa immunotherapy. Ndibwino kuti timvetsetse momwe chitetezo cha mthupi chimakhalira, bwino momwe tingagwiritsire ntchito mankhwala othetsera mavuto omwe amatha tsiku lina.
Zotsatira:
Goswami S, Allison JP, Sharma P. Immuno-Oncology. Mu: HM Kantarjian, Wolff RA. eds. Buku la MD Anderson la Oncology Medical, 3e . New York, NY: Hill ya McGraw; 2016. Kufikira pa 19 May, 2016.
Kantoff PW et al. Kufufuza Kwambiri Kwachigawo cha Phase II Yoyesedwa Wowonongeka Poyesa Pogwiritsa Ntchito Poxviral-Based Based PSA-Targeted Immunotherapy mu Matenda a Metastatic Castration-Resistant Prostate Cancer. J Clin Oncol. 2010 Mar 1; 28 (7): 1099-1105.
Pienta KJ. Mutu 96. Khansa ya prostate. Mu: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. eds. Hazzard's Geriatric Medicine ndi Gerontology, 6e . New York, NY: Hill ya McGraw; 2009. Kufikira pa May 22, 2016.
Rosenberg SA, Yang JC Restifo NP. Khansa Immunotherapy: Kusunthira Pambuyo Panthawi Yamakono. Nat Med . 2004 September: 10 (9): 909-915.