Kuzindikira Kuzungulira Maselo Am'matala ndi DNA Yopanda DNA
* Pa June 1, 2016, a FDA adavomereza kuyesa kwachidziwitso kuti azindikire kusintha kwa EGFR kwa anthu omwe ali ndi khansara yopanda mphamvu ya selo. Iyi ndi yoyamba "yoyezetsa magazi" yomwe imavomerezedwa ndikuyesa ndi kuchiza khansa ya m'mapapo.
Kodi chiwombankhanga cha madzi ndi chiyani? Katswiri wanu wamagetsi angakhale atatchula njira yatsopano yopenda khansara yamapapo kapena mwinamwake mwakumva za njirayi pamene mukufufuza kansa yanu pa intaneti.
Kodi ndi njira yanji yomwe, yomwe ingakhoze kuchitidwa liti, ubwino ndi zovuta ndi ziti, ndipo kodi tikupita kuti?
Kodi Zamadzimadzi Zimakhala Bwanji?
Mwinamwake mumadziŵa bwino zapadera za khansa yamapapu. Kuti azindikire khansara yamapapu , chitsanzo cha chotupacho chimapezeka m'njira inayake. Kenaka, monga chithandizo cha mankhwala, zowonjezereka zimayenera kuchitidwa kuti ziwone ngati chotupacho "chasintha" -ndipo ngati chasintha kusintha kwatsopano komwe kumapangitsa kukhala kosagwirizana ndi chithandizo chamakono.
Kodi sizingakhale zabwino ngati zikhalidwe zachikhalidwezi (zowonjezereka) zingasinthidwe ndi mayeso a magazi? Kansera yamapapo, kuti muyang'ane anthu ena omwe ali ndi mbiri yeniyeni ya maselo, chokhumbacho chikukhala chenicheni.
Pali zambiri zomwe sitidziwa pokhudzana ndi zomwe zingatheke kuti zitha kuwonetsa khansa ya m'mapapo ndi mankhwala, koma tidzakambirana zina zomwe timadziwa lero.
Pakalipano ku United States, zonsezi zimayesedwa ngati kufufuza za matenda a khansa ya m'mapapo ndipo siziyenera kugwiritsidwa ntchito paokha kuti zitsogolere kapena kuyeretsa chithandizo cha khansa imeneyi.
Mitundu ya Zamadzimadzi Zamadzimadzi
Kodi magazi angathenso bwanji kuthandizira kansalu?
Kodi maselo amapita bwanji? Ndizothandiza kuyamba ndikulankhulana zomwe madokotala amayang'ana muzitsulo zamadzi (magazi) kuchokera kwa wina yemwe ali ndi khansara. Tikudziwa kuti maselo otupa, ndipo nthawi zambiri mbali za maselo otupa, nthawi zambiri amachoka ku chotupa ndikulowa m'magazi. Izi sizikutanthauza kuti chotupa chimakhala chosakanikirana ndi zigawo za maselo a khansa zingawoneke m'magazi ngakhale m'mayambiriro akale a khansara. Pofufuza mpaka pano, asayansi akhala akufufuza chimodzi mwa izi:
- Kutulutsa maselo a tumor (CTCs) - Izi zikutanthauza maselo amtundu omwe angapezeke m'magazi a anthu ena omwe ali ndi khansa. Pakalipano CTCs ndizofunika kwambiri mu khansa ena osati khansa yaing'ono yamapapu ya m'mapapo ndipo imagwiritsidwa ntchito makamaka pofuna kutsimikizira za matendawa . Pali umboni wina wakuti CTCs ikhoza kuthandizira khansa yaing'onoting'ono ya m'mapapo , ndipo pakufufuza kwina, 85 peresenti ya odwala omwe ali ndi khansa yaing'ono ya m'mapapo ili ndi CTCs. Kufufuza kwa CTCs m'magulu ang'onoting'ono a khansa ya m'mapapo akuoneka kuti ndikumangoganizira za moyo wonse.
- DNA (ctDNA) yopanda magetsi (ctDNA) popanda magetsi . Mosiyana ndi maselo onse otupa omwe sapezeka mumagazi , zitsanzozi zimatha kuona zidutswa za maselo otupa omwe amathyola mu thumba ndipo amakhetsedwa m'magazi. Izi zikhoza kuchitika kuchokera ku chotupa chachikulu kapena zotupa zamatenda. CtDNA iyi inapezeka mu phunziro limodzi kuti likhalepo pa 82 peresenti ya odwala khansa omwe sali ndi ubongo wambiri. Anapezeka mu zotupa za magawo onse koma anali otheka kupezeka ndi magawo apamwamba a khansa.
- Tumor RNA mu mapepala - Mwinamwake simunamvepo pang'ono za tumtundu wa RNA mu mapapulaneti kuposa CTCs ndi ctDNA, koma iyi ndi malo ena osangalatsa pansi pa mutu wa zinyama zamadzimadzi. Mipata yapamwamba imadziwika kuti imatha kutenga RNA kuchokera kumatenda ndipo ikhoza kuthandizira kufalitsa khansa.
Pakalipano, chidziwitso cha FDA chinaperekedwa kuti tigwiritse ntchito CTCs ngati chiwerengero choyesa kuchulukitsa (ndipo tsopano ctDNA ikuzindikira kusintha kwa EGFR) koma kugwiritsa ntchito ctDNA ndi chotupa cha RNA mu mapapulaneti kungapereke chithandizo choonjezera pa khansa yowonongeka pamene nthawi ikupita on.
Kusokoneza Mitsempha Yotsutsana ndi Matenda Ovuta Ambiri - Chifukwa Chake Chisangalalo ndi Chotani Chimawoneka?
Mwinamwake mukudabwa chifukwa chake pali chisangalalo chochuluka mlengalenga chifukwa chotheka kutsatira khansa ndi zamadzimadzi.
Tidzalemba ubwino ndi zovuta zina m'munsimu, koma tiyeni tiyambe kuyerekeza chitsanzo cha momwe kansa ya m'mapapo ingayang'anire ndikusamalidwa ndi popanda kugwiritsa ntchito ma biopsies.
Kodi Mungatani Kuti Musamangokhala ndi Matenda a Khansa?
Tangoganizani kuti mwapezeka kuti muli ndi khansara ya m'mapapo yomwe ilibe yaing'ono. Kawirikawiri, matendawa amagwiritsidwa ntchito pogwiritsa ntchito mankhwala a kansa wamapapu omwe amapezeka ndi:
- Nsoko ya singano
- Kachilombo kotchedwa ultrabound and ultrasound (a singano yomwe imalowa mu chotupa pogwiritsa ntchito chifuwa cha bronchial)
- Matenda a mapapu otseguka (mwina thoracoscopy, imene chida chowongolera chimayikidwa kudzera m'mabowo ang'onoang'ono m'chifuwa, kapena thoracotomy, yomwe imaphatikizapo khoma lachifuwa kuti lipite m'mapapo)
Njira zamakono zamakono zonsezi zimakhala ndi chiopsezo cha matenda, kutuluka m'magazi, kugwa kwa mapapo (pneumothorax), komanso kumva ululu.
Pamene minofu imapezeka, imatumizidwa kuti wodwalayo ayang'ane pansi pa microscope komanso pofuna kuyesetseratu mayesero apadera akuyang'ana zovuta zenizeni za maselo otupa. Kafukufuku wa jini (kapena maselo) nthawi zambiri amatenga milungu ingapo (nthawi zambiri zisanu ndi zisanu ndi chimodzi) zisanachitike zotsatira. Ngati chibadwa chosabadwa (monga kutembenuka kwa EGFR) chikupezeka, mankhwala akhoza kuyamba ndi mankhwala opatsirana, monga tyrosine kinase inhibitor Tarceva (erlotinib.)
Ndi njira yothira madzi, mmalo mochita chiopsezo chosautsa monga chingwe cha singano kuti apeze minofu ya kufotokozera kwa jini (mwachindunji kuyesayesa kwa jini kusintha kwazitsulo ziwiri zomwe mayeso angayesedwe panopa), kukopa kwa magazi kungakhoze kuchitidwa - zambiri mayeso ochepa kwambiri. Ndipo mmalo mwa kuyembekezera masabata kuti apeze zotsatira, kuthamanga kwa magazi kumapangitsa kuti azitha masiku atatu. Choncho pa nthawi ya matenda, odwala omwe ali ndi kusintha kwa EGFR akhoza kukhala osinthika mwadzidzidzi osati pokhapokha mwa mayesero ochepa kwambiri koma angayambe pa chithandizo kuti athetse kusintha kwa masiku angapo okha. (Sitidalipo ndi luso kuti "tipeze" zolakwika zina monga ma ALK rearrangements ndi rearrangements ROS1 .)
Kodi Mungayang'ane Bwanji Kusintha kwa Khansa Yam'mimba?
Chosangalatsanso kwambiri ndi mwayi wogwiritsira ntchito zida zamadzi kuti aziwunika anthu amene akuchiritsidwa kale ndi mankhwala okhudzana ndi kusintha kwa EGFR.
Panthawiyi, munthu atayambika pa EGFR inhibitor monga Tarceva, njira ya matenda awo imayang'aniridwa poyesa kafukufuku wa CT kuti ayang'ane kukula kwa chotupacho. Tikudziwa kuti pafupifupi chotupa chilichonse chidzakane mankhwalawa nthawi, koma nthawi imeneyo imasiyanasiyana kwambiri pakati pa anthu osiyanasiyana. Kodi mungadziwe bwanji nthawi imeneyo? Mwachizolowezi, timaphunzira kuti pathupi lakhala likulephera kukana (monga CT scan kapena PET scan) zikusonyeza kuti chotupachi chayamba kukula. Nthawi zambiri (kupatula ngati zizindikiro zikusonyeza kuti khansayo ikuipiraipira) odwala amadziwa kuti mankhwala awo atha kugwira ntchito akamalandira zotsatira za sewero zomwe zimasonyeza kuti chotupa chimakula kachiwiri.
Panthawi imeneyo, mankhwala amaletsedwa ndipo anthu akuyang'ananso ndi kuchita chiopsezo china kuti ayang'ane chotupacho kuti ayang'anire kusintha kumene kunapangitsa kuti zikhale zovuta. Monga tanenera pamwambapa, zochitika zamakono zamapapu zimakhala ndi zoopsa zowonjezereka, ndipo zimatengera masabata opanda mankhwala kuti adziwe zotsatira ndi kumvetsetsa komwe angapite.
Mosiyana, ndi chiwombankhanga cha madzi chimachitidwa nthawi ndi nthawi, madokotala akhoza kudziwa mofulumira ngati chotupa chakhala chosagonjetsedwa ndi mankhwala. Zapezeka mu maphunziro omwe kusinthaku kumawonekera mu ctDNA nthawi zambiri zisanakhale zosinthika zotsutsana ndi kuwonetsa kwa CT. Panthawi imeneyi - pakati pa kuyezetsa magazi kumasonyeza kutsutsa ndikupezeka pa kanthani ya CT - anthu amakhala akugwiritsa ntchito mankhwala omwe sagwiranso ntchito komanso kuthana ndi zotsatira za mankhwala osayenera. Kumatanthauzanso nthawi yaitali kuti asinthidwe kukhala mankhwala othandiza.
Ndi zotsatira zamadzimadzi zomwe zimapangitsa kuti zisawonongeke, zowonongeka (kuchokera ku madzi akumwa) zikhoza kuyesedwa ndipo wodwalayo akhoza kusintha kuti azitsatira mankhwala omwe amachititsa kuti gene geneation kapena mtundu wina wa mankhwala, monga chemotherapy kapena immunotherapy .
Matenda a Kutupa ndi Zamadzimadzi Zamadzimadzi
Chinthu chinanso chimene chingapangitse kuti madzi akumwa amatha kukhala ndi kansa ya mapapu yowonongeka yokhudzana ndi chifuwa chachikulu. Tikudziwa kuti khansa ya m'mapapo ndi yopanda malire, kutanthauza kuti magawo osiyanasiyana a chotupacho (komanso ziwalo zosiyana kwambiri monga chotupa chachikulu ndi metastasis) zikhoza kukhala zosiyana kwambiri ndi ma maselo awo. Mwachitsanzo, kusinthika komwe kulipo mu maselo a khansa mu gawo limodzi la chotupa sikutheka kukhala m'maselo mbali ina ya chotupacho. Kuti mumvetse izi, zimathandiza kuzindikira kuti khansa ikusintha, ndikusintha makhalidwe atsopano ndi kusintha.
Chidziwitso chokhazikika chimakhala chochepa chifukwa chimapanga malo amodzi okha. Kuthana ndi madzi, mosiyana, kungakhale kosavuta kusonyeza makhalidwe a chotupacho chonse. Izi zakhala zikuwoneka kale mu maphunziro, momwe kusintha kwa dalaivala yosasinthika kungawoneke ndi chisokonezo chamadzi chomwe sichikanasokonekera pa chidziwitso cha minofu.
Ubwino wa Kutentha kwa Madzi Pamwamba pa Chimake Chokhazikika
Kuti mumvetsetse chisangalalocho, komanso kuti zingatheke zitsanzo zamadzimadzi, zingakuthandizeni kulemba zina mwa ubwino ndi kuipa kwa njirayi.
- Zotsatira za chiwonetsero cha madzi zili pafupi ndi "nthawi yeniyeni." Mwa kuyankhula kwina, akhoza kulola kuunika koyambirira kwa mphamvu ndi kukana kwa chotupa panthawi ya mankhwala. Pamene chiwopsezo cha minofu chachitidwa, zotsatira za ma kulogalamu yowonongeka (jekeseni ya jini) pa chotupa nthawi zambiri zimafuna masabata angapo (nthawi zambiri zisanu ndi zisanu ndi chimodzi) pamene kuyesa kusintha kwa majini pazomwe zimakhala ndi madzi amodzi kumatenga masiku atatu okha. Iyi ndiyo nthawi imene mankhwala enieni angagwiritsidwe ntchito kapena pamene mbadwo wotsatira wogwiritsira ntchito mankhwala ungagwiritsidwe ntchito ngati chotupacho chikupezeka kuti chikukanika.
- Njira yowonongeka yamadzimadzi yokha imakhala yofulumira kwambiri kuposa chidziwitso chodziwika bwino.
- Zamadzimadzi zamadzimadzi zimakhala zochepa kwambiri.
- Matenda ena ali m'madera omwe sali ovuta kuwathandiza kuti achite zochitika zapadera.
- Matenda ena ndi metastase sizitsanzo zabwino pakuchita ma profesi - mwachitsanzo, mafupa a mitsempha
- Zamadzimadzi amadzimadzi amalola kuti chiphuphu chikhale chofewa. Monga taonera kale, matumbo ambiri ali osiyana kwambiri. Madzi akumwa amatha kupereka zitsanzo zambiri kuti ziyimire chotupacho chonsecho kusiyana ndi chitsanzo chodziwika bwino chomwe chingakhale choimira maselo omwe ali m'gulu lomwelo.
- N'zosakayikitsa kuti njira zamagetsi zamadzimadzi zimakhala zosakwera mtengo kusiyana ndi zachilengedwe zowonjezereka.
- Zamadzimadzi amadzimadzi amachititsa kuti pakhale mavuto ochepa kusiyana ndi omwe amagwiritsidwa ntchito masiku ano, monga chiopsezo cha matenda, kutuluka m'magazi, ndi kugwa kwa mapapo (pneumothorax.) Izi zimangowonjezera ubwino wa moyo koma zingathe kuchepetsa kuperewera kwa mankhwala (ndipo zotsatira za kuchedwetsa zingatanthauze kupititsa patsogolo chotupa.)
- Zamadzimadzi zamadzimadzi sizikhala zopweteka kwambiri.
- Ngati biopsy imafunika kubwerezedwa chifukwa cha minofu yosakwanira, zimakhala zosavuta kubwereza kukopa magazi kusiyana ndi kubwezeretsa chidziwitso chodziwika bwino.
- Kupititsa patsogolo sayansi ya khansa. Mwa kuyang'ana zotsatira za zinyama zamadzimadzi zowonongeka mobwerezabwereza m'kupita kwa nthawi, ofufuza angaphunzire zambiri za momwe matenda amasinthira mthupi mwa nthawi.
- Zamadzimadzi zamadzimadzi zimatha kusintha kusintha komwe kumasowa pathupi.
- Zamadzimadzi amadzimadzi - ngati atulukira kusachedwa mwamsanga - zingathandize kupepesa chithandizo chosafunikira (ndi zotsatira zina zomwe zimaperekedwa ndi mankhwalawa) poonjezera nthawi imene munthu akugwiritsa ntchito mankhwala oyenera.
- Zamadzimadzi zamadzimadzi zimatha kuchepetsa chiwerengero cha ma radiation operekedwa chifukwa chosowa zowonongeka kuti muwone momwe zikuyendera.
Kuipa kwa Zamadzimadzi Zamadzimadzi
Panthawiyi, pali zambiri zoti muphunzire za zamoyo zamadzimadzi. Zomwezi zimakhalanso zochepa kuti zizindikire kusintha kwa majini monga EGFR (ngakhale kuti akuyankhula kuti posachedwapa angathe kugwiritsidwa ntchito kuti azindikire kusintha kwa zinthu ndi kusintha kwina.) Ambiri mitundu ya khansa ya m'mapapo, kufalikira kwa maselo a khansa kapena khansa ya DNA imapezeka m'magawo ang'onoang'ono a khansa ya m'mapapo ndipo imakhudzidwa ndi mtundu ndi sitepe ya khansa. Chotsatira chosayenerera kuchokera ku madzi akumwa sichikutanthauza kuti khansa sichipezeka mu thupi.
Mkhalidwe Watsopano wa Zamadzimadzi Zamadzi a Khansa Yam'mimba
Ma biopsies amadzimadzi akugwiritsidwa ntchito makamaka pa kafukufuku ku United States, ngakhale ena oncologists akugwiritsa ntchito izi kuti azindikire kapena kuyang'anira odwala omwe ali ndi kusintha kwa EGFR. Izi zanenedwa kuti mayesero a chiwopsezo cha madzi - kuyesa koyambirira kwa mtundu wa khansa ya m'mapapo - inavomerezedwa pa June 1, 2016, kuti ayese kusintha kwa kusintha kwa EGFR kwa odwala omwe ali ndi khansa ya m'mapapo yambiri.
Kachilombo kakang'ono kamene kamayambitsa matenda a khansa tsopano akupereka mayeso limodzi ndi mazira ochepa omwe amapanga mafinya a m'magazi kwa odwala onse omwe ali ndi khansa yapakhungu yopanda makapu, panthawi yomwe amadziwa kuti ali ndi kansa ya m'mapapo .
Ku Ulaya, tsopano akugwiritsidwa ntchito kwa anthu omwe ali ndi khansa ya m'mapapo yopanda makapu kuti ayese kusintha kwa kusintha kwa EGFR ndipo amaonedwa kuti ndi kofunikira kudziwa ngati anthu akufuna chithandizo ndi tyrosine kinase inhibitor.
Nchiyani Chikutitengera Ife Kubwerera?
Zingakhale zosokoneza pamene mukuphunzira za zigawo zamadzi, kuti n'chifukwa chiyani njirayi siidakwaniritsidwe. Chimene sitidziwa ndi momwe madzi amadzimadzi adzakwaniritsira zofunikira ziwiri: zolondola ndi zodalirika. Ziyenera kutsimikiziridwa kuti zamoyo zamadzimadzi zimapereka chidziwitso chofanana (kapena chabwino) kuposa ma biopsies a minofu ndipo nthawi zonse amapereka chidziwitso chimenecho.
Tsogolo
Ziri zovuta kudziŵa chomwe chithakwi cha zamadzimadzi zamadzimadzi chiri pa gawo ili la kafukufuku chifukwa chatsopano. Potsirizira pake, akuyembekeza kuti njirayi sizithandiza pokhapokha poyerekeza ndikuyang'ana ndi kuyang'ana kwa kukana koma ngati chida choyang'anira kuti azindikire khansa - ngakhale kuti akadali njira. Njira imodzi, ndi gawo losangalatsa la kafukufuku wa khansa m'nthaŵi ya mankhwala oyenera.
Zotsatira:
Bettegowda, C., Sausen, M., Leary, R. et al. Kuzindikira kuyendetsa DNA yotupa kumayambiriro ndi mapeto a anthu. Sayansi Kusandulika Mankhwala
Imamura, F., Uchida, J., Kukita, Y. et al. Kuwunika kwa mayankho a chithandizo ndi kusinthika kwa maselo a zotupa mwa kutulutsa DNA yotupa ya majeremusi osakanikirana a EGFR opangidwa mu khansa ya m'mapapo. Khansa Yam'mimba . 2016. 94: 68-73.
Jiang, T., Ren, S., ndi C. Zhou. Ntchito ya kansa ya DNA yozungulira pang'onopang'ono ya khansa ya m'mapapo. Khansa Yam'mimba . 2015. 90 (2): 128-34.
Karachaliou, N., Mayo-de-las-Casas, C., Molina-Vila, M. et al. Zomwe zimagwiritsidwa ntchito nthawi zonse zimakhala zenizeni pa chithandizo cha khansa. Annals of Translational Medicine . 2015. 3 (3): 36.
Mahaswaran, S., Sequist, L., Nagrath, S. et al. Kuzindikira kusintha kwa EGFR pakufalitsa maselo a khansa ya m'mapapo. The New England Journal of Medicine . 2008. 359 (4): 366-77.
Sacher, A., Paweletz, C., Dahlberg, S. ndi al. Kuvomereza Kwambiri kwa Rapid Plasma Genotyping kwa Kuzindikira kwa EGFR ndi KRAS Mutations mu Advanced Lung Cancer. JAMA Oncology . Idasindikizidwa pa intaneti pa April 7, 2016.
Santarpia, M., Karachaliou, N., Gonzalez-Cao, M. et al. Kutheka kwa selo kumayendera kansa ya DNA yoyezetsa khansara yamapapo. Zida zamankhwala . 2016. 10 (4): 417-30.