Kufufuza Zomangamanga Zomwe Zingalengeze Chinga cha Khansa Yanu Kutha
Lingaliro la kugwiritsira ntchito chitetezo cha munthu kuti chiteteze khansa si buku, koma kupeza lingaliro limeneli kuti limasulire kuchipatala kwakhala kulimbana kwakukulu.
Nkhani yabwino ndi yakuti kupambana kwa mankhwala omwe amatchulidwa posachedwa kutchedwa immune checkpoint inhibitors , kugwiritsa ntchito njira ya immunotherapy kuchiza khansara kwabwezeretsedwa. Tsopano, kuphatikizapo kupanga njira zambiri zowonongeka ku chitetezo cha mthupi, ochita kafukufuku akupeza njira zowonetsera bwino omwe angapange mankhwala osokoneza bongo.
Mwa kuyankhula kwina, akatswiri akufuna kuphatikizana pamodzi omwe odwala angapindule ndi mtundu uwu wa immunotherapy, kutanthauza kuti khansa yawo imatha kuchepa kapena kuthera chifukwa cha mankhwalawa.
Mayankho si olunjika, choncho ndi bwino kutenga nthawi kuti mumvetsetse zofunikira za kafukufuku wopita patsogolo.
Kuyankha kwa Immune Checkpoint Blockade: Biomarkers
Ochita kafukufuku akufufuza momwe angadziwire kuti ndi ma immunotherapi ati omwe angakhale othandiza kwambiri kwa wodwala aliyense. Mwamtheradi, wa oncologist (dokotala yemwe amadziwika kwambiri pochiza khansa) angafune kuyesa maselo a khansa a munthu kuti akhale ndi zamoyo zamakono (kapena zojambula zambiri).
Odziwika bwinowa anganeneratu kuti munthu angathe kuchitapo kanthu pa matenda enaake. Mwanjira imeneyi, nthawi ndi zotsatira zowonongeka siziwonongeka pa mankhwala omwe kale amadziwika kuti sagwira ntchito kwa mtundu umenewo wa khansa.
Zitsanzo zitatu za akatswiri a kansa omwe angathandize kufotokoza momwe munthu angayankhire pa chitetezo cha chitetezo cha m'thupi chimaphatikizapo:
- Mafotokozedwe a PD-L1 (kaya maselo ali m'kati mwa chotupa amasonyeza mapuloteni otchedwa programmed death-ligand 1)
- Mchitidwe wamtundu (kaya maselo ali mkati mwa chotupa amakhala ndi miyandamiyanda ya kusintha kwa majini)
- Sungani malo okonzanso (kaya maselo ali mkati mwa chotupa amatha kukonzanso molakwika kapena ali ndi luso)
Tiyeni tifufuze zinthu zitatu izi mofotokozera mwatsatanetsatane.
Mwanjira imeneyi mukhoza kumvetsa za sayansi chifukwa chake chitetezo cha m'thupi chimatha kugwira ntchito kwa munthu mmodzi osati wina.
PD-L1 Kulongosola
PDL-1 ndi mapuloteni omwe amasonyeza pamwamba pa maselo ena a khansa. Cholinga chake ndikunamizira chitetezo cha mthupi kuti chiganizire kuti maselo a khansa ndi abwino kapena "abwino." Mwanjira imeneyi chotupachi chimapangitsa chitetezo cha mthupi kuti chiukire-njira yowopsya, koma yopambana komanso yosavuta.
Komabe, palinso mankhwala omwe amaletsa PD-L1 . Mwanjira imeneyi khansayo imadziwika ndi chitetezo cha mthupi chifukwa maselo a khansa ataya maski awo, motero. Mankhwala omwe amaletsa PD-L1 amatchedwa immune system checkpoint inhibitors ndipo akuphatikizapo:
- Tecentriq (atezolizumab): amatseka PD-L1
- Bavencio (avelumab): amaletsa PD-L1
- Imfinzi (durvalumab): amatseka PD-L1
Mankhwalawa akhala othandiza pochiza khansa yambiri yofanana ndi khansa ya chikhodzodzo, kansa yaing'ono ya mapapo, ndi khansara ya khungu la Merkel.
Palinso chitetezo cha m'thupi choteteza PD-1 (chomwe chimamangiriza PD-L1 ndipo chikhoza kufotokozedwa ndi maselo a kansa), ndipo izi zikuphatikizapo:
- Opdivo (nivolumab): amaletsa PD-1
- Keytruda (pembrolizumab): amaletsa PD-1
Kafukufuku amasonyeza kuti mankhwalawa ndi othandiza pochiza khansa ngati khansa ya khansa, kansa yaing'ono ya mapapo, kansa ya impso, khansa ya chikhodzodzo, khansa ya mutu ndi khosi , ndi Hodgkin lymphoma.
Pofunafuna zamoyo zomwe zingayese kuti munthu athe kuyankha mankhwalawa, ofufuza ayamba kuyesa maselo a khansa kwa PD-L1. Zoonadi, pamene kafukufuku akuwonetsa PD-L1 kufotokozera ndi chinthu chimodzi chomwe chikugwirizana kwambiri ndi kuyankha kwa blocker PD-L1 kapena PD-1, kufufuza kwina kumafunikanso kuchitidwa.
Mwa kuyankhula kwina, mawu a PD-L1 okha sangakhale chizindikiro chokwanira ngati khansara ya munthu idzawonongeka kapena kuthawa ndi mankhwala omwe atchulidwa pamwambapa. Sizowona bwino, koma zabwino lero.
Mtolo Wosokonezeka
Kuwonjezera pa kufotokoza kwa PD-L1 pa maselo a khansa, ofufuza afufuza kugwirizana pakati pa vuto la kusintha kwa chotupa ndi momwe amachitira ndi chitetezo cha m'thupi.
Choyamba, kuti mumvetsetse zomwe mutengerezi, muyenera kumvetsetsa kuti kusintha ndikutani ndi momwe izi zikukhudzira khansa.
Kodi Chisinthiko N'chiyani?
Kusinthasintha kwamasinthidwe ndi kusintha kwa chiwerengero cha DNA chomwe chimapanga jini. Kusintha kwa thupi kungakhale kobadwa (kutanthauza kuti zidaperekedwa kuchokera kwa makolo anu) kapena zinapatsidwa.
Ndi kusintha kwamasinthidwe, kusintha kwa thupi kumapezeka m'maselo a somatic (maselo onse m'thupi, koma mazira ndi umuna wa umuna), kotero sangathe kupitsidwira ku mbadwo wotsatira. Zosintha zamoyo zimatha kusintha kuchokera ku zinthu zachilengedwe, monga kuwonongeka kwa dzuwa kapena kusuta fodya, kapena kuchokera ku zolakwika zomwe zimachitika pamene DNA ya selo ikudzijambula yokha (yotchedwa kubwereza).
Mofanana ndi maselo ochiritsira, kusintha kwamasinthidwe kumapezanso ku maselo a khansa, ndipo mitundu ina ya khansa imakhala ndi kusintha kwakukulu kuposa ena. Mwachitsanzo, mitundu iwiri ya khansa yomwe ili ndi chiwerengero chachikulu cha kusintha kwa thupi ndi kansa ya m'mapapo , kuchoka ku utsi wa ndudu, ndi khansa ya khansa , kuchokera ku dzuwa.
Kodi Mtolo Wamtundu Wapamwamba Ndi Chiyani?
Pali kafukufuku amene amasonyeza kuti zotupa ndi mitsempha yambiri ya kusintha kwa thupi (kuthamangitsidwa kwamtundu wamtundu wautali) amatha kuchitapo kanthu ku chitetezo cha mthupi chitetezo m'matumbo kusiyana ndi matenda omwe ali ndi chiwerengero chochepa cha kusintha kwa chibadwa.
Izi zimakhala zomveka chifukwa, pang'onopang'ono, chiphuphu chikanakhala chodziwika kwambiri kwa thupi la munthu. Mwa kuyankhula kwina, ndi kovuta kubisala ndi zonsezi zomwe zimayambitsa zolakwika.
Ndipotu, maselo atsopanowa amatha kupanga mapuloteni atsopano omwe amatchedwa neoantigens. Ndizirombo zomwe zimatsimikiziridwa kuti zimatetezedwa ndi chitetezo cha mthupi ndipo zimayesedwa (yotchedwa khansara ya immunogenic neoantigens chifukwa imayambitsa chitetezo cha mthupi).
Chikhalidwe Chokonzekera Mismatch
Thupi la munthu limapyola njira yokonzekera nthawi zonse pokonza zolakwika za DNA zomwe zimapangidwa panthawi yolankhulana. Njira iyi yokonzetsera zolakwika za DNA imatchedwa kukonza molakwika.
Kafukufuku wodziteteza ku immune checkpoint inhibitors wasonyeza kuti vuto losawonongeka la chotupacho lingagwiritsidwe ntchito pofotokoza momwe munthu angayankhire ndi matenda a immunotherapy. Makamaka, zotupa zomwe zimangokhala zosafunikira kwenikweni kukonza (kutanthawuza kuti zonse zojambula za galimoto zosasintha zimasinthidwa kapena zimatonthozedwa) sangathe kukonzanso zolakwika za DNA.
Ngati maselo a khansa asachepera kuthetsa vuto la DNA, amatha kupeza zinthu zambiri zomwe zimapangitsa kuti zidziwike ku chitetezo cha mthupi . Mwa kuyankhula kwina, amayamba kuyang'ana mosiyana kwambiri ndi maselo achibadwa (osakhwima).
Kafukufuku amasonyeza kuti khansa yokhala ndi vuto lokonzekera mosalekeza ili ndi maselo oyera amagazi ambiri omwe asiya mwazi kuti aloŵe chotupa-chizindikiro chokhala ndi chitetezo champhamvu cha mthupi ndi chisonyezero chakuti khansara ili yotetezeka kwambiri ku immunotherapy.
Izi ndi zosiyanitsa ndi khansa yowonongeka yosasokonezeka, ndi kusonyeza pang'ono kupyolera mu maselo oyera.
Khansara ndi Chitetezo cha Immune: Kuyanjana Kwambiri
Kutuluka kwa ma immunotherapies omwe amapangitsa kuti mapuloteni aziwoneka akubweretsa chisangalalo ndi chiyembekezo kwa omwe amachiza khansa. Koma chifukwa chodziwikiratu opanda ungwiro wa mawu a PD-L1, anthu ena odalirika amafunika kudziwika ndi kufufuza. Ngakhale kutengeka kwa thupi ndi DNA kukonza zolakwika kumayambira, mayeso amayenera kutsimikiziridwa kuti agwiritsidwe ntchito kwa odwala.
Ndipotu, kudziŵa kuti munthu ali ndi mwayi wotsatila chithandizo cha immunotherapy chingakhalepo chifukwa cha kusanthula mitundu yosiyanasiyana ya deta-tanthauzo la chifuwachi, mwachitsanzo.
Mawu Ochokera
Pamapeto omaliza, ndikofunikira kuti musagwedezeke kwambiri ndi mfundo zovuta zomwe zikufotokozedwa apa.
M'malo mwake, chonde mvetserani kuti ngakhale mukulonjeza ndi zosangalatsa kwambiri, chitetezo cha mthupi chitetezo cha mthupi ndi FDA chovomerezeka kuti chiteteze mitundu ndi magawo ena a khansa. Zingatheke kapena sizingakhale yankho kwa inu kapena wokondedwa wanu koma zikuwonetseratu kupita patsogolo kwakukulu mu chitukuko cha mankhwala atsopano a khansa. Mwanjira iliyonse, khalani ndi chiyembekezo ndikupitiriza ulendo wanu wokhazikika.
> Zotsatira:
> Farkona S, Diamandis EP, Malawi IM. Cancer immunotherapy: chiyambi cha kutha kwa khansa? BMC Med . 2016 May 5; 14: 73.
> Le Dt et al. Pulogalamu ya PD-1 imatetezedwa mu zotupa ndi kusowa kosawonongeka. N Eng J Med . 2015 Jun 25; 372 (26): 2509-20.
Masucci GV et al. Kutsimikiziridwa kwa anthu osokoneza bongo kufotokoza momwe angayankhire pa matenda a khansa: Buku 1 - zisanayambe kufotokoza ndi kusanthula. J Mayi Kansa . 2016 Nov 15; 4: 76. eCollection 2016.
> Mouw KW, Goldberg MS, Konstantinopoulos PA, D'Andrea AD. DNA yawonongeka ndi kukonzanso zida zowonongeka. Cancer Discov . 2017 Jul; 7 (7): 675-93.
> Shoushtari AN, Wolchok J, Hellman M. (2017). Malamulo a khansa ya immunotherapy. Atkins MB, ed. Zaposachedwa. Waltham, MA: UpToDate Inc.