Kodi Muyenera Kudziwa Zotani Zokhudza mankhwala a Immuotherapy?
Ngati inu kapena wokondedwa wanu mwafunsidwa kuti mumve mankhwala a Opdivo (nivolumab), kodi muyenera kudziwa chiyani? Kodi mankhwalawa amagwira ntchito bwanji? Kodi khansa ingayankhe bwanji mankhwalawa? Kodi Opdivo amagwira ntchito kangati ndi mtundu wanji wa mayankho omwe anthu ali nawo? Pomaliza, kodi zotsatira zake zimakhala zotani?
Opdivo (Nivolumab) -Definition
Opdivo (nivolumab) amaonedwa kuti ndi mtundu wa immunotherapy mankhwala, mankhwala oyamba m'gulu lino omwe amavomereza khansara yamapapo (mu 2015) komanso tsopano akuvomerezedwa kwa khansa zina zingapo.
Immunotherapy ndi mtundu watsopano wodwala khansa umene umagwiritsa ntchito chitetezo cha mthupi kapena mfundo za chitetezo cha mthupi pofuna kulimbana ndi khansa.
Pali mitundu yosiyanasiyana ya immunotherapy. Opdivo imatengedwa ngati "checkpoint inhibitor" (yomwe tidzakambirana m'munsimu).
Opdivo (nivolumab) yakhala yowonjezerapo yosangalatsa pochiza khansa zaka zingapo zapitazo, ndipo chisangalalo chachikulu sichiri chabe. Anthu ena akhala ndi mayankho kwa mankhwala omwe sanamvetse ngakhale zaka zisanu zapitazo. Mwamwayi, Opdivo siigwira ntchito kwa aliyense, koma ikagwira ntchito imatha kupeza yankho losatha (lofotokozedwa m'munsimu). Zotsatira zake zimakhala zachilendo, koma kawirikawiri zimakhala zovuta kwambiri kusiyana ndi zotsatira zopezeka ndi mankhwala ambiri a chemotherapy.
Kodi Opdivo (Nivolumab) ndi Mtundu wa Chemotherapy?
Anthu ambiri amasokonezeka ndi momwe mankhwala a chemotherapy ndi immunotherapy amathandizira. Kodi imatenda, komanso makamaka nivolumab, mtundu wa chemotherapy?
Nthawi zina, chemotherapy imagwiritsidwa ntchito mosasamala pofotokoza mtundu uliwonse wa mankhwala operekedwa kuti amenyane ndi khansa. Pankhaniyi, nthawi zina mankhwala osokoneza bongo amatha kutchedwa chemotherapy. Komabe pali kusiyana kwakukulu komanso. Mawu akuti "chemotherapy" kawirikawiri amatanthauza kugwiritsa ntchito mankhwala omwe amachititsa kuti maselo onse okula mofulumira asaguluke.
Zotsatira zodziŵika bwino za chemotherapy zimabwera chifukwa, kuwonjezera pa kumenyana ndi maselo a kansa, mankhwalawa amakhudzanso maselo omwe amatha kugawa mofulumira. Izi ndizochita za chemotherapy pa maselo abwino, monga mafupa (zomwe zimapangitsa kuti thupi likhale loyera komanso zina), tsitsi lopaka tsitsi (zomwe zimachititsa tsitsi), ndi kupweteka kwa thupi (zomwe zimabweretsa chisokonezo) zomwe zimachititsa kuti munthu azikhala wamba zotsatira zake.
Mosiyana ndi zimenezi, mankhwala osokoneza bongo amalinganizidwa kuti asinthe mawonekedwe a chitetezo cha thupi kapena kugwiritsa ntchito zinthu zopangidwa ndi chitetezo cha m'thupi kuti amenyane ndi khansa. Pa chifukwa chimenechi, mankhwala osokoneza bongo amakhala ndi zotsatira zochepa kusiyana ndi mankhwala am'thupi.
Kodi Opdivo (Nivolumab) amagwira ntchito bwanji?
Opdivo (nivolumab) ndi mankhwala omwe amatchedwa immunotherapy.
Checkpoint inhibitors ndi osavuta kumvetsetsa ngati mukuganiza za chitetezo cha m'thupi lanu ngati galimoto, ndi ma check-inhibitors pokhala mabasi pa galimoto. Ma chitetezo chathu a chitetezo cha m'thupi amatengedwera kupha mabakiteriya, mavairasi, ngakhale maselo a khansa m'matupi athu. Chitetezo chathu cha chitetezo cha mthupi chimadziwa kale momwe tingamenyane ndi khansa. Monga momwe thupi lathu likulimbana ndi mabakiteriya ndi mavairasi athu, zimapangidwira kumenyana ndi maselo achilendo monga maselo a khansa.
Chitetezo cha mthupi chimakhala ndi ma check and balance. Mankhwalawa amathandiza kuti chitetezo cha mthupi chitetezedwe kotero kuti sichitha kapena kupitirira. Njira yowonongeka yoteteza thupi kuthupi, ndipotu, ndi vuto la matenda omwe amadzimadzimadzimadzi monga matenda a rhumum ndi nyamakazi.
"Maburashi" a galimoto amene amachepetsa njirayi ndi mapuloteni otchedwa checkpoint inhibitors. Mapuloteni oterewa amachepetsera mphamvu ya chitetezo cha mthupi kotero kuti sichitha. Chimodzi mwa mapuloteni amenewa ndi PD-L1. PD-L1 imamangiriza kwa PD-1 receptors pa maselo T (maselo omwe amatetezedwa ndi chitetezo cha mthupi amawopsa kwambiri poyambitsa khansa), kuwauza kuti akhale chete.
Maselo a khansa ndi achinyengo. Maselo ena a khansa apeza njira yobweretsera PD-L1 ambiri. Pamene izi zimamangiriza PD-1 receptors pa maselo a T , zimalola kuti maselo a khansa ayambe kutsekedwa, monga ngati kuyika maski pa maselo a khansa kuti chitetezo cha mthupi sichiwazindikira ndi kuwaukira.
Opdivo amagwira ntchito pomangiriza PD-1 ndi PD-L1, ndikumasula mavitchi pamagalimoto (kuti chitetezo cha mthupi) chiteteze khansa. Zonsezi, Opdivo amagwira ntchito pochotsa masewera a khansa kotero kuti sangathe kubisala ku chitetezo cha mthupi, ndipo amatha kuwonongedwa ndi chitetezo cha thupi lathu.
Kodi ndi liti ndipo Opdivo (Nivolumab amagwiritsa ntchito bwanji)?
Opdivo kawirikawiri amagwiritsidwa ntchito pa kanthana ka IV (kosagwiritsidwa ntchito) khansa, khansa yomwe siingakhoze kuchiritsidwa ndi opaleshoni ndipo nthawi zambiri imafalikira ku mbali zina za thupi (zotchedwa metastatic).
Opdivo imaperekedwa ndi jekeseni ya m'mimba chifukwa cha kulowetsedwa kwa pafupifupi ola limodzi. Nthawi zambiri amapatsidwa milungu iwiri iliyonse.
Kodi "Kutha Kuyankha" Kumatanthauza Chiyani?
Musanakambirane za maphunziro a nivolumab, ndizothandiza kufotokoza mawu omwe amagwiritsidwa ntchito nthawi zambiri pofotokoza momwe angayankhire mankhwala osokoneza bongo: mawu akuti "yankho lokhazikika."
"Yankho lokhalitsa" limatanthawuza kuyankha kwabwino kwanthawi yaitali kwa chotupa kwa mankhwala. Palibe nthawi yeniyeni, koma "nthawi yokhazikika" nthawi zambiri imatanthauza osachepera chaka chimodzi ndipo nthawi zina nthawi yaitali.
Ngati muwona maphunziro akuyankhula za "yankho lokhalitsa," nthawi zambiri izi zimasiyana ndi mtundu weniweni wa mayankho omwe amapezeka ku chemotherapy. Pochita masewera olimbitsa thupi, mankhwala a chemotherapy akhoza kukhala othandiza koma chotupa nthawi zonse chimakhala chosagwirizana ndi chemotherapy patapita nthawi yochepa (nthawi zambiri imatchulidwa miyezi). Ndi mankhwala othandizira, nthawi yotsatila imakhala yayitali, komabe kukana nthawi zambiri kumachitika nthawi ya chaka malinga ndi mankhwala, mtundu wa khansara, ndi zina zambiri.
Yankho lokhazikika silitanthawuze "mankhwala" koma limatanthauzira yankho lomwe m'njira zambiri ndilo chinthu choyandikana kwambiri chomwe tili nacho panthawiyo-pamene chimagwira ntchito.
Mosiyana ndi mankhwala a chemotherapy ndi mankhwala opatsirana-omwe ali othandiza kokha ngati munthu akumwa mankhwala-kwa anthu ena omwe atenga Opdivo, zikuwoneka kuti izo zikhoza kupitiriza kukhala zogwira mtima. Ndi khansa ya m'mapapo yopanda maselo, anthu ena akhala ndi mayankho odalirika ngakhale atasiya mankhwala.
Kodi Ndi Matenda Otani Amene Angakwaniritsidwe ndi Opdivo?
Opdivo (nivolumab) yavomerezedwa kuti athe kuchiritsidwa ndi anthu omwe ali ndi mapapu adenocarcinoma (mtundu wa khansa yaing'ono yamapapu ya m'mapapo), squamous cell carcinoma m'mapapo (mtundu wina wa khansa yaing'ono ya m'mapapo ya khansa), matenda a khansa ya mthempha, matenda a Hodgkin khansa ya mutu ndi khosi, Merkel cell carcinoma, ndi renal cell carcinoma (khansa ya impso).
Kodi Maphunziro ndi Zomwe Amayesedwa Amatiuza Zokhudza Opdivo?
Kafukufuku akhala akuyang'ana zotsatira za Opdivo pa khansa yeniyeni m'malo mwa khansa lonse:
- Kansalu yaing'ono ya m'mapapo ya m'mapapo - A 2017 kukambiranso maphunziro okwana asanu ndi anayi omwe ali ndi siteji III ndi gawo lamasanu ndichinayi la khansa yamapapu yopanda mapiko, amapeza kuti nivolumab (ndi atezolitumab ndi pembrolizumab) zimapangitsa kuti munthu akhale ndi moyo wambiri kusiyana ndi chemotherapy pamene agwiritsidwa ntchito mzere wachiwiri (komanso pembrolizumab mzere woyamba mu PDL-1 zotupa zabwino). Kuonjezerapo, anthu adapeza zochepa zochepa pa checkpoint inhibitors kusiyana ndi mankhwala a chemotherapy. Opdivo ingagwiritsidwe ntchito pamapapo adenocarcinoma kapena squamous cell carcinoma m'mapapu . Opdivo iyenera kugwiritsidwa ntchito kwa anthu omwe alibe vuto la gene mutations kapena sanayankhepo kuchipatala chowongolera.
- Metastatic melanoma - Opdivo tsopano ikuvomerezedwa mzere woyamba (monga mankhwala oyamba) a metastatic melanoma .
- Zakale za Hodgkin lymphoma - Opdivo zingagwiritsidwe ntchito kwa anthu omwe ali ndi kachilombo ka mtundu wa Hodgkin lymphoma omwe sakhala akukula pambuyo pa kusamba kwa tsinde komanso kugwiritsa ntchito mankhwala opatsirana.
- Msuzi wamaselo a squamous ndi khansara ya m'khosi (masewera kapena achizolowezi).
- Renal cell carcinoma - Opdivo imavomerezedwa mzere wachiwiri (pambuyo poletsa anti-angiogenesis inhibitor therapy) kwa khansa yapamtima yambiri ya khansa ya kansa.
- Urothelial carcinoma - Opdivo imavomerezedwa kwa anthu omwe ali ndi khansa ya chikhodzodzo ichi chomwe sichikulirakulira pa chemotherapy.
- Merkel cell carcinoma
Kodi Immunotherapy Imagwira Ntchito Yabwino Motani?
Kafufuzidwe ka Opdivo ndi mankhwala ena omwe ali ndi matenda a immunotherapy akadakali aang'ono, koma ndi khansara yamapapo pang'ono, zikuwoneka kuti anthu omwe asuta kale ndi omwe amavomereza mankhwalawa kuposa omwe sanasute fodya. Izi zimakhala zomveka tikamaganizira njira. Ziphuphu zowumitsa mwa anthu omwe akusuta ali ndi "kutsika kwabwino kwa kusintha." Mwa kuyankhula kwina, maselo a kansa ali ndi kusintha kwakukulu komwe kumawoneka mu maselo a khansa omwe amapezeka panthawi ya selo kukhala khansara. (Izi sizikugwirizana ndi chikhalidwe komanso kusintha kumeneku sikudapitsidwira m'banja). Maselo omwe ali ndi kusintha kwakukulu mwina amawoneka ophweka (osachepera ngati maselo ochibadwa) ku chitetezo cha mthupi, kupanga mankhwala omwe amagwiritsa ntchito chitetezo cha mthupi kapena mfundo zake zowonjezereka kukhala zogwira mtima.
Zotsatira Zowopsa za Opdivo (Nivolumab)
Monga momwe zilili ndi khansa iliyonse, zimakhala zovuta komanso zoopsa ku mankhwala ndi Opdivo.
Zotsatira zofanana (zomwe zimachitika pa 10 peresenti kapena anthu ambiri) zikuphatikizapo:
- Kuthamanga kwa khungu
- Kuyamwa (pruritis)
- Mapamwamba a potaziyamu ( hyperkalemia ) ndi low level sodium (hyponatremia)
- Zovuta zachilendo zowononga chiwindi monga ALT ndi alkaline phosphatase
- Kukuda
- Kupuma pang'ono
- Kutopa
- Kuchuluka kwa maselo oyera a magazi
- Kupweteka kwa minofu makamaka khansara yamapapo
Zosavuta zomwe zimawoneka koma zoyipa zingaphatikizepo:
- Pafupifupi chirichonse chimene chimathera ndi chokwanira "itis" - kutanthauza kutupa; monga colitis, pneumonitis, hepatitis, nephritis, pancreatitis, ndi zina zambiri
- Maonekedwe a diso monga uveitis ndi maso owuma
- Matenda otchedwa endocrine omwe amachititsa chithokomiro, zilonda za adrenal, ndi gland
Machenjezo Ali pa Opdivo (Nivolumab)
Anthu omwe amagwiritsa ntchito Opdivo ayenera kuyang'aniridwa chifukwa cha zizindikiro zotupa, ndipo ngati alipo, mankhwalawa angafunikire kuchitidwa kapena kuimitsidwa. Izi zikuphatikizapo zinthu monga pneumonitis, encephalitis, nephritis, ndi colitis. Mankhwalawa amachititsa mtundu wa shuga wa mtundu, ndipo shuga ya magazi iyenera kuyang'aniridwa.
Kulephera kwa adrenal kapena kutopa kwadakali kungachitike, ndipo anthu ayenera kudziwa momwe angathere matendawa komanso zizindikiro zomwe zingatheke.
Matenda okhudzana ndi chitetezo cha mthupi monga Stevens-Johnson matenda angathe kuchitika, ndipo muyenera kuyankhula ndi dokotala wanu za zinyama zilizonse zomwe mumayambitsa.
Komabe, kupweteka kwakukulu komwe kumachititsa kuti mankhwalawa asakhale achilendo, zimachitika zosakwana 1 peresenti ya nthawiyo. Onetsetsani kuti mukulankhulana ndi oncologist wanu za zizindikiro zina zomwe mungathe kuchita komanso nthawi yomwe muyenera kuitanira.
Mawu Ochokera
Opdivo (nivolumab) ndi mankhwala atsopano omwe amatchulidwa ngati mtundu wa immunotherapy. Kwa omwe mankhwalawa ali othandiza, nthawi zina takhala tikuwona mayankho a ziphuphu zolimba zomwe sanaganizire zaka zingapo zapitazo. Izi zikuti, sagwira ntchito kwa aliyense, ndipo sitidali ndi njira yabwino yodziwira yemwe angayankhe bwino kuchipatala.
Zotsatira zake zimakhala zachilendo, makamaka zizindikiro monga kuthamanga, kuyabwa, ndi kutayika kwa chithokomiro. Zochitika zazikulu zowopsya nthawi zina zimachitika. Kawirikawiri, Opdivo amalekerera kusiyana ndi mankhwala a chikhalidwe.
Pakhala chisangalalo chochuluka kuchokera kuchipatala kwa zifukwa zingapo. Opdivo ingagwiritsidwe ntchito pochizira ngakhale zotupa zowopsa kwambiri. Kuphatikiza apo, ikhoza kukhala yothandiza mu mitundu yosiyanasiyana ya khansa. Zikuoneka kuti ntchito zatsopano za mankhwalawa zidzavomerezedwa posachedwapa, ndipo mayesero ambiri azachipatala akuyesa kufufuza zotsatira za Opdivo pa mitundu yosiyanasiyana ya khansa, onse okha, komanso kuphatikizapo mankhwala ena ochepetsa matenda a umoyo.
> Zotsatira:
> Abdel-Rahman, O., > Oweira >, H., Petrausch, U. et al. Mavuto Oopsya Okhudzana ndi Matenda Okhudzana ndi Matenda Okhudzana ndi Matenda Okhudzana ndi Matenda Okhudzana ndi Matenda Aakulu Omwe Amadziwika ndi Opaleshoni Yopometsa Mthupi: Kuunika Kwambiri. Kufufuza kwa Akatswiri a Mankhwala a Anticancer . 2017. 17 (4): 387-394.
> Ellis, P., Vella, E., ndi Y. Ung. Zizindikiro Zowonongeka kwa Mthupi kwa Odwala Amene Ali Ndi Zapamwamba Zosasintha-Khansa Yolimbana ndi Mitsempha: Kufufuza Kwambiri. Khansara Yam'mimba Yamakono . 2017 Feb 16. (Epub patsogolo pa kusindikiza).
> Postow >, M., ndi J. Wolchok. Toxicities Ophatikiza ndi Checkpoint Inhibitor Immunotherapy. Kupititsa patsogolo . Kusinthidwa 05/31/17.
> Wang, X., Bao, Z., Zhang, X. et al. Kugwira Ntchito ndi Kutetezeka kwa PD-1 / PD-L1 Zopewera Pachipatala Chokhazikika: Kukonzekera Mwadongosolo ndi Meta-Analysis. Oncotarget . 2017 May 31. (Epub patsogolo pa kusindikiza).