Thandizo la Mthupi la Khansa ya Prostate

Zomwe timateteza ku chitetezo cha mthupi zathu ndi zodabwitsa-zimasunga mabakiteriya athu m'mimba; amamenyana ndi mavairasi othawa, ndipo amatha kuthetseratu khansa zambiri pachiyambi asanakhale vuto. Zinthu zofunika kwambiri zomwe zimapezeka m'kati mwa zaka makumi awiri zapitazo zakhala zikuchitika mwatsopano pa zamachiritso zomwe zimapangitsa kuti chitetezo cha thupi chitetezeke.

Kusinthika kwa Immunotherapy

Musanayambe kugwiritsira ntchito chithandizo cha immunotherapy kwa khansara ya prostate, onani kuti pakhala pali zowonongeka zambiri ndi mauthenga oyambirira a kupambana pamsewu wopita ku chitetezo chamagetsi. Mwachitsanzo, FDA inavomereza interleukin 2 ya khansa ya khansa zaka 20 zapitazo. Ngakhale kuti peresenti yokwana 10 peresenti yowonongeka ndi zotsatira zoopsa kwambiri, interleukin 2 inapereka chiyembekezo cha chiyembekezo panthawi yomwe chiwerengero cha mastanomasi ya metastatic inalibe chiyembekezo ndipo sichingawathandize. Mankhwalawa anali ochepa koma olimbikitsa chiyembekezo chamtsogolo, ogwira mtima, mankhwala.

Tsopano ife tikukumva za kusintha kwakukulu mu njira ya chithandizo cha khansa ya khansa. Mwachitsanzo, posachedwapa ma TV amatiuza kukonzekera kutha kwa Purezidenti Jimmy Carter-khansa yake yafala ku ubongo. Kenaka chozizwitsa chodziwika bwino-mankhwala atsopano a immunotherapy-anali atamupangitsa kuti asamakhale ndi khansa. Nkhani zabodza? Ayi konse. Matenda a masiku ano angapangitse milandu yopanda chiyembekezo kuti iwonongeke.

Kodi kupita patsogolo kwakukulu kwakhala bwanji? Zakhala zowonjezereka kwakukulu mukumvetsetsa kwathu kwa chitetezo cha m'thupi. Mwachidule, ife tsopano tikudziwa kuti chitetezo cha mthupi chimakhala ndi zigawo zikuluzikulu zitatu:

1. Maselo otsogolera, otchedwa TRegs, apitirize kuchita zambiri za chitetezo cha m'thupi kuti asatuluke.

1. Maselo a T-T akuukira maselo a khansa ndikuwapha.
2. Maselo osokoneza amagwira ntchito ngati maselo a detector, akuthawa ndi kupeza khansa ndikuyendetsa chitetezo cha mthupi kotero amadziwa maselo kuti awononge. Maselo osokoneza, atapeza khansa, atsogolere maselo opha "kuti alowemo" ndi kuyambitsa khansara.

Perekani Kansa ya Prostate

Khansara ya prostate inali yowonongeka kwambiri ndi gulu la chitetezo cha m'thupi pamene Zoperekazo zinavomerezedwa ndi FDA mu 2010. Chivomerezo cha FDA chinachokera ku zotsatira za mayesero osokoneza bongo, omwe ali ndi kachilombo kawiri, omwe amasonyeza kuti Amapereka chiyembekezo chokhala ndi moyo wabwino Amuna omwe ali ndi khansara yotchuka ya prostate ndi 22.5 peresenti.

Perekani ntchito ndi njira zatsopano zomwe zimapangitsanso maselo opangidwa ndi dendritic. Monga tanenera kale, maselo a dendritic ndi "magazihounds" a chitetezo cha mthupi, amatha kufuula ndikupeza maselo a kansa. Ndondomeko ya njirayi imadalira pazigawo za magazi ndi leukapheresis kuchotsa maselo a dendritic. Maselo amenewa amatulutsidwa mu labu, kuti athe kuzindikira prostatic acid phosphatase (PAP) -chiwalo chokhala ndi maselo omwe ali pamwamba pa maselo a khansa ya prostate. Akachitidwa, maselo a dendritic amalowetsedwa m'magazi a wodwalayo kumene amachititsa kuti maselo a T akudziwe bwino ndikuwongolera maselo a kansa, popeza athandizidwa kuti azindikire mbali ya PAP ndi kuigwiritsa ntchito monga cholinga.

Kupereka kungapangidwe kuti ndizofunikira kwambiri pamtundu wa khansa chifukwa chayekha chifukwa maselo a dendritic amatsukidwa kuchokera mwazi wa wodwala aliyense, amathandizidwa mu labotale kuti awononge maselo a kansa ya prostate, kenaka amabwezeranso kubwerera kwa wodwala yemweyo. Zokondweretsa monga teknolojiyi zimamveka zingakhale zodabwitsa kumva kuti madokotala ndi odwala amangozizira pang'onopang'ono kuti agwiritse ntchito njira. Maganizo oterewa ponena za kulandira Zopanga zinali zosayembekezereka pamene Provenge atabwera pamsika, chifukwa cha kutchuka kwa njira zambiri zothandizira njira zolimbitsa thupi monga Graviola, shiitake bowa, pau de arco, ndi tiyi ya Essiac.

Chifukwa chiyani pangakhale kulimbika kugwiritsira ntchito FDA kuvomereza mtundu wa chitetezo cha mthupi?

Zotsutsa

Otsutsawo ankanena kuti Kupatsa ndi kofunika ndipo wothandizira wamba amakhala ndi miyezi itatu kapena inayi yowonjezera. Komabe, m'dziko lenileni la kansa (osati dziko la mayesero a chipatala), izi ndizolakwika. Amuna omwe akuchita nawo mayesero a zamankhwala sakuyimira odwala khansa ya prostate yomwe imalandira mankhwala ovomerezeka a FDA. Kawirikawiri, amuna omwe akukumana ndi mayesero a zachipatala ali ndi matenda opititsa patsogolo kwambiri. Izi ndi chifukwa chakuti odwala amachedwa kuchepetsa mayesero am'thupi mpaka mutatha mankhwala.

Choncho, kupulumuka kwa amuna mu mayesero a zachipatala kumakhala kochepa, mosasamala mtundu wa chithandizo chomwe chimaperekedwa. Komabe, mankhwala aliwonse omwe amatsimikiziridwa kuti apitirize kukhalabe pansi pa zovuta izi ziyenera kukhala zopindulitsa. Ndicho chifukwa chake mankhwala omwe amasonyeza kupitiriza kupulumuka amalandizidwa ndi FDA. Mfundo ndi yakuti mankhwala amasonyeza zotsatira zabwino ngati agwiritsidwa ntchito pochiritsa amuna pachiyambi.

Kuchiza Pazigawo Zosiyana

Cholinga chakuti Zopereka zimakhudzidwa kwambiri ngati zimagwiritsidwa ntchito pochiza khansa ya prostate poyamba, anafufuzidwa kudzera mu reanalysis ya deta yapachiyambi yomwe inachititsa kuti avenge avomerezedwe ndi FDA. Kusanthula kumeneku kunasonyeza kuti amuna omwe ali ndi matenda oyambirirawo amakhala ndi nthawi yochulukirapo. Ndipotu, kuchuluka kwa kupulumuka kunayamba kukula pang'onopang'ono pamene Kukonzekera kunayamba mofulumira.

Mu reanalysisyi, magulu anayi a amuna, omwe amagawidwa ndi magulu awo a PSA kumayambiriro kwa kupereka mankhwala, anayesedwa: Amuna omwe ali ndi PSA m'munsimu 22, amuna ndi PSA pakati pa 22 ndi 50, amuna ndi PSA pakati pa 50 ndi 134, ndi amuna ndi PSA wamkulu kuposa 134.

Gome ili m'munsimu likufotokozera mwachidule za kupulumuka kwa amuna omwe amathandizidwa ndi Zopereka, poyerekeza ndi amuna omwe ali ndi placebo, omwe amagawidwa ndi mlingo wa PSA kumayambiriro kwa magawo. Kusiyana kwa kusamba kwaukonde (mu miyezi) pakati pa Zopangira ndi placebo kumatchulidwa kotsiriza.

Monga momwe gome likusonyezera, kupindula kwapadera kwa magulu onse operekedwa ndi anthu oyenerera operekera poyerekeza ndi amuna ochitidwa ndi malowa. Komabe, kuchuluka kwa kupulumuka kwapadera kunali kwakukulu mwa amuna omwe anayamba kupereka PSA pomwe PSA inali yotsika kwambiri. Amuna omwe adayamba Kupereka pamene PSA yawo inali ndi zaka zosachepera 22 ankakhala miyezi 13 kupitirira kuposa amuna omwe ali pamsinkhu wofananowo omwe anali opangidwa ndi placebo. Amuna apakati, kwambiri ndi ma PSA oposa 134, ankangokhala miyezi ingapo kuposa amuna omwe adalandira malo awo.

Ntchito

Naysayers funso Funsani zothandiza pa chifukwa china. Mitundu yambiri ya mankhwala a prostate, monga mankhwala a hormonal ndi chemotherapy, amachititsa kuchepa kwa PSA. Koma ndi Zopereka, izi sizinali choncho. Chifukwa chake anthu amadabwa kuti angapangitse bwanji kupulumuka kwa nthawi yayitali?

Amaiwala kuti mphamvu ya mankhwala a kansa ya prostate, monga chemotherapy ndi hormone blockade, imangotetezedwa ndi kugwiritsa ntchito mosalekeza. Ngati mankhwala atayimitsidwa, zotsatira zake zimatha ndipo khansa imayambiranso kukula.

Mmene chitetezo cha mthupi chimatulutsira, chimachitika mosalekeza. Choncho, ngakhale kupatsa kumangopangitsa kuchepetsa kuchepa kwa matenda, chifukwa zotsatira zake zimakhala zochitika pamapeto pa moyo wa wodwalayo. Ndipo munthu amakhala ndi moyo wautali, kukula kwakukulu kwa phindu.

Kutsata Canast Metastases

Malinga ndi deta yomwe ili pamwambapa, mwachidziwikire chimatsiriza kuti Katengedwe kake kamayambidwe mwamsanga mwa munthu wina yemwe watengedwa ndi kansalu yofunika kwambiri ya kansa ya prostate . Mwamwayi, makampani a inshuwalansi amangotenga chithandizo chamankhwala anthu atayamba kukana mankhwala (hormone) (Lupron) ndi kansa metastases. Popeza nthawi zambiri mavitamini amatha kusokonezeka pamaso pa metastases, amuna omwe ali ndi kansa ya prostate yowonongeka omwe akulamulira PSA yawo ndi Lupron ayenera kuyang'ana kuti PSA ikule. Kuthamanga kwa mahomoni kumatanthawuza kuti kuwuka kwa PSA pomwe pa Lupron kapena mankhwala aliwonse a Lupron.

Pa chiwonetsero choyamba kuti PSA ikuyamba kuwuka, amuna ayambe kuyang'ana mwamphamvu kwa metastases. Pakalipano, kuyang'ana kwa PET ndiyo njira yabwino kwambiri yopezera metastases pamene PSA ikhalabe yochepa, kunena pansi pa ziwiri. Pali mitundu yosiyana yosiyanasiyana ya PET yomwe imalingalira kugwiritsira ntchito: F18 fupa zowonongeka, Axumin, C11 acetate, C11 choline, kapena Gallium68 PSMA. Ngati zowonongeka sizingathe kuzindikira matenda oyambitsa matenda, ziyenera kubwerezedwa mobwerezabwereza miyezi isanu ndi umodzi iliyonse mpaka mthenda yamatenda ikapezeka, pambuyo pake Zopereka ziyenera kuyambitsidwa mofulumira.

Mtundu Wina wa Immunotherapy

Pazaka 30 zapitazo, kuyesa kwa chitetezo cha mthupi kwalephera kuyesetsa. Tikuyamba kuphunzira kuti zolephereka izi zimachokera ku ntchito zowonjezereka za chigawo cha chitetezo cha mthupi. Nthawi iliyonse pamene thupi limapanga ntchito yatsopano yoteteza thupi lanu, ntchitoyo imachititsa munthu kudziletsa kuti asamayende bwino. Izi ndikuteteza chitukuko cha matenda opatsirana a chitetezo monga lupus, nyamakazi ya nyamakazi, kapena multiple sclerosis.

Tsopano ofufuza aphunzira kuti maselo a kansa amagwiritsa ntchito mbali imeneyi yolamulira ya chitetezo cha mthupi mwa kupanga mahomoni otha kuteteza thupi. Mahomoni amenewa amachititsa kuti chitetezo cha mthupi chiteteze, motero zimathandiza kuti maselo a khansa apitirizebe kusunga maselo a T akupha. Maselo otsogolera, maselo a Treg, amatanthauza "kutengedwa" ndipo amatengedwa ngati chishango kuti achepetse ntchito yathu yoteteza thupi la mthupi. Kulephera kwa chitetezo cha mthupi kuteteza khansa si chifukwa cha kufooka kwa thupi; M'malo mwake, zimakhala zosokoneza thupi kuchokera kuntchito zowonjezereka zomwe zimayambitsidwa ndi maselo a khansa. Ndikumvetsetsa kwatsopano kumeneku, opanga mankhwala ena apangidwa kuti athetsere vutoli.

Yervoy ndi mankhwala otero, omwe ndi FDA omwe amavomereza kuti athetse khansa ya khansa. Yervoy amagwira ntchito poletsa CTLA-4, lamulo "kusintha" pamtunda wa Treg maselo. Pamene mawotchiwa ali "pa," ntchito yowonongeka ikuwonjezeka ndipo chitetezo cha mthupi chimachotsedwa. Pamene Yervoy akusintha CTLA-4 "kuchoka," ntchito yoletsera ya Treg maselo imachotsedwanso ndipo zotsatira zake zimachokera ku chitetezo cha mthupi.

Kafukufuku woyamba pofufuza Yervoy mwa amuna omwe ali ndi khansara ya prostate amasonyeza malonjezano, makamaka pamene akuphatikizidwa ndi ma radiation (onani m'munsimu). Komabe, kafukufuku waposachedwapa amasonyeza kuti mankhwala ena oletsa oletsa otchedwa Keytruda akhoza kugwira ntchito bwino.

Keytruda imatsegula chosinthira china chotchedwa PD-1. Ophunzira oyambirira a khansa ya prostate amasonyeza kuti Keytruda ikhoza kuyambitsa mphamvu yowonongeka kwambiri kuposa Yervoy, ndipo imayambitsa mavuto ochepa kuti ayambe kutentha. Ngati zotsatirazi zowonjezera ndi Keytruda zatsimikiziridwa, mankhwala othandizira ndi Keytruda pamodzi ndi Njira zowonjezera zingakhale njira yabwino yopititsira patsogolo ntchito yowonongeka ya chitetezo cha mthupi.

Mtheradi wa Absopal

Njira yothandizira chitetezo cha m'thupi ndi njira ina yomwe ingathandize kuti chitetezo cha mthupi chitengeke. Pamene phokoso la dzuwa limapweteka maselo otupa, maselo a chitetezo chathu cha mthupi amayandikira chifuwa chofa ndikuchotseratu zinyalala zomwe zimatsalira. Mphunoyi imaphatikizapo maselo a chitetezo kumbuyo komwe amadziwika kuti ndi maselo okhudzidwa ndi maselo omwe amatha kufa, kenako amasaka maselo a khansa m'madera ena a thupi pogwiritsira ntchito mamolekyumu omwewo.

Pali zinthu zambiri zokongola zomwe zimapangitsa kuti chitetezo cha m'magazi chitengedwe:

1. Pogwiritsidwa ntchito mosankha komanso mwaluso pamakhala palibe zotsatirapo.
2. Mankhwalawa amadzazidwa ndi mitundu yonse ya inshuwalansi.
3. Mafutawa ndi amphamvu kwambiri kuti athetse vutoli.
4. Ndi zophweka kuphatikizapo ma radiation ndi Provenge, Keytruda kapena onse awiri.

Mawu Ochokera

Kumvetsetsa kwathu kwa chitetezo cha mthupi kwa khansara ya prostate ikukula mwamsanga koma akadakali mwana. Ngakhale zili choncho, ndizosangalatsa kuzindikira kuti tili ndi zipangizo zingapo zomwe tingathe. Chovuta kupita patsogolo ndicho kuphunzira momwe zipangizo zatsopanozi zingagwiritsire ntchito bwino, kaya mwaokha kapena kuphatikiza. Pitirizani kukambirana ndi dokotala wanu za momwe mungagwiritsire ntchito matenda a immunotherapy kuti mudziwe ngati zili zoyenera kwa inu.

> Zotsatira:

> Higano, Celestia S. "Sipuleucel-T: Autologous Cellular Immunotherapy kwa Khansa ya Prostate ya Metastatic Castration-Resistant." Kugwiritsa Ntchito Mankhwala Osokoneza Bongo la Khansa ya Prostate , tsamba 321-328. Springer New York, 2010.

> Kantoff, Philip W., Celestia S. Higano, Neal D. Shore, E. Roy Berger, Eric J. Small, David F. Penson, Charles H. Redfern et al. "Sipuleucel-T immunotherapy kwa kansa ya prostate yosagonjetsedwa." New England Journal of Medicine 363, ayi. 5 (2010): 411-422.

> Lipson, Evan J., Patrick M. Forde, Hans-Joerg Hammers, Leisha A. Emens, Janis M. Taube, ndi Suzanne L. Topalian. "Otsutsana ndi PD-1 ndi PD-L1 omwe akudwala khansa." Mu Seminare mu zamatsenga , vol. 42, ayi. 4, masamba 587-600. WB Saunders, 2015.

> Silvestri, Ida, Susanna Cattarino, Sabrina Giantulli, Cristina Nazzari, Giulia Collalti, ndi Alessandro Sciarra. "Maganizo a khunyu ya prostate." Khansa 8, ayi. 7 (2016): 64.