Arimidex, Femara, ndi Aromasin Kuyerekezera ndi Zotsatira Zotsatira
Ngati mwatsiriza kuchipatala msanga, khansa ya m'mawere yotchedwa estrogen, dokotala wanu angakulangize mankhwala a hormonal kwa zaka 5 mpaka 10. Kusankha mankhwala osokoneza bongo kungadalire chifukwa cha matenda a minofu, ndi aromatase inhibitors kawirikawiri kusankha koyamba kwa amayi omwe ali ndi amayi am'mawa komanso amayi ena omwe ali ndi chiopsezo chachikulu komanso mankhwala opatsirana ovari.
Kodi kusiyana pakati pa Femara, Arimidex, ndi Aromasin, ndi zotsatira zotani zomwe mungayembekezere, ndipo mankhwalawa amasiyana bwanji ndi tamoxifen? Kodi ndi zothandiza bwanji kuti asaletse khansa ya m'mawere?
Tizilombo toyambitsa matenda a Aromatase: Tanthauzo
Aromatase inhibitors ndi mankhwala omwe amalepheretsa kupanga estrogen m'thupi. Pochita zimenezi, amachepetsa chiopsezo cha kubwereka kwa khansa ya m'mawere (ndi kuonjezera kupulumuka) kwa amayi omwe ali ndi khansa ya m'mawere yoyambilira yotchedwa estrogen-receptor ndipo ali ndi ammopa. Angathandizenso kuchepetsa chiopsezo cha amayi ena omwe ali ndi khansa ya m'mawere ya premenopausal kuposa tamoxifen. Pali mankhwala atatu osiyana mu mankhwalawa.
Mankhwala a aromatase inhibitor ayamba pambuyo poyambitsidwa kwambiri ndi khansa ya m'mawere. Izi zikuphatikizapo opaleshoni ya khansa ya m'mawere komanso mwinamwake mankhwala othandiza kudwala khansa . Chithandizo chikupitirira kwa zaka 5 mpaka 10 malinga ndi chiopsezo cha munthu chobwereza ndi kulekerera zotsatira zake.
Thandizo la mahomoni la khansa ya m'mawere
Khansa ya m'mimba yomwe imapezeka ndi estrogen receptor positive imadyetsedwa ndi estrogen. Maselo a khansa ya pachifuwa, monga maselo oyambirira a m'mawere, ali ndi maselo otchedwa estrogen pamwambapa. Khansa yomwe imatchedwa "zabwino" kwa estrogen kapena pulogalamu ya progesterone ndiyo yomwe maestrogen awa ndi omwe amachititsa kukula kwa khansa.
Udindo wa estrogen mu zotupazi ndikumangiriza ku zotchedwa estrogen receptors kuti ziwathandize kukula ndi kupatukana kwa maselo.
Pofuna kuchepetsa kapena kuchepetsa kukula kwa maselo a khansa ya m'mawere, timayenera njira yothetsera kuchepa kwa estrogen m'thupi kapena kutseka ma recerogen kuti estrogen yomwe ilipo ikhale yosagwirizane.
Njira za Hormonal Therapy: Tamoxifen ndi Aromatase Inhibitors
Musanayambe kusamba, mazira a m'mimba ndi malo enieni a estrogen yopanga thupi. Tamoxifen mankhwala amagwira ntchito poletsa mavitro a estrogen pa maselo a kansa ya m'mawere (ndi maselo ena) kotero kuti estrogen sungamange. Tamoxifen kwenikweni ali ndi zotsatira zotsutsa-estrogen kumbali zina za thupi monga bere, koma ma pro-estrogen amachititsa ena, monga mafupa (angachepetse mafupa). Choyamba chovomerezeka mu 1998, tamoxifen wakhala akugwiritsidwa ntchito kwambiri kwa khansa ya m'mawere kwa zaka zoposa makumi awiri.
Pambuyo pa kusamba, chitsime chachikulu cha estrogen chimachokera kumalo osungunuka a androgens (mahomoni amtundu wamwamuna omwe amapezeka m'ma maselo ambiri) mu estrogen. Izi zimawathandiza ndi mavitamini otchedwa aromatase. Aromatase inhibitors amagwira ntchito potseka aromatase kuti androgens isasinthe kukhala estrogen mu thupi.
Popeza chitsimikizo chachikulu cha isrogen musanayambe kusamba ndi mazira ambiri, osati kutembenuka kwa pulogalamu ya androgens, aromatase inhibitors okhawo sangakhale othandizira kwa amayi amene amakhalabe amodzi (ndipo mkazi akhoza kukhala wamwamuna ngakhale atasiya mankhwala ake).
Kumvetsa Aromatase Inhibitors: Arimidex, Femara, ndi Aromasin
Pakali pano pali mitundu itatu yosiyana ya aromatase inhibitors yomwe imavomereza kuchepetsa chiopsezo cha kubwereza kwa amayi omwe ali ndi msinkhu woyambirira, khansa ya m'mawere yotchedwa estrogen. Izi zikuphatikizapo:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (chiwombankhanga)
Mankhwalawa amawoneka ngati othandiza popewera kubwereza koma amakhala ndi kusiyana. Aromasin ndi steroid, pamene Arimidex ndi Femara sali. Kuopsa kwa mankhwala atatuwa akuwoneka kuti ndi ofanana.
Tamoxifen ndi Breast Cancer Recurrence
Tili ndi zambiri zambiri panthawiyi tikuyang'ana kugwiritsa ntchito tamoxifen komanso chiopsezo cha kubwerera kwa khansa ya m'mawere . Zonsezi, zikagwiritsidwa ntchito pamayambiriro oyambirira, zotupa zotchedwa estrogen, zimathandiza kuchepetsa kupweteka kwa pafupifupi 50 peresenti. Tamoxifen imathandizanso kuti mukhale ndi chotupa china m'mimba mwanu (ngati muli ndi lumpectomy) kapena kuti mukhala ndi khansa yachiwiri ya m'mawere m'thupi lanu.
Aromatase Inhibitors ndi Kubwereza Khansa ya M'bwere
Aromatase inhibitors amawoneka kuti amachepetsa chiopsezo cha kubwereranso kuposa tamoxifen ndipo tsopano akuonedwa kuti ndi mankhwala osankhidwa kwa amayi omwe amamwalira pambuyo pake kapena omwe ali a premenopausal ndipo akhala akuchiritsidwa kuchipatala.
Ndondomeko Yowonjezeredwa ya Thandizo la Hormonal
Azimayi omwe amatha kumwa mankhwalawa amatha kutenga aromatase inhibitor, ndondomeko ya 2017 tsopano amalangiza kugwiritsa ntchito bisphosphonate Zometa (zoledronic acid) pamodzi ndi aromatase inhibitor. Kuphatikizidwa kwa mankhwala awiriwa pamodzi kumaoneka kuti kuchepetsa chiopsezo cha khansa ya m'mawere yomwe ikufalikira mafupa kuposa aromatase inhibitor yekha. Phunzirani zambiri za kugwiritsidwa ntchito kwa bisphosphonates kwa khansa ya m'mawere .
Aromatase Inhibitors a Atmenopausal Women With Ovarian Suppression
Funso lakuti kuwonjezerapo mankhwala ochotsera ovarian (pogwiritsa ntchito gonadotropins kuti mankhwala amachititse kuti asinthe) tamoxifen wakhala nkhani yotsutsana. Komabe, kafukufuku wofalitsidwa ku New England Journal of Medicine mu 2015, akuwoneka kuti akuwonetsa kuti amayi omwe ali ndi amayi omwe amachiritsidwa ndi ovarian antibiotic kuti athe kugwiritsa ntchito aromatase inhibitor mmalo mwa tamoxifen akhoza kukhala ndi moyo wabwino.
Kafukufuku wina amene anafalitsidwa m'magazini yomweyi mu 2014 anapeza kuti Aromasin (mpweya wamkuntho) kuphatikizapo mankhwala ochotsera ovari anathandizira kupulumuka poyerekeza ndi mankhwala a tamoxifen komanso ovarian suppression.
Popeza aromatase inhibitors ali ndi zotsatira zoopsa kwambiri za minofu ndipo zingayambitse mafupa ambiri, akatswiri ambiri ovomerezeka amalangiza kuti asunge njira imeneyi kwa amayi omwe ali ndi matendawa omwe ali ndi Gawo 2 ndi khansa ya m'mawere yachitatu , yomwe ingakhale yobwereranso.
Zotsatira Zotsatira za Aromatase Inhibitors
Mofanana ndi mankhwala aliwonse, zotsatirapo ndi zotsatira zolakwika zingayambe kwa amayi ena pa aromatase inhibitors.
Zina mwa zotsatira zofala kwambiri ndi zomwe zimachepetsa kuchepa kwa estrogen mu thupi (menopausal zizindikiro) ndipo zimaphatikizapo kutentha, kutentha usiku, kuuma kwa amayi, ndi kutaya kwa mkazi. Ngakhale zizindikirozi zingakhale zokhumudwitsa, kafukufuku amasonyeza kuti kutentha ndi chizindikiro chabwino kwa amayi omwe ali ndi khansara ya m'mawere, ndipo omwe akukumana ndi zotsatirazi amakhala ndi zotsatira zabwino.
Kupweteka kofanana komanso kumaliseche kumakhalanso koopsa kwambiri kwa aromatase inhibitors. Ndizimene thupi limapanga kuti ndi chimodzi mwa zifukwa zazikulu zomwe amayi akuchotsera mankhwalawa.
Chimodzi mwa zovuta kwambiri pa aromatase inhibitors ndi kuperewera kwa mafupa, pogwiritsira ntchito mankhwalawa omwe angabweretse kufooka kwa magazi ndi mitsempha. Ofufuza ambiri amavomereza kuti ayese kuchulukitsa mafupa asanayambe kumwa mankhwalawa monga maziko, ndikutsata malinga ndi zotsatira za mayeso oyambirirawa.
Kuwonjezera kwa bisphosphonates (Zometa) ku aromatase inhibitor thérapizo kungachepetse kwambiri chiopsezo ichi. Mabisphosphonates amavomerezedwa koyamba ngati mankhwala odwala matenda otupa mafupa, ndipo Zometa zapezeka kuti zithetsa chiwopsezo cha mphuno ndi kupweteka kwa m'chiuno (ndi kulemala komwe kumapita nthawi zambiri ndi izi). Zometa analimbikitsidwa kwa anthu omwe ali ndi khansa ya mthupi, chifukwa ikhoza kuchepetsa ululu wa fupa komanso chiopsezo cha mafupa okhudzana ndi mafupa. Kafukufuku wina amasonyeza kuti Zometa amasintha kachilombo ka HIV kuti mafupa a m'mawere asagwire "mosavuta" mosavuta. Kugwiritsa ntchito kuchipatala, zikuwoneka kuchepetsa mwayi woti khansara ya munthu idzafalikira mafupa awo.
Aromatase inhibitors akugwirizananso ndi ngozi yowonjezereka ya mavuto a mtima. Ngakhale izi ziri zoona, zapezeka kuti matenda oopsa komanso owopsa a mtima monga matenda a mtima ndi mikwingwirima sizinanso zofala kwa amayi omwe amatenga aromatase inhibitors kusiyana ndi omwe samamwa mankhwalawa. Matenda a mtima omwe amapezeka kawirikawiri pa mankhwalawa amatengera matenda a mtima , mavuto a mtima wa valve , ndi pericarditis (kutupa kwa nembidzi kumbali ya mtima).
Ngati zotsatira zoyipa zimakupangitsani kufuna kuimitsa mankhwala anu
Zotsatira za aromatase inhibitors, makamaka thupi aches, zingakhale zovuta nthawi zina. Mwamwayi, zotsatira zake zimapangitsa akazi ambiri kusiya chithandizo msanga komanso kutaya nthawi yowonongeka (komanso kupulumuka kwabwino) komwe amapereka.
Ngati muli ndi zotsatira zoyipa, lankhulani ndi oncologist wanu. Ngakhale chitetezo ndi poizoni wa mankhwala atatuwa m'kalasili ndi ofanana, pafupifupi gawo limodzi mwa magawo atatu a amayi amatha kulekerera mankhwala osiyanasiyana mukalasiyi.
Kusintha kuchokera ku Tamoxifen kupita ku Aromatase Inhibitor
Anthu ena omwe ali ndi matendawa amachititsa kuti am'bwewe pambuyo pake. Izi ndizowona makamaka kwa amayi amene amachititsa khansa ya m'mawere nthawi yoyamba. Popeza chemotherapy nthawi zambiri imabweretsa amenorrhea (kusowa kwa nthawi), kuyezetsa magazi kungafunikire kuchitidwa kuti mudziwe ngati mulidi m'kupita kwa nthawi. Kafukufuku apeza kuti kusinthasintha kwa aromatase inhibitor pakatha zaka 2 mpaka 3 za mankhwala a tamoxifen kumapangitsa kukhala ndi moyo wabwino kusiyana ndi kupitiriza tamoxifen.
Kutalika kwa Chithandizo ndi Aromatase Inhibitors
Ngakhale zinali zovomerezeka kuti anthu apitirize tamoxifen kapena aromatase inhibitor kwa zaka zisanu m'mbuyomo, deta yatsopano imasonyeza kuti kutenga mankhwalawa kwa zaka khumi kumachepetsa kuchepetsa kubwereza. Ndizodziwika bwino kuti khansara ya m'mawere ingabwererenso zaka zambiri kapena zaka makumi atatu pambuyo pa chithokomiro chachikulu, ndipo chiopsezo choterechi ndi chachikulu kwambiri kwa amayi omwe ali ndi zotupa zotchedwa estrogen. Sitikudziwa chifukwa chake khansa ya m'mawere imabwerera pambuyo pa zaka zambiri kapena makumi, koma tikudziwa kuti izi zimachitika kawirikawiri.
Tamoxifen ndi aromatase inhibitors zikuoneka kuti zikupitirizabe kugwira ntchito atasiya, ngakhale akatswiri ena akukhulupirira kuti mankhwala opitirira mahomoni angapitirire kwa zaka zoposa 10 m'tsogolomu. Izi zinati, phindu loyenera liyenera kulemedwa pa zoopsa.
Mtengo wa Aromatase Inhibitors
Mosiyana ndi tamoxifen yomwe yakhala yozungulira zaka makumi angapo ndipo ili ndi mitundu yowonjezera, aromatase inhibitors angakhale odula. Mapulani a inshuwalansi amatenga mbali imodzi ya mtengo, ngakhale angapereke chithandizo cha mankhwala amodzi m'kalasili. Ngati mukuvutika kuika AI yanu, yang'anani malangizo awa pa kuyendetsa mtengo wa mankhwala opatsirana .
Mawu Ochokera
Aromatase inhibitors amagwira ntchito poletsa kutulutsa estrogen m'maselo ambiri, omwe amachokera ku estrogen m'mayi am'maopaopausus. Tidziwa kwa zaka makumi angapo kuti tamoxifen ikhoza kuchepetsa kwambiri chiopsezo cha kubwerera kwa khansa ya m'mawere ndipo manambalawa akuwoneka bwino kwambiri ndi aromatase inhibitors.
Mwamwayi, ndipo monga ndi mankhwala aliwonse, zotsatira zake zimakhala zachilendo, ndipo thupi limakhala lokhumudwitsa kwambiri. Ngati mukukumana ndi izi, gwiritsani ntchito ndi oncologist yanu. Nthawi zina zimakhala zosangalatsa kuti mutembenuke ku mankhwala osiyana mukalasiyi. Mankhwala othandizira okhudza kusisita ndi kusinkhasinkha angakhalenso othandiza. Ndifunikanso kudzikumbutsa chifukwa chake mukugwiritsa ntchito mankhwalawa. Zotsatirapo zingakhale zokhumudwitsa koma ndizotheka kubwereza. Tsopano kuti ma bisphosphonates akulimbikitsidwa pamodzi ndi aromatase inhibitors, kudandaula kwa kuchepa kwa kupuma kwa mafupa ndi kufooketsa mafupa kungakhale kovuta kwambiri mmbuyomu.
Kumbukirani kuti mkazi aliyense ndi wosiyana ndipo palibe "matsenga" nthawi yomwe aliyense ayenera kumwa mankhwalawa. Kwa munthu aliyense, ndikofunika kufufuza zomwe zingapindule ndi zotsatirapo zomwe zimayambitsa mavuto komanso zoopsa. Onetsetsani kuti mufunse mafunso ochuluka ndipo khalani ovomerezeka anu mu chisamaliro chanu. Palibe yemwe akulimbikitsidwa kwambiri kuti mukhale moyo wanu wopanda khansara.
> Zotsatira:
> Francis, P., Regan, M., Fleming, G. et al. Kuchulukitsa Ovarian Adjuvant mu Premenopausal Khansa ya m'mawere. The New England Journal of Medicine . 2015. 372 (5): 436-446.
> Hague, R., Shi, J., Schottinger, J. et al. Matenda a Mtima Pambuyo pa Aromatase Inhibitor Ntchito. JAMA Oncology . 2016. 2 (12): 1590.
> Pagani, O., Regan, M., Walley, B. et al. Exemestane ya Adjuvant ndi Kuponderezedwa kwa Ovarian mu Premenopausal Cancer ya Breast. The New England Journal of Medicine . 2014. 371 (2): 107-118.
> Tjan- > Hejinen >, V., Hellemond, I., Peer, P. et al. Kuchulukitsidwa kwa Adjuvant Aromatase Kudzitsitsa Pambuyo Pogwiritsa Ntchito Matenda a Endocrine Opatsirana (DATA): Zomwe Zidzakhala Zosintha, Gawo 3. Lancet Oncology . 2017. 18 (11): 1502-1511.