Mankhwala ochiritsidwa ndi mankhwala atsopano a khansa ya m'mawere yomwe ingagwiritsidwe ntchito yokha kapena kuphatikizapo mankhwala ena. Mosiyana ndi mankhwala omwe amachititsa kuti maselo aliwonse omwe akukula mofulumira, omwe amawongolera amatha kutsogolera maselo a khansa kapena njira zowonetsera kukula kwa maselo a kansa. Pa chifukwa chimenechi, mankhwala ambiri akhoza kukhala ndi zotsatira zochepa kuposa mankhwala a chemotherapy.
Mankhwala ochiritsidwa amapezeka kwa omwe ali ndi khansa ya m'mawere yotchedwa estrogen, khansa ya m'mawere yokha ya 2 , komanso khansa ya m'mawere itatu.
Mankhwalawa amatha kugwira bwino ntchito nthawi zina, koma monga mankhwala ena omwe amagwiritsidwa ntchito pokonza khansa ya m'mawere, nthawi zambiri amayamba kutsutsa. Zina mwa mankhwalawa zimagwiritsidwa ntchito panthawi yoyambirira komanso khansa ya m'mawere, pamene ena amagwiritsidwa ntchito makamaka kwa anthu omwe ali ndi kansa ya m'mawere.
Kwa HER2 Cancer Positive
Monga tanenera kale, pafupifupi 25 peresenti ya khansa ya m'mawere, jini yotchedwa epidermal growth receptor 2 (kapena HER 2 / neu) amachititsa kuwonongeka kwakukulu kwa mapuloteni a HER 2 (receptors) pamwamba pa maselo a khansa ya m'mawere.
Mofananamo, mwa njira, njira yomwe estrogen yolandira imayenera kusonyeza selo ya khansa kukula ndi kufalikira, HER 2 receptors zingayambitse kukula ndi kufalikira kwa khansa 2 zabwino za khansa.
Mankhwala omwe amalepheretsa kulandira mankhwalawa amatero kuti asokoneze chizindikiro cha maselo a khansa, kuchepetsa kukula kwawo.
Mankhwala omwe amawunikira HER 2 akuphatikizapo:
- Herceptin (trastuzumab) - Herceptin amapatsidwa IV nthawi zambiri pamlungu kapena kamodzi pa masabata atatu. Zotsatira zoyipa zimaphatikizapo kutentha ndi kuzizira kumayambiriro. Kulephera kwa mtima kungapangitse anthu atatu kapena asanu peresenti ya anthu omwe amachizidwa ndi mankhwala, koma mosiyana ndi mtima wosagwirizana ndi chemotherapy mankhwala monga Adriamycin (doxorubicin), kulephera mtima kumatha kusintha ngati mankhwala atayimitsidwa. Zotsatira zake zochokera kwa Herceptin nthawi zambiri zimawongolera pakapita nthawi.
- Kadcyla (ado-trastuzumab) - Kaydcyla ndi mankhwala omwe amaphatikizapo Herceptin ndi mankhwala amphamvu kwambiri a chemotherapy otchedwa emtansine. Gawo la Herceptin la mankhwalawa limaphatikizapo HER 2 maselo abwino a khansa, koma mmalo motseka kokha katemera kuti asaletse kukula kwa ma hormoni kuti asamangidwe, imapereka "kulipira" kwake-mankhwala a chemotherapy omwe ali ndi maselo a khansa.
Herceptin amalola mankhwala a chemotherapy kulowa m'maselo a khansa, kumene emtansine imamasulidwa. Ngakhale mankhwalawa amathandizidwa kwambiri ku maselo a khansa, palinso mankhwala enaake omwe amawathandiza kuti azitha kudwala khansa.
Pachifukwa ichi, mankhwalawa akhoza kukhala ndi zotsatira zochizira mankhwala a chemotherapy monga kuphwanya mafuta a mitsempha ndi phokoso la m'mimba. Kaydycla ikhoza kukhala yothandiza ngakhale kwa anthu omwe Herceptin sakuwathandiza. - Perjeta (pertuzumab) - Perjeta ndi FDA yomwe inavomerezedwa ndi khansa ya m'mawere m'chaka cha 2013 ndipo kafukufuku apeza kuwonjezeka kwa chiwerengero cha amayi omwe ali ndi kansa ya m'mawere (HER 2 positive) amene amachizidwa ndi mankhwalawa. Angagwiritsidwe ntchito payekha kapena kuphatikiza ndi Herceptin kapena chemotherapy.
- Tykerb (lapatinib) - Tykerb amatsutsanso HER 2 maselo a kansa ya m'mawere, koma mwa njira yosiyana ndi Herceptin. Tykerb, yosiyana ndi Herceptin si anti-antibody, ingagwiritsidwe ntchito yokha, kapena yogwirizana ndi Herceptin kapena chemotherapy. Zotsatira zofala kwambiri ndizophulika zomwe zimawoneka ngati zofanana ndi acne (koma sizitengedwa monga acne) ndi kutsekula m'mimba.
Zotsatira Zotsatira za Mankhwalawa
Herceptin, Kaydcyla, ndi Perjeta ali ndi njira zofananamo zochitiramo kanthu, choncho, zotsatira zofanana. Chimodzi mwa zotsatira zokhudzana ndi mankhwalawa ndi kuwonongeka kwa mtima. Wachikulire wanu angakulimbikitseni kufufuza mayeso a mtima wanu musanayambe kumwa mankhwalawa ndikukulangizani zizindikiro zomwe zimasonyeza kuti muyenera kuitanira.
Kwa Estrogen Receptor Positive Cancer
Kwa amayi omwe ali ndi khansa ya m'mawere ya mthupi la mahomoni, zovuta zothandizira zimapezeka. Mankhwala awa amagwiritsidwa ntchito kwa amayi omwe ali postmenopausal (kapena omwe ali ammenopaususal ndipo adalandira mankhwala ochotsera ovarian) kuti apange mankhwala ochizira odwala.
Mankhwalawa ndi awa:
- Mafuta (palbociclib ) - Mankhwalawa amaletsa mavitamini otchedwa cyclin-dependent kinases (CDK4 ndi CDK6) ndipo amagwiritsidwa ntchito pambuyo pa kansa ya m'mawere ya m'mimba yotchedwa estrogen. Zingagwiritsidwe ntchito limodzi ndi aromatase inhibitor monga Femara (letrozole) kapena mankhwala oletsa anti-estrogen Faslodex (fulvestrant.)
- Afinitor (everolimus) - Mankhwalawa amaletsa mapuloteni mu thupi lotchedwa mTOR. Wokonda kugwiritsira ntchito nthawi zambiri amagwiritsidwa ntchito pa cholera cha estrogen chabwino ndi chotupa cha HER 2 choipa pambuyo poti sagonjetsedwa ndi mankhwala a aromatase monga aromatase (exemastine).
Kwa khansa ya m'mawere yochepa
Matenda omwe amapezeka ndi estrogen receptor, odwala progesterone, ndi HER 2 zoipa (khansa ya katatu yosagonjetsa khansa) ingakhale yovuta kwambiri, monga mankhwala achimuna ndi ma ARV awo nthawi zambiri sagwira ntchito. Pogwiritsidwa ntchito mopanda panthawiyi, Avastin amatha kuwongolera anthu ena.
- Avastin (bevacizumab) - Izi sizikugwiritsidwanso ntchito kuti tizitha khansa ya m'mawere chifukwa nthawi zina zimakhala zowawa kwambiri. Amakhala ngati angiogenesis inhibitor. Mawu akuti angiogenesis amatanthawuza "magazi atsopano" ndipo amatanthauza mitsempha yatsopano yomwe imayenera kupangidwira kuti khansa ikule.
Angiogenesis inhibitors amagwira ntchito popewera khansa kukulitsa mitsempha yatsopano ya magazi, ndipo makamaka "njala" ya khansa.
> Zotsatira:
> DeVita, Vincent., Et al. Khansara: Mfundo ndi Zochita za Oncology. Khansa ya pachifuwa. Wolters Kluwer, 2016.
> Liedtke, C., ndi H. Kolberg. Thandizo labwino la Khansa yapamwamba / Metastatic Breast Breast-Umboni Weniweni ndi Malingaliro Amtsogolo. Care Care . 2016. 11 (4): 275-281.