Dokotala wanu adzayang'ana zotsatira zotani?
Monga mankhwala ena alionse, pali chingwe chokwanira komanso chotsutsana. Chotsatira chake ndi chakuti matendawa amagwiritsidwa ntchito kuti apangitse zizindikiro zina za khansara ngati khansa yapakhungu yopanda makompyuta, khansa ya khansa ya khansa ya khansa, khansa yamtundu wa khansa, ndi khansa ya Hodgkin's lymphoma. Mwa kuyankhula kwina, anthu akupatsidwa mwayi wachiwiri pokhala ndi moyo wathanzi komanso wokhala ndi moyo wabwino-chinthu chodabwitsa chomwe chimasintha nkhope ya khansa.
Zoonadi, kuyendetsa mu immunotherapy kumangoyambika, ndipo iyi ndi malo osangalatsa komanso osangalatsa kwambiri pa kafukufuku wa khansa ndi chisamaliro pakalipano.
Chifukwa chake, ngati anthu ambiri akuchiritsidwa ndi immunotherapy, makamaka the checkpoint inhibitors (ipilimumab, nivolumab, ndi pembrolizumab), madokotala akuwona mavuto omwe angakhalepo chifukwa cha kumwa mankhwala atsopanowa.
Chidule cha Checkpoint Inhibitors
Pofuna kumvetsetsa zotsatira zovulaza kapena zoopsa za poizoni, ndizofunika kumvetsa momwe mtundu uwu wa immunotherapy umagwirira ntchito.
Mwachidule, zizindikiro za chitetezo cha mthupi zimayang'ana pa maselo a chitetezo cha mthupi (otchedwa T maselo). Mamolekyu ameneŵa amatha kudutsa njira zovuta kuti athetse maselo a munthu T kuti asawononge maselo abwino, omwe ali kunja kwa maselo (mwachitsanzo, maselo omwe ali ndi kachilombo).
Mwamwayi, maselo a khansa amanyenga chifukwa amapanga ndi kufotokozera mamolekyu awo, ndipo chifukwa chake thupi lanu siligonjetsa chotupa chachikulu, momwe mungaganizire.
Komabe, asayansi athandizanso kupanga mankhwala omwe amaletsa ma checkpoints omwe ali ndi maselo a khansa, omwe amayembekezera kuti tsopano chitetezo cha mthupi chikhoza kuzindikira kuti khansa ndi yachilendo.
Toxicities of Checkpoint Inhibitors
Inde, mavuto angabwere ngati chitetezo cha mthupi chitayamba kusokonezeka ndikuyamba kuyambitsa maselo abwino, kuphatikizapo maselo oipa a khansa.
Mwa kuyankhula kwina, kutupa kwakukulu, kuwonongeka kwa thupi, ndi matenda omwe amadzimadzimadzimodzi amatha kuchitika pogwiritsira ntchito zizindikiro za checkpoint.
Ndipotu, kafukufuku amasonyeza kuti mankhwalawa amachititsa anthu 85 peresenti atalandira chithandizo ndi checkpoint inhibitor ipilimumab. Amapezeka mpaka 70 peresenti ya anthu atalandira chithandizo ndi checkpoint inhibitors nivolumab kapena pembrolizumab.
Monga mbali, philimumab imaletsa chitetezo cha mthupi cha CTLA-4 (cytotoxic T- lymphocyte-protein protein 4) ndipo yayigwiritsidwa ntchito pochizira khansa .
Nivolumab ndi pembrolizumab cholinga cha PD-1 (cholandilira imfa yolandira 1) ndipo akhala akugwiritsidwa ntchito pochizira khansa ngati khansa ya khansa ya khansa ya m'mimba, khansa ya m'magazi yamtundu umodzi, ndi khansa ya Hodgkin's lymphoma.
Kubwereranso ku toxicities, komabe zida zoyambirira zomwe ziwonetsero zowonongeka "zolakwika" mu thupi ndi khungu, m'mimba, chiwindi, ndi matenda a endocrine.
Khungu Toxicities
Matenda a khungu ndi omwe amachititsa kuti thupi likhale lopweteka kwambiri lomwe limagwiritsidwa ntchito poyendetsa chezinesi.
Zitsanzo za mavuto a khungu zimaphatikizapo kuthamanga, kuyabwa, alopecia (tsitsi lotayika), ndi vitiligo .
Mphuno imakhala ngati pakamwa youma ndi pakamwa mumcositis (pamene zilonda zimakhala pakamwa) zingathenso kuchitika.
Chithandizo cha mphutsi kawirikawiri chimaphatikizapo kugwiritsa ntchito mankhwala a kirimu corticosteroid. Ngakhale ngati kutukuka kuli koopsa, nthawi zina pamakhala corticosteroid yamlomo. Kutenga antihistamine wamlomo monga Benadryl (diphenhydramine) kungakhale kothandiza kwa kuyabwa.
Kawirikawiri, ngati kutukuka kuli koopsa, kutanthauza kuti thupi limapitirira 30 peresenti ya thupi, munthu amafunikira steroids kuperekedwa kudzera mu mitsempha (mkati mwake) kenako amatsatira taper of oral steroids.
Ndikofunika kudziwa kuti ziphuphu zazikulu monga matenda a Stevens-Johnson akhala akudziwika kawirikawiri ndi anthu omwe amachititsa chezinesi.
Ichi ndichifukwa chake inu kapena dokotala wanu wokondedwa wa khansa adzakuyang'anitsitsa mosamala kwambiri pamene mutenga immunotherapy ndipo mwamsanga mukuwona dermatologist ngati kupweteka kwanu kukuwoneka koopsa (ngati ngati akupanga ziphuphu) kapena ngati simukupeza mpumulo ndi njira zosavuta monga kirimu cha corticosteroid.
Matenda a m'mimba
Kutsekula m'mimba ndi kupweteka kwa m'mimba, komwe kumayambitsa kupweteka kwa m'mimba ndi nthawi zina magazi mu mpando, ndi mavuto a m'mimba awiri omwe angayambe chifukwa chotsatira njira yochezera. Ngati zotsatirazi zikuchitika, amasonyeza masabata asanu ndi limodzi kapena kenako atayamba immunotherapy.
Izi zidawoneka kuti izi zimawoneka ngati zofala kwambiri kwa omwe amalandira anti-STD-4 (antibiotic), monga ipilimumab ya melanoma yapamwamba, poyerekeza ndi omwe amalandira PD-1 tizilombo toyambitsa matenda (mwachitsanzo, nivolumab ya epamous cell osati yaying'ono kansa yamapapu ya m'mapapo).
Kuchiza kwa matenda otsegula m'mimba komanso kumayambiriro kwakumayambiriro kumaphatikizapo kudya kwa madzimadzi okwanira, zakudya zowonongeka , komanso mwina mankhwala oletsa kutsekula m'mimba monga Imodium (loperamide). Koma ngati kutsekula m'mimba kumapitirira masiku awiri kapena atatu, ngakhale mankhwalawa ndi osavuta, kapena kutsekula m'mimba kumakhala kovuta kwambiri (mavitamini anayi kapena kuposerapo patsiku pafupipafupi), kufufuza koyenera kudzachitidwa kuti apitirize kuyesa kutsekula m'mimba ngati Matenda ndi ochimwa, osati mankhwala.
Ngati nthendayi imatulutsidwa, ndipo chifukwa chake chimawoneka ngati chokhudza mankhwala, corticosteroids ndizofunikira ndipo nthawi zina imakhala ndi mankhwala amphamvu omwe amaletsa chitetezo cha mthupi ngati Remicade (infliximab).
Imodzi mwazikuluzikulu zomwe zimawopsyeza moyo, ngakhale zachilendo, zovuta za matenda a colitis zomwe madokotala amazisamala ndi matumbo a m'mimba (kumene dzenje limapanga khoma lamatumbo chifukwa cha kutupa kwakukulu).
Chiwindi Toxicities
Checkpoint inhibitors ikhoza kutsogolo kwa michere ya chiwindi, yomwe imaonetsa kutentha kwa chiwindi. Zokwera izi zimawoneka pafupifupi miyezi iwiri kapena itatu mutayamba mankhwala.
Kawirikawiri, dokotala angayang'ane mayeso a magazi a chiwindi , makamaka pamaso pa mlingo uliwonse wa immunotherapy, ndipo ngati michere ikuwonjezeka, ntchito idzachitidwa kuti adziwe ngati chifukwa chake chikugwirizana ndi immunotherapy kapena china (mwachitsanzo, mankhwala ena kapena matenda a tizilombo).
Mofanana ndi zotsatira zina zolimbana ndi chitetezo cha mthupi, ngati chifukwa chake chikugwirizana ndi immunotherapy, corticosteroids idzalamulidwa. Ngati chiwindi cha chiwindi ndi choopsa, chithandizo ndi immunotherapy chiyenera kuimitsidwa palimodzi.
Endocrine System Toxicities
Zochitika zovuta zokhudzana ndi mthupi zingathe kuchitika mkati mwa thupi la endocrine, lomwe limaphatikizapo ululu wamatenda, chithokomiro, ndi matenda a adrenal. Kawirikawiri, zizindikiro zimawonekera patatha milungu isanu ndi iwiri mutangoyamba chithandizo ndipo zingaphatikizepo:
- Kutopa
- Kufooka
- Nausea
- Kusokonezeka
- Mutu
- Kutaya njala
- Mavuto a masomphenya
- Fever
Chimodzi mwa zomwe zimafala kwambiri m'thupi ndi matenda a hypothyroidism , omwe ndi pamene munthu amayamba kutulutsa chithokomiro chosawonongeka.
Matenda a chithokomiro opitirira muyeso, otchedwa hyperthyroidism, awonetsedwanso. Zonsezi zikhoza kuyang'aniridwa ndi katswiri wamaphunziro otulukira magazi ndipo amapezeka kupyolera mu kuyesedwa kwa magazi, makamaka matenda a chithokomiro omwe amachititsa kuti magazi awonongeke. Hypothyroidism imafuna chithandizo ndi hormone ya chithokomiro, yotchedwa Synthroid (levothyroxine).
Kuphatikizana ndi hypothyroidism, vuto lina lotchedwa endocrine vuto limene lingakhalepo chifukwa chotsatira chithandizo chodziletsa kuti munthu asatengere thupi ndi hypophysitis, ndiko kutukusira kwa ntchentche yomwe imatchedwa master gland chifukwa imatulutsa mahomoni ambiri m'thupi.
Hypophysitis ingayambitse kutopa ndi kupweteka mutu ndi kuyezetsa magazi kumasonyeza mahomoni ambiri otsika. Mayesero ojambula angasonyeze kutukusira kwa ntchentche ya pituitary. Ngati atapezeka posachedwa, mlingo waukulu wa corticosteroids ukhoza kutontholetsa kutupa pansi mokwanira kuti zisawononge kufunika kwa mankhwala osokoneza bongo omwe amatenga nthawi yaitali.
Ngati matenda a adrenal akhudzidwa, munthu akhoza kuyamba kuthamanga kwa magazi, kutaya madzi kwa madzi, ndi mavuto a electrolyte monga mazamu a potassium ndi ma sodium otsika m'magazi. Izi ndizodzidzidzi zamankhwala ndipo zimafuna kuti munthu alowe m'chipatala ndi kulandira corticosteroids.
Pomaliza, mtundu wa shuga watsopano wa mtundu wa shugawu sungagwirizane ndi kutenga PD-1 inhibitor. Ichi ndi chifukwa chake madokotala nthawi zambiri amafufuza shuga (shuga m'magazi anu) pamene mukuyamba mankhwala.
Zovuta Zosokoneza
Mankhwala amatha kuchepetsa kupweteka m'mapapo, ndipo izi zimatchedwa pneumonitis, ngakhale kuti ndizochepa, poyerekezera ndi toxicities. Izi zimakhudza kwambiri anthu omwe ali ndi khansara yamapapu yapamwamba yomwe imakhala ndi immunotherapy, monga momwe mapapu awo amachitira kale ndi khansara. Zingayambitse zizindikiro monga chifuwa kapena kupuma.
Ngakhale kuti nthawi zambiri zimakhala zovuta, pneumonitis ikhoza kuika moyo pachiswe. Ngati mukuganiza kuti, dokotala wanu adzachotsa zifukwa zina za kutupa kwa mapapo monga matenda a mapapu (otchedwa chibayo) kapena kupita patsogolo kwa khansa. Dokotala nthawi zambiri amapanga CT scan ya chifuwa kuti athandizidwe.
Chithandizo nthawi zambiri chimaphatikizapo kuimitsa thupi lake nthawi yeniyeni pamene munthuyo akuyang'anitsitsa mapapu awo. Corticosteroids imaperekedwanso nthawi zambiri, ndipo pakakhala zovuta kwambiri, imodzimodzi ngati Remicade (infliximab) ingafunike ngati munthu sakhala bwino ndi steroid.
Potsirizira pake, zina zoterezi zowonongeka zokhudzana ndi chitetezo cha mthupi zakhala zikudziwika ngati mavuto a mitsempha kapena maso. Pachifukwa ichi, dokotala wanu adzakutumizirani kwa katswiri, katswiri wa zamagulu kapena katswiri wa ophthalmologist , kuti adziwe momwe angapangire chithandizo choyenera cha mankhwala ndi mankhwala.
Mawu Ochokera
Ngati inu kapena wokondedwa wanu mukutenga checkpoint inhibitor, ndibwino kudziŵa zambiri zokhudza zoopsa zomwe zimayenderana ndi izo, chifukwa zimakhala zosiyana ndi zomwe zimagwirizana ndi mankhwala a chikhalidwe.
Mwa kuyankhula kwina, zizindikilo zowonongeka za zotsatirazi zimakhala zovuta kwenikweni kwa madokotala a khansa. Ngakhale zili choncho, musachite mantha ndi iwo. M'malo mwake, phunzirani ndi kukhala tcheru, monga ambiri angathetsere ngati adazindikira mwamsanga.
> Zotsatira:
> Kroschinsky F et al. Mankhwala atsopano, toxicities atsopano: zotsatira zoopsa za zamakono komanso zamaganizo za khansa ndi kasamalidwe kawo. Kusamalira Crit. 2017; 21: 89.
> Linardou H, Gogas H. Toxicity management of immunotherapy kwa odwala matenda a melanoma. Ann Transl Med . 2016 Jul; 4 (14): 272.
> Micho JM et al. Zochitika zolimbana ndi chitetezo cha mthupi ndi chitetezo cha chitetezo cha mthupi. Eur J Cancer . 2016 Feb; 54: 139-48.
> Pakhomo M, Wolchok J. Toxicities okhudzana ndi checkpoint inhibitor immunotherapy. Mu: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, Amin A. Immune checkpoint inhibitors m'zochita zowathandiza: kuwonetsanso za kayendedwe ka zida zolimbana ndi chitetezo cha mthupi. Tanthauzani khansa yowonjezera . 2015 Oct; 4 (5): 560-75.