I-Immunotherapy ikhula ngokukhawuleza njengesixhobo esinamandla sokulwa nezifo, ngakumbi izifo ezinzima ukunyanga. Ngomdlavuza we-immunotherapy , i-immune system ixilwe ukulwa nezicubu kwiindlela ezintsha. Ukungenelela kwe-Immunotherapy kunokuthi kukhuthaze ngokufanelekileyo umzimba wokuzikhusela okanye ukubonelela i-immune system kunye nama-protein, okanye i- antigens , ukuze uqeqeshe indlela yokuzivikela ngayo.
Izigulane zonyango zonyango zihlobo lwe-immunotherapy elisetyenziselwa ukunyanga i-cancer. Ngokuqhelekileyo, izigulane zonyango lomhlaza ziyizinto eziphilayo, okanye i-biopharmaceuticals. Ezinye i-biologics ziquka izixhobo zegazi, unyango lwezityalo, i-allergenics kunye nezinye izitofu.
Okwangoku, isifo sokugonywa ngumhlaza kuphela esiya kuvunywa yi-FDA sibizwa ngokuthi iMfuno yokuphatha unyango lomhlaza wesifo somhlaza .
Unyango lweNtsholongwane
I-Antigens zizinto ezibangela ukuphendula kwamagciwane omzimba. Uninzi lwezigulane zonyango lomhlaza ekuphuhliseni zihlinzeka ngama-antigens anxulumene nomhlaza kwiiseli ezidanga. La maseli e-dendritic ngamaseli omzimba asebenza ngqo kwindawo yokujola (dermis) kwaye asebenze i-antigen. Ukongezelela, iimodlekli ze-immunostimulatory ezikhoyo kwi-vaccine ye-vaccination upregulate, okanye ukwandisa imveliso, yee-molecule ezifunekayo ekugqibeleni ukusebenzisana neeseli ze-T. Ingqalelo, i-antigens echaphazeleka ngumhlaza ingaba yinto ethile kumhlaza omnye okanye iqela leekliniki eziliqela.
La maseli e-dendritic asebenzayo aya kwii-lymph node, ezincinci zeethambo ezifakwe kuwo wonke umzimba. Xa la maseli e-dendritic esebenzayo enza ukuba lymph node, abonisa i-antigen ethile ye-antigen kumaseli eT. Amaseli e-T asebenze aze ajikeleze kuwo wonke umzimba kwaye ajolise kwiiseli zomhlaza ezikhoyo kunye ne-antigen kunye ne-lyse, okanye aphule, iseli somhlaza.
(Ngaphezulu kweetekisi, iiseli ze-CD4 + ezisebenzayo zivelisa i-cytokines eziququzelela ukukhula komzimba wee-CD 8, emva kokuhamba komzimba kuwo wonke umzimba.)
Ngokutsho kwe-FDA, iintsholongwane ezininzi zomhlaza okwangoku ekuphuhliseni zisebenzisa iibhaktheriya, iintsholongwane, okanye imvubelo njengezithuthi, okanye iimvumi , ukuthutha ama-antigen. Iibhaktheriya, iintsholongwane, imvubelo nokunye okunjalo ngokwemvelo zi-immunogenic kwaye zenza i-response immune ngokwayo; nangona kunjalo, ziguqulwa ukuze zingabangeli izifo.
Ngaphandle koko, izigulane zonyango zonyango zingenziwa ngeDNA okanye i-RNA leyo ikhowudi yama-antigen. Olu hlobo lwezinto zofuzo lufakwe kwiiseli ezize zivelise ama-antigens. Ithemba kukuba le iiseli zomzimba ezitshintshileyo ziya kuthi zivelise ama-antigens anxulumene nomdlavuza okwaneleyo ukukhuthaza iimpendulo zomzimba zomzimba zokubulala iintsholongwane zesisu.
Ekugqibeleni, imilinganiselo emithathu kufuneka ifumaneke ukuba iisilini zeesisu zichithwe yi-vaccine:
- ubuninzi bamaseli omzimba omzimba obunokwaneleyo kunye nolwalamano olunezilwanyana zesifo kufuneka luveliswe
- la maseli e-T kufuneka akwazi ukungena ngaphakathi kwe-tumor
- la maseli e-T kufuneka aqale asebenze kwisayithi ye-tumor ukudala umonakalo othile
Iimpawu zentsholongwane zeCancer?
Ngexesha elidluleyo leminyaka edlulileyo, amagciwane omhlaza (i-dendritic-cell) ahlolwe.
Nangona kunjalo, izinga lokuphendula kwezi zitofu liphantsi kakhulu-malunga neepesenti ezingama-2,6. Enyanisweni, ezinye iintlobo ze-immunotherapy ziye zafakazela ukuba zisebenza kakuhle, eziye zachaphazela ezininzi iingcali ukuba zibuze "imiphunga" yomhlaza wegazi.
Ngoko ukuba izitofu zengqondo zonyango azinqabile zisebenza kubantu, kutheni sifuna ukutshala imali kunye nexesha ekuphuhliseni imithi yokugonya? Kukho ubuncinane izizathu ezintathu ezichazela umdla wethu kulolu hlobo lokungenelela.
Okokuqala, izitofu ziye zaphumelela ekukhuseleni umhlaza, kwaye le mpu melelo iqhubekile kunyango lomhlaza ngeentsholongwane.
Ngamanye amazwi, umsebenzi esiwenzile ukuvelisa i-vaccines yomhlaza wokukhusela usisifundise inkatho malunga nokuzikhusela komzimba weeseli zeomhlaza kwaye unikeze isakhelo sobugcisa sokuphucula imithi yokugonywa ngumhlaza. Kwangoku kukho izitofu ezimbini ezikhusela umdlavuza: ukugonya kwe-hepatitis B kuvimbela umdlavuza wesibindi, kwaye isitofu sokugonywa kwe-papillomavirus (HPV) sivimbela umlomo, umlomo wesibeleko kunye nezinye i-cancer
Okwesibini, izitofu zengculaza zonyango zilula ukulawula kwaye zenze iziphumo ezinobungozi.
Okwesithathu, abaphandi bahlala bexelisekile ekuchazeni kwabo iziphumo zovavanyo ezibandakanya umhlaza wezonyango zonyango, ezondla kwi-hype ejikeleze le ndlela yokungenelela. Ngokukodwa, abaphandi banokugxininisa kwi-hertological, okanye amaselula, utshintsho kunye ne-lymphocyte (T cell) ukungena kwe-tumors endaweni yokugxininisa utshintsho lokwenene : ukunciphisa ubukhulu be-tumor okanye ukuphucula kwiimpawu zeklinikhi.
Ngaphezu koko, uphando oluphambili oluhlola imithi yokugonywa kanomdla ngokuqhelekileyo isebenzisa iinkcazo ezikhohlisayo kunye namagama ukubonisa iziphumo, ezifana "neempawu ezidlulayo," "ukuphela kwesikhashana ukuphela kweminastas," "i-tumor necrosis" kunye "nokuphila okungalindelekanga." Ngaphandle kweenkcukacha ezithe vetshe, la magama asho nto encinci.
Kwinqaku edibeneyo, uphando oluninzi lwegciwane lomhlaza luyenziwe kwinqanaba lezesayensi zonyango usebenzisa imizekelo yezilwanyana. Iigundane, njengokuba unokuthi ungancike kwisayizi, ukuziphatha kunye nobukeka obukhulu, bahluke kubantu. Ngaloo ndlela, nayiphi na impumelelo esiyibonayo ekuphatheni ezi zilwanyana ngomhlaza we-chronic vaccines ayiguquleli kubantu.
Ngokukodwa, nangona izitofu zomhlaza ziye zabonakaliswa ukuba ziyasebenza kwizilwanyana, akunakukwazi ukufumana nayiphi na impembelelo enjalo kubantu. Ngokukodwa, kukho umgudu owodwa wonyango ophunyeziweyo yi-FDA ekwenzeni unyango lomntu kubantu: Nika. Nangona kunjalo, kukho enye i-vaccine yomgudu wokugonya umhlaza we-prostate njengamanje kwiimvavanyo zeSigaba 3 ezibonakaliswe ukuba zisebenza: Prostvac.
Ngaphambi kokuba sijonge zombini i-Provenge kunye neProstac, masihlaziye kancinci ulwazi lwethu ngomdlavuza wesibeletho .
Cancer Cancer
Ngaphandle komdlavuza wesikhumba, umdlavuza weprotate ngumdla oqhelekileyo ochaphazela amadoda aseMerika. Nangona i-1 kuma-7 amadoda aseMelika avelisa umdlavuza we-prostate, kuncinci kufa kwesi sifo (malunga no-1 ngo-39). Kunoko, amadoda ahlala efa ngesinye isifo kuqala, njengesifo senhliziyo. Nangona kunjalo, ngo-2016, kwakukho ukufa kwabangu-26,120 okubangelwa ngumhlaza wesibeletho.
Ngenxa yovavanyo olubanzi lwe-prostate-specific (PSA) antigen, i-biomarker yomhlaza wesifo seprotate, siye sakwazi ukubona iimeko zesifo somhlaza wesifo seprotate ngaphambili, ngelixa umhlaza usalugcinwe kwi-prostate, Okungaqhelekanga, amadoda anesifo somhlaza wesisu oye wahluthwa okanye wandaza emathanjeni waza waba ngukufa.
Izinto ezibangela umngcipheko womhlaza wesibeletho zibandakanya umdala, ubuhlanga baseMerika kunye nembali yentsapho.
Uninzi lwabantu abanomdlavuza wesibeletho abayidingi unyango kwaye kunoko bajongwa ngamagqirha abo. Unyango lomhlaza wesibeletho unokubandakanya ukulawula okulindelekileyo (ukujonga ngenyameko), ukuhlinzwa (i-prostatectomy okanye ukususwa kweprotate), i-radiotherapy kunye ne-androgen, okanye i-hormone yesondo, ukunyanzelwa.
Nika
Ukubonelela okanye ukuphawula-T yi-dendritic-cell-vaccine eyagunyazwa yi-FDA ngo-2010. Ukunikezela yinto eyaziwa njenge- autologous cell immunotherapy kwaye isetyenziselwa ukuphatha isifo se-metastatic esingasasazeka kude kakhulu (nxamnye ne-invasive). Ukongezelela, Ukubonelela ngomdlavuza wesibeletho ongenakuchukumisa ama-hormone (i-hormone refractory).
Kwinqaku ehambelanayo, i-hormone refractory cancer can respond to therapy-deprivation therapies, okanye iziyobisi ezixhamlayo kunye ne-orrogens, okanye i-hormones yesini (cinga ukuxilongwa kwezokwelapha).
Ukubonelela kulungiselelwe kusetyenziswa iiseli zegazi ezimhlophe zegulane (iipilisi zegazi zogonyamelo lwegazi). Iiprotheyini ezibizwa ngokuba yi-granulocyte-macrophage-colony-stimulating factor (GM-CSF) kunye neprotatic acid phosphatase, okanye i-PAP, isifo somhlaza we-prostate.
Isizathu sokuba i-GM-CSF inikezwe nge-PAP ye-antigen kukuba abaphandi bakholelwa ukuba i-GM-CSF iququzelela ukuhanjiswa kwe-antigen. Ingqalelo, i-blood peripheral blood mononuclear cells isebenza njengeeseli ze-dendritic apho i-antigen ifakwe.
Ngelishwa, Isibonelelo sandisa ubomi ngeenyanga ezi-4 kuphela. Nangona kunjalo, eli xesha lingavumela umntu ukuba enze imicimbi yakhe kwaye achithe ixesha elithile kunye nosapho lwakhe.
Imiphumo emibi yoMbonelelo ibandakanya oku kulandelayo:
- umkhuhlane
- bhinqa
- ukukhathala
- umqolo obuhlungu
- intloko
Ngexesha leemvavanyo zonyango ze-Provenge, amadoda ambalwa afumana imiphumo emibi kakhulu ebandakanya ukuphefumula, intlungu yesifuba, intliziyo engavumelekiyo, ukunyamezela ukuxhamla kunye nokuguquka kwegazi. Ngaloo ndlela, abantu abaneengxaki zeentliziyo kunye nemiphunga kufuneka baxoxe ngale miqathango kunye nomboneleli wezempilo.
Prostvac
Inkqubo yeProstvac ihluke kwiMiqathango.
Iprostvac iqukethe i-poxvirus (fowlpox) vector, i-prostate-specific antigen (PSA) kunye ne-costiculatory complex called TRICOM. Le gciwane lokugonywa kwe-PSA-TRICOM lichaphazela iiseli ezibonisa i-antigen ezenza ukuba bachaze iiproteti-specific antigen proteins ebusweni. La maseli e-antigen avela kwii-T zeeseli kwaye aqeqeshe ukuba ahlasele iiseli zomhlaza zesifo somhlaza.
I-Prostvac Isigaba 2 sezilingo zonyango zibandakanya abathathi-nxaxheba abangama-82 apho 42 bafumana iProstvac. U-Prostvac wandise ubomi kwinqanaba lokulinga ngoxabiso eliphakathi kweenyanga eziyi-8.5. Okwangoku, i-Prostvac isekulingweni lweSigaba sesi-3, kwaye abaphandi abazami nje ukuzama ukuxhasa inzuzo yezilwanyana kodwa bazama nokuba iGM-CSF ifakwe kwi-vaccine.
Ngexesha leemvavanyo zecandelo lesiGaba 2, iziphumo ezimbi zeProstvac zafakwa ezi zilandelayo:
- impendulo ye-injection site (intlungu, ukuvuvukala, ubomvu nokunye)
- ukukhathala
- umkhuhlane
- ukuvuvukala
- bhinqa
- ubuhlungu obudibeneyo
- ukungcola
- isicaphulelo
- ukuhlanza
- isifo sohudo
- ukuqothulwa
Iigciwane lomhlaza wesifo seprotate asisetyenziselwa ukusetyenziswa njengonyango lokuqala lomhlaza wesibeletho. Kunoko, zilawulwa ngokukongeza kwi-chemotherapy.
Yintoni i-Imlygic?
Ngo-2015, i-FDA ivume i-Imlygic, isitofu sokugonywa kwe-oncolytic yonyango okanye i-melanoma ebulalayo engakwazi ukusebenza. Nangona engekho umhlaza wesifo sokugonywa komhlaza, i-Imlygic ineziphumo zesibini ezifana nezigulane zengqondo zomhlaza.
Ii-virus ze-oncolytic zihlobo lwe-immunotherapy apho i-virus eguqulwe ngezofuzo ifakwe ngqo kwi-tumor tumor and lyses okanye iphula ii-cell tumors. Ukongeza kokuphula iiseli, ezi zintsholongwane zineempembelelo eziqhelekileyo zokubangela isiphumo sokuchasana esifana nesitofu se-antiticancer.
IiNtsholongwane zonyango kunye nam
Okwangoku, ukusetyenziswa kwezigulane zomhlaza kwizilungiselelo zonyango kuyancinci. Ukongezelela, njengoko kushiwo ngaphambili, kunzima kakhulu ukufumana iintsholongwane zomhlaza ezichaphazela abantu abathatha inxaxheba. Akunakwenzeka ukuba sibone izitofu zomhlaza ezisetyenziselwa ukuphatha iintlobo ezahlukeneyo zeekhensi nanini na.
Nangona kunjalo, izitofu zomhlaza zimela ukuqhubela phambili kwenkqubo yokuzivikela komzimba kwakunye nensimu ye-immunotherapy. Kungcono ukuba siqonde i-system immune, bhetele sinokujolisa kwiimpawu zonyango ezinokuthi zilondoloze ubomi.
Imithombo:
Goswami S, Allison JP, Sharma P. Immuno-Oncology. Ku: i-Kantarjian HM, i-Wolff RA. eds. Incwadi ye-Anderson ye-Oncology Medical, 3e . New York, NY: McGraw-Hill; 2016. Kufumaneke ngoMeyi 19, 2016.
Kantoff PW et al. Uhlalutyo oluPhezulu loPhulo lweSigaba II I-Trimmed Trial Trial of a Poxviral-based Based PSA-Targeted Immunotherapy kwi-Metastatic Can-Resistant Prostate Cancer. J Clin Oncol. 2010 uMar 1; 28 (7): 1099-1105.
Pienta KJ. Isahluko 96. I-prostate Cancer. Ku: I-Halter JB, i-Ouslander JG, i-Tinetti ME, i-Studenski S, i-KP ephezulu, i-Asthana S. eds. I-Medicine Geriatric and Gerontology, 6e . New York, NY: McGraw-Hill; 2009. Ukufikeleleka ngoMeyi 22, 2016.
I-Rosenberg SA, i-Yang JC i-Restifo NP. I-Cancer Immunotherapy: Ukuhamba ngaphaya kweentsholongwane zamanje. Nat Med . 2004 Septemba: 10 (9): 909-915.