I-osteoporosis ingayinceda njani i-Zometa okanye i-Bonefos?
Nangona iyeza ze-osteoporosis ziye zasetyenziselwa abantu abanomdlavuza webele we-metastatic ne-boneast metasase, izikhokelo ezintsha ze-2017 ezivela kwi-American Society ye-Clinical Oncology zincoma ukusebenzisa izidakamizwa ze-bisphosphonate kwi-Zometa kubafazi abathile abanomhlaza wesifuba. Ziyintoni na ii-bisphosphonates kwaye zisebenza njani? Ngaba banokunciphisa amathuba okuba umdlavuza wakho webele usasazeke emathanjeni akho kwaye uphucule ukusinda?
Unokwazi njani ukuba ngaba amayeza anokulungele?
I-Cancer yomhlaza kunye neengozi yokuphindaphinda
Isifo somhlaza wesifuba sekuncinci siphethwe kakhulu, kwaye izinga lokusinda liye laphuculiswa kunye nokongezwa kwe-chemotherapy ene-adjuvant kunye nonyango lwama-hormone kulabo abaviwa kuba lala mayeza. Sekunjalo nangomdlavuza webele wamandulo ( isigaba sam , isigaba II , kunye nesigaba se-III ), ukuphindaphinda kuqhelekileyo.
Umngcipheko wokuphindaphinda uhluka kunye nenani lezinto ezinobungozi kwisigaba somhlaza wakho, ubudala bakho, unyango olulwamkelayo kunye nezinye izinto. Asazi ukuba kutheni i-kansa ibuye ibuyele emininzi kwiminyaka okanye emashumi eminyaka kamva, nangona iingcamango malunga nokuba kutheni umhlaza wesifuba webele usenokubandakanya ingcamango yokuba kukho ubukhulu bomzimba wamaseli esifo somhlaza, kwaye ukuba amaseli esifo somhlaza (aseburhulumenteni) angahlala elele emnxeni wethambo kude kube imeko iqala ukukhula kwakhona.
Umhlaza wesibeletho sesisu unokuba neentlobo ezintathu:
- Ukuphindaphinda kwendawo , apho i-tumor ibuyela ebileni kufuphi nesiza se-tumor yangempela.
- Ukuphindaphinda kwesithili , apho umhlaza uphindaphinda khona kwii-lymph node okanye izakhiwo eziseduze.
- Ukuphindaphinda okuqhelekileyo , apho umhlaza uphindela kwindawo ekude yomzimba njengamathambo, isibindi, imiphunga, okanye ingqondo. Kule ndawo, amathambo yindawo eqhelekileyo yeemastastases.
Ingumdlavuza webele weemastanti ezikude (isigaba se-4 somhlaza wesifuba) -izo zijongene neepesenti ezingama-90 zokufa kwe-cancer ebele.
Ngubani Osemngciphekweni weTatastas ezivela kwiCarcer Breast?
Phantse nabani na obenomdlavuza wesifuba bangasengozini yokuphuhlisa i-boneastas yamathambo, kodwa kukho izicwangciso apho kunokwenzeka khona.
I-Boneastast ye-Bone ixhaphakile kubantu abanomdlavuza webele we- estrogen . I-Estrogen receptor i-tumors ezihle zinokuthi zidibaniswe nokuphindaphinda kwexesha, umzekelo, iminyaka emininzi okanye eminyaka emva kokuba umhlaza wesiqhelo ufunyenwe kwaye uphathwe. Ezinye izinto ezandisa ingozi yokuba umdlavuza webele uya kuphinda ufake i- lymph node-positive disease.
Phantse iipesenti ezingama-70 yabasetyhini abanomdlavuza wesisu (isigaba se-4 somhlaza wesibeleko) baya kuba nethambo.
Indima yeBisphosphonates kwiCanscer Breast
I-Bisphosphonates yayisetyenziselwa okokuqala ngo-1990 xa ivunyiwe ukuba yonyango lwe- osteoporosis . Ukususela ngeli xesha baye bavunywa ukuba unyango lwe-boneastases lwe-boneastases (kunye nezinye i-cancer) kunye ne-hypercalcemia ehambisana nomhlaza.
Zininzi iindlela ezinokuthi i-bisphosphonates ingaba luncedo kubantu abanomhlaza wesibeleko kubandakanya:
- Kubasetyhini abanomdlavuza wesibeleko osasazeka kumathambo ( isifo somhlaza wesifuba nesifo se-boneastas ), ii-bisphosphonates ezifana neZometa zinciphisa umngcipheko weengxaki ezinjengezifo zenyama. Ekubeni i-bone fractures yimbangela ebalulekileyo yentlungu nokukhubazeka, la mayeza angakwazi ukuphucula kakhulu umgangatho wobomi kubasetyhini abaneesigaba se-4.
- I-Aromatase inhibitors, i- hormonal therapy yomhlaza wesifuba esoloko esetyenziswa kuma-postmenopausal women, ingabangela ukulahleka kwethambo kuholele ekutheni i-osteoporosis. Ukulahleka kwethambo kungakhokelela kwiziqhekeza ngokwalo, kodwa kunokunyusa ukwanda kweengxaki xa i-boneastas ze-bone zikhoyo.
- Kwizifundo, ukusebenzisa i-Zometa kwisifo somhlaza wesisu se-breastast.
- Oku kuninzi, ukusetyenziswa kwe-bisphosphonates kwi-esrogen receptor-positive ekuqaleni kwesikhumba sesifuba sasinomngcipheko omncinci wokuphuhlisa i-metastase yamathambo kwindawo yokuqala kunye nezinga eliphezulu lokusinda (jonga ngezantsi).
Izinzuzo zeBisphosphonates njenge-Adjuvant Treatment for Cancer Stage Cancer
Kwiingcaphephe ezijongene nomdlavuza webele webele, kwafunyanwa ukuba i-bisphosphonates ayinakunciphisa umngcipheko wezaphuko ngenxa yemastastases kodwa yabonakala ekuthintela ukusasazeka komhlaza kumathambo kwindawo yokuqala.
Ngelixa singaqinisekanga ukuba basebenza njani, ezi ziyobisi zibonakala zichaphazela i-microenvironment yethambo ngendlela iiselomhlaza zebele zesisu ezingenakukwazi ukuhlala kuzo.
Ekubeni i-boneastas i-boneastas ibangela enkulu yokufa kunye nomhlaza wesifuba, ukunciphisa umngcipheko wale mastasase inokuphucula ukusinda kwabasetyhini abanezifo zesantya.
Izifundo ezilandelayo ziqinisekisile ukuba ezi ngcamango zichanekile. Xa kunikwa emva kokuhlinzwa kunye ne-chemotherapy kunye kunye neyeza zonyango ukusetyenziswa kwe-bisphosphonates kwisifo somhlaza wesifuba esasesikweni kwintsapho yabasetyhini abasemva kwe-postmenopausal bafunyenwe ukunciphisa umngcipheko wokuphucula i-metastases yesinye kwisithathu kunye nokunciphisa umngcipheko wokufa omnye -Isithandathu. Nangona la manani ekhangeleka njengamangalisa, ukunciphisa ngokwenene ingozi enkulu kuncinci xa ukhangela umfanekiso omkhulu, kunye ne-bisphosphonates enika u-1 ukuya kwe-2 ekhulwini ukunciphisa ubungozi bokufa kwabasetyhini abaviwa beziyobisi.
Ukongezelela ekunciphiseni umngcipheko weemastastases kunye nokuphucula ukuphila, i-bisphosphonates inokukhonza enye inxaxheba. I-Aromatase inhibitors, uhlobo lwe-hormonal adjuvant unyango lwe-hormone olucetyiswayo kwabasetyhini abane-menopausal (okanye abafazi be-premenopausal emva kokunyangwa kwe-ovarian threating treatment) kunokukhokelela ekulahlekeni kwethambo kunye ne-osteoporosis. Oku kukuxhalabisa ngakumbi ngoku ukuba le miyeza inconywa ixesha elide okanye emva kwonyango kunye ne-tamoxifen. I-Zometa ifumaneka ukunciphisa umngcipheko we-osteoporosis ehambisana ne-aromatase inhibitors. Izidakamizwa ezichazwe njenge-aromatase inhibitors ziquka i-Aromasin (i-exemestane), i-Arimidex (i-anastrozole) kunye ne-Femara (letrozole).
Izikhokelo zeBisphosphonate kwiCatter Step Breast Cancer
Izikhokelo zamanje zikhuthaza ukusetyenziswa kwesinye semithi emibili ehlukeneyo kule ndlela:
- I-Zometa (i-zoledronic acid): I-Zometa ifom ye-bisphosphonate. I dose icetyiswa njenge-adjuvant therapy kwisifo somhlaza wesifuba se-early-grade 4 mg IV rhoqo emva kweenyanga ezintandathu ukuya kwiminyaka emithathu ukuya kwemihlanu.
- I-Bonefos (i-clodronate): I-Bonefos yimiyalezo ye-bisphosphonate yomlomo engasetyenziselwa enye i-Zometa xa ifuneka. Umthamo wonyango olumalunga ne-adjuvant yiphilisi ye-1600 mg ithathwa rhoqo ngosuku ngeminyaka emibili ukuya kwimithathu. I-Bonefos ayiyi-FDA evunywe e-United States.
Isilinganiso seZometa esisetyenziselwa isifo somhlaza wesifuba sokuqala sasihluke (esingaphantsi rhoqo) kunokuba sisetyenziselwa umhlaza wesibeletho se-metastatic.
Ngubani Ongasebenzisa I-Zometa okanye i-Bonefos yeCreatcer Cancer Treatment?
I-Zometa (okanye i-Bonefos) inconywa ukuba unyango olungumdlavuza we-estrogen-positive positive intraductal. Kufuneka kusetyenziswe kuphela kwabasetyhini abathunyelwe kwi-postmenopausal ngexesha lokuxilongwa okanye ngubani ongu-premenopausal kodwa sele efumene unyango lwe-ovarian .
Abasetyhini abaninzi abaphethwe ngethuba lokuqala lomhlaza wesifuba ngaphambi kokuba esi sincomo bangase bazibuze ukuba ngaba kufuneka baqale isiqhamo ngoku. Impendulo kukuba kuya kuxhomekeka, kwaye kukho izinto ezininzi ezithatha ingqalelo. Izifundo zenziwa ngabasetyhini abaqala i-bisphosphonates emva kokugqiba ukuhlinzwa kunye ne-chemotherapy, kwaye asinayo idatha efanelekileyo ekunciphiseni i-metastase okanye inzuzo yokuphila kubantu abaqalisa le madyeza kamva.
Siyazi ukuba i-bisphosphonates inokunciphisa ukulahleka kwethambo kubantu abane- osteopenia kunye ne-osteoporosis, kwaye i-aromatase inhibitors inxulumene nokulahlekelwa kwethambo ebalulekileyo kwabanye abantu. Abanye oogqirha bacebisa ama- bisphosphonates kwi-osteopenia ukuba ulindeleke ngakumbi ukulahleka kwethambo (nangona iimeko ezihlukeneyo zingasetyenziselwa) okanye ukuba umntu unemingcipheko ebalulekileyo yokwahlukana. Unokunqwenela ukuthetha ne-oncologist yakho malunga nokwenza uvavanyo lwethambo loxinzelelo ngaphambi kokuba wenze isigqibo sakho. Ukuba usenayo okanye usengozini yokunyuka kwe-osteoporosis, kunokufumana inzuzo ecacileyo yokusebenzisa la mayeza.
Iingozi kunye Neempembelelo Zecala zeBisphosphonates
Impembelelo yecala eliqhelekileyo ye-Zometa yimizimba efana nesifo-sifo esihlala ixesha elide emva kokunyuswa.
Imiphumo emibi yomlomo we-Bonefos inokuquka ukutshabalalisa, ukunyanzelisa, kunye nokuvutha komzimba. Amachiza omlomo kufuneka athathwe ngamanzi kwaye abantu bayalelwa ukuba bahlale bezithe tye imizuzu engama-30 ukuya kweyesi-60 ukunciphisa umngcipheko wokukrakra komzimba.
Iziphumo eziqhelekileyo ezichaphazelekayo ze-bisphosphonates ezisetyenziswe ngomlomo okanye nge-intravenly ziquka iqondo le-calcium ephantsi (i-hypocalcemia), imisipha, idibeneyo kunye / okanye ithambo leentlungu (oku kwenzeka nakweyiphi ixesha ngexesha lokusetyenziswa kwamachiza), kunye nemisebenzi yengxaki engenasifo. Abantu abanesifo sengqondo sokukhubazeka ngaphambi kokuxilongwa kwabo abanakukwazi ukusebenzisa le mayeza. Ezinye izinto ezingaqhelekanga ezichaphazelekayo zibandakanya i-femy fractures kunye ne-fibrillation ye-atrial.
Umphumo ongaqhelekanga kodwa onzima kunye nomngeni onzima we-bisphosphates yi-osteonecrosis yomhlathi. I-Osteonecrosis ibhekisela ekutshatyalalisweni kwethambo kwaye inokuthi iqhutywe kwi-mandible okanye i-maxilla. Iimpawu zivame ukuqala ngentlungu yomhlathi okanye ukulahleka kwezinyo. Kwizifundo ezibhekiselele ekusebenziseni iZometa njenge-adjuvant therapy yomhlaza wesifuba, i-osteonecrosis yomhlathi iyenzeka malunga nama-2 ekhulwini kwabasetyhini abathatha iZometa.
Imiba yengozi yokuphuhlisa i-osteonecrosis ibandakanya isifo segum, ucoceko lwamazinyo olungamahlwempu, okanye ukusetyenziswa kwezixhobo zezinyo. Izifundo zikhangele ngeendlela zokunciphisa umngcipheko. Kwisifundo esinye, ukuqaliswa kweemviwo zamazinyo rhoqo emva kweenyanga ezintathu nokusebenzisa i-antibiotic prophylaxis phambi kweenkqubo zezinyo zidibene nomngcipheko omncinci wemeko. Xa i-osteonecrosis yomhlathi ivela, kunokuba nzima ukunyanga. Uninzi lwamaxesha amaninzi udibaniso lwee-antibiotics, utyando, imilenze yomlomo kunye ne-hyperbaric therapy ye-oxygen.
Ngelixa i-osteonecrosis yomhlathi ingenzeka nanoma yiyiphi i-bisphosphonate, kubonakala ngokuqhelekileyo (94 pesenti yexesha) kunye ne-bisphosphonates engena-intravenous.
Ngaphambi kokuthatha iZometa okanye i-Bonefos
Ngaphambi kokuba uqale u-Zometa okanye i-Bonefos kunconywa ukuba unobungcali obuhlolisayo bamazinyo bukhangele nabuphi na ubungqina besifo segum. Ukuba udinga nawuphi na umsebenzi wamazinyo owenziweyo, njengokwakheka kwezinyo, kunconywa ukuba uzalise iinkqubo zamazinyo ngaphambi kokuqala i-bisphosphonates.
I-Bisphosphonates kunye neCastral Breast Metastatic Breast Cancer
I-Bisphosphonates kunye nolunye uhlobo lweyeza, i-denosumab (i-Xgeva okanye i-Prolia) ibhekiswa njengezilwanyana eziguqula amathambo. La machiza asebenza kakhulu ekunciphiseni umngcipheko weentlobo ezithintekayo ezinxulumene neethambo zesifo esivela kumdlavuza webele. Ngoku kuyacetyiswa ukuba i-bisphosphonates okanye i-denosumab iqalwe xa i-boneastases ye-bone isifo sokuqala. Xa zisetyenziselwa amathambo e-boneastases, i-dose yeZometa iphakamileyo kwaye inikezwe ukukhushulwa kwe-4 mg kwiiveki ezili-12 okanye kwiiveki ezintathu ukuya kwezine.
Ngaphantsi kwi-Adjuvant Bisphosphonates kwiCatter Step Stage Cancer
I-Bisphosphonates (i-Zometa) yongezwa kwi-2017 izikhokelo zengonyango zonyango lwe-adjuvant unyango lwesifo se-esrogen se-receptor-positive kuma-postmenopausal women. Akunakwenzeka nje ukuba ezi nkunkuma zinganciphisa umngcipheko we-osteoporosis echaphazeleka unyango, kodwa kubonakala ngathi ukunciphisa umngcipheko wokuphuhlisa i-metastasis yamathambo kwaye inokuphucula ubomi.
Ezi zi yobisi ziqaliswa emva kokugqiba utyando kunye ne-chemotherapy kwaye ngexesha elifanayo ukuba unyango lwe-hormone luqaliswe.
I-Boneastas ne-cancer yesifuba ayithethi nje ukuba umhlaza awusayi kuphulukiswa kodwa kubangela intlungu enkulu kunye nokukhubazeka. Iingxaki zethambo zesitastas zibandakanya i-fractures, ukunyanzeliswa komthambo, kunye nezinga eliphezulu le-calcium yegazi, konke okunciphisa umgangatho wobomi nokunciphisa ukusinda.
I-Bisphosphonates, njengamachiza, ingaba nemiphumo emibi. I-Zometa idla ngokubangela isifo esifana nesifo somkhuhlane ngosuku okanye emibini emva kokungena kunye ne-Bonefos kunokukhokelela ekuthukutheleni kwesifo. Abanye abantu baphinde bahlakulele umsebenzi we-kidney or a low calsium level. Iimeko ezingavamile kodwa ezibi kakhulu yi-osteonecrosis yomsebenzi, imeko ecinga ukuba inokuchaphazela omnye wabasetyhini abangama-50 abasebenzisa leziyobisi ngale ndlela. Ukucoceka kwamazinyo okulungileyo kunye nokuhlolwa kwamazinyo ngaphambi kokuqala unyango kunokunciphisa umngcipheko.
Kubasetyhini abaphathwayo kwi-cancer yesifuba yexesha elidlulileyo kodwa abaya kuba ngabaviwa ukuba baphathe unyango olufanelekileyo, okwangoku akukho ziphakamiso ezikhoyo. Thetha kunye ne-oncologist yakho malunga neengcamango zakhe kunye noko akujonga ukuba ziyinzuzo kunye nokungalunganga kwonyango. Ukukwazi ukuxhomekeka kwethambo kunye nokujonga ingozi, mhlawumbi ngokuphindaphinda okanye kwimiphumo emibi yonyango kunokunceda ukukhokela isigqibo sakho. Njengawo wonke unonophelo lwakho, ukuba ngummeli wakho kumnonophelo wakho womhlaza kwenza umehluko.
> Imithombo:
> IBeti-Tasdogan, N., iMeya, B., u-Hussein, H., no-O. Zolk. Amanyathelo okuLawula i-Osteonecrosis ephathelene neMithi. I-Cochrane Database yeeNkqubo eziPhezulu . 2017. 10: CD012432.
> Coleman, R. Impact ye-Bone-Targeted Treatments kwi-Skeletal Morbidity and Survival kwi-Cancer Breast. I-Oncology (Williston Park) . 2016. 30 (8): 695-702.
> I-Dhesy-Intshumayelo, S., Fletcher, G., Blanchette, P. et al. Ukusetyenziswa kwee-Adjuvant Bisphosphonates kunye nezinye i-Bone-Modifying Agents kwiCanscer Breast: I-CancerCare yase-Ontario kunye neMelika yaseMelika ye-Clinical Oncology Clinical Practice Guideline. Umbhalo we-Clinical Oncology . 2017. 35 (18): 2062-2081.
> Hadii, P., Coleman, R., Wilson, C. et al. I-Adjuvant Bisphosphonates kwi-Cancer yaseBrazil yasekuqaleni: Isikhokelo soBoniselwano ngeZenzo zeCliniki kwi-Panel yaseYurophu. Amanqaku e-Oncology . 2016. 27 (3): 379-90.