Unonophelo oluthambileyo kulabo abanomdlavuza omkhulu wamaphaphu
Nangona i- chemotherapy ijolise iiseli ezinjengeeseli zomhlaza ezisasazeka ngokukhawuleza emzimbeni, i-immunotherapy ijolise kumzimba womntu, ivuselele ukuba ihloniphe kwaye ihlasele amaseli omhlaza. Ngamanye amazwi, i-immunotherapy ivumela umntu ukuba asebenzise isisombululo sakhe esona sihle kakhulu (impilo yawo yokuzivikela emzimbeni) ukulwa nomhlaza.
Kubantu abanomdlavuza ongasetyenzana wamancinci we-cell lung (NSCLC), iindaba ezilungileyo kukuba i-novel immunotherapi ibe yinto kwaye iqhubeka iphuhliswa yizinzulu.
Ezi zonyango, ngokuqinisekileyo, aziphilisi umdlavuza wamaphaphu, kodwa zinokukunceda okanye wakho umthandayo uzive ngcono kwaye aphile ixesha elide.
Imigomo yesifo somhlaza
Ngaphambi kokungena kwi-immunotherapi esetyenziswa ekuphatheni i-NSCLC ephakamileyo, kubalulekile ukuchaza amagama ambalwa anxulumene nomdlavuza wamaphaphu.
Yintoni i-Can-Small Small Lung Cancer (NSCLC)?
Kukho iintlobo ezimbini eziphambili zomhlaza wamaphaphu : umhlaza ongasetyenzana wesifo somhlaza nomhlaza wesifo samangcwaba omnxeba, kunye neeseli elincinane. Enyanisweni, malunga ne-80 ukuya kuma-85 ekhulwini lamanomdla emiphunga amaphaphazi awona amancinci amancinci amancinci.
Xa uva igama elithi "umhlaza wemiphunga" lisetyenziswe, umntu udla ngokubhekiselele kumhlaza omninzi wesifo somhlaza wamaphaphu, nangona oku akunjalo.
Yiyiphi i-Cancell Lung Cancer (NSCLC) ehamba phambili?
Ngomdlavuza omninzi wesifo samangcwaba, amangqamuzana amabi (umhlaza) akhula ngokukhawuleza kwaye angalawuleki ukuba enze i-tumor ngaphakathi kwezicubu zomphunga. Njengoko umhlaza ukhula, ungase uqale ukusasaza kwii-lymph nodes, nakwiindawo ezikude emzimbeni njengengqondo, amathambo, isibindi okanye enye imiphunga.
Ngokusekelwe kwiimvavanyo eziliqela (umzekelo, i-biopsy ye-tumor kunye neemvavanyo zokucinga ezifana ne-CT scan), isigaba se-NSCLC sinqunywe. I-NSCLC ephakamileyo ngokubanzi ibhekisela kumgangatho we-IIIb okanye umhlaza wesigaba se-IV , oko kuthetha ukuba umdlavuza usasazeke kwezinye i-lymph nodes kunye / okanye kwiindawo ezikude (oku kuthiwa yi- metastasis ).
Ziziphi Iimpawu zokuHlola eziMzimba?
Ukuze uqonde ukuxilongwa kwe-immunotherapy, kubalulekile ukuqonda ingcamango yendlela yokuhlola i-immune system, njengokuba ezi zi-molecule ezinomdlavuza we-lung immunotherapies.
Iimpawu zokujonga i-immune zihlala zihlala kumaseli omzimba omntu, kwaye ziyakhusela isistim somzimba somntu ekuhlaseleni amaseli asemzimbeni, aqhelekileyo, kuphela amaseli angaqhelekanga (njengamaseli anesifo).
I-Cancer iyinkathazo, nangona kunjalo, kuba enye indlela ekugwema ngayo ukuhlaselwa ngumzimba womzimba kukuba ngokwenza kunye nokuvakalisa iiprotheni zokujonga. Kodwa i-immunotherapies yomhlaza isebenza ukuvimbela ezi ziko zokuhlola ukwenzela ukuba umzimba uqaphele ngokwenene umhlaza njengomntu wangaphandle kwaye uvelise ukuhlaselwa kuwo.
Immunotherapy for Cancer Lung: PD-1 Antibody
Enye ye-immune system checkpoint ejoliswe yi-NSCLC immunotherapies yinkqubo yokufa 1 (PD-1), i-receptor eqhelekileyo kwiiseli ze-T kodwa ingenziwa kwaye iboniswe ngamaseli omhlaza wamaphaphu.
Ngokuqhelekileyo, le ngongoma yokukhusela i-immune ishiywe kwindawo yesifo se-lungum, ngoko isistim somzimba sokuphepha sikhuphe ukulwa nomhlaza. Kodwa kunye neziyobisi ezivimba iP-1-1, isistim somzimba singaphendula kwaye sihlasele iiseli zomhlaza.
Kukho izibini zonyango ezi-PD-1 ezi-antibodies (okanye i-PD-1 checkpoint inhibitors), kwaye ziyavunyelwa yi-FDA ukuphathwa kwe-NSCLC.
Zomibini zezi zonyango zihanjiswa njengeengcathulo (nge-vein) nganye ezimbini ukuya kwiiveki ezintathu. Ezi zi yobisi zilapha:
- Nivolumab
- Pembrolizumab
Ubume beNivolumab
Njenge-PD-1 antibody, i-nivolumab iye yafundiswa kwinani lezilingo kubantu abane-NSCLC ephakamileyo. Ngokomzekelo, olunye uvavanyo luka-2015 lwesigaba se- New England Journal of Medicine luthelekisa unyango kunye nevolumab ngokubhekiselele kunyango kunye ne-docetaxel kubantu abaqhube phambili be-NSCLC baqhutywe phambili okanye emva kokuba baphantsi kwe-platinum ene-chemotherapy regimen. Iziphumo zityhila ukuba abo bafumana i-nivolumab basinde ixesha elide kunabo bafumene i-docetaxel-ukuhlala kwimizuzu eyi-9.2 kwiqela le-nivolumab malunga neenyanga ezintandathu kwiqela le-docetaxel.
Njengecala, i-Taxotere (docetaxel) yi- chemotherapy eyenziwa ngabantu abaye baphathwa nge-NSCLC ngaphambili, ngoko ke lo mzekelo uqikelele i-immunotherapy entsha kumgangatho okhoyo wokunyamekela kwe-chemotherapy.
Ukongeza kwi-benefit benefit, i-nivolumab ibonwa ngokukhuselekileyo kune-docetaxel kulolu cwaningo-into enhle, kuba ukukhathazeka okukhulu ngama-immunotherapi kukuba isistim somzimba somntu siya kuhlasela kungekhona kuphela iiseli zomhlaza kodwa nezitho ezinempilo.
Enye yezona ziphumo ezimbi ezigqithisileyo oogqirha abanenkxalabo malunga nokunyangwa ngumhlaza yi-pneumonitis, okuyiyo xa izidakamizwa zivuselela ukuvuvukala kwemiphunga (kungekhona intsholongwane, oyabona nge-pneumonia). Oogqirha bakhathazeka ngokuphathelele i-pneumonitis kuba ichaphazela umsebenzi wamaphaphu, osele usweleke emdlalweni wamaphaphu. Kule sifundo, i-pneumonitis yenzeke kakhulu kwiqela le-nivolumab kwaye yayinomlinganiselo ophantsi xa kwenzeka.
Oko kwathiwa, ezinye iziphumo ezimbi (ngaphandle kwe-pneumonitis) ezixhunywe kwi-nivolumab ukuba oogqirha bajonge ukuba ba ndakanya:
- Iingxaki zesikhumba (umzekelo, ukukhawuleza nokutshiza)
- Iingxaki zokugaya (umzekelo, urhudo)
- Ukungavumelekanga kubomi be-enzyme test blood
- Iingxaki zeTyroid
- Impendulo ephathelene nokuxhamla
Ubume bePembrolizumab
I-Pembrolizumab i-FDA igunyaziwe ukuphatha i-NSCLC ephezulu kubantu abangenalo uhlobo oluthile lomzimba lomhlaza wabo wamaphaphu ( uguquko lwe-EGFR okanye i- ALK translocation ) kwaye ubuncinane ubuncinci beesilini zabo ze-tumor zilungile kwi-PD-L1. I-PD-L1 yiprotheni ebophelela kwi-PD-1 kwiiT cell, ekuthintela ukuba bahlasele iseli somhlaza.
I-Pembrolizumab iphinde ivunyiwe ukuba iphathe i-NSCLC engahambelaniyo ( lung lung adenocarcinoma ) kunye ne-chemotherapy, kungakhathaliseki ukuba iiseli ze-tumor ziyadlala kwi-PD-L1.
Ngophando luka-2016 kwi- New England Journal of Medicine , abantu abane-NSCLC kunye ne-PD-L1 ibinzana okungenani ama-50 ekhulwini lamaseli abo abomvu bafumana ininzi yokuqhubekayo yokuqhubekayo (inyanga ezili-103 kunye neenyanga ezili-6) kunye nemiphumo emibi ( ukhuselekileyo) kunabo bantu bafumana i - chemotherapy esekelwe kwi-platinum yemveli.
Ngokukodwa, ukuqhubekeka kokungenasiphelo okuqhubekayo kwachazwa njengokuba ixesha izigulane zazingenakulinganiswa ukufumana i-pembrolizumab okanye i-chemotherapy, kwinqanaba apho isifo sabo siphumelele okanye sife.
Kule sifundo, imiphumo emibi kakhulu yabonwa kwiingama ezingama-27 zalabo bafumana ipembrolizumab ngokumalunga nama-53 ekhulwini abo bafumana i-chemotherapy.
Ngokubanzi, iimpembelelo eziqhelekileyo ezichaphazelekayo kulabo baphantsi kweyeza kunye ne-pembrolizumab zi:
- Uhudo
- Ukukhathala
- Fever
I-pneumonitis yenzeke kwiqela le-pembrolizumab ngezinga eliphezulu ngaphezu kweqela le-chemotherapy (ama-5.8 ekhulwini kunye nama-0.7 ekhulwini).
Immunotherapy for Cancer Lung: PD-L1 Antibody
I-Atezolizumab iyimichiza evunyiweyo ye-FDA yokuphatha abantu abane-NSCLC eqhubekayo isifo sayo siyaqhubeka siphumelele xa siphelile okanye emva kokuba sithobele i-chemotherapy ene-platinum .
I-Atezolizumab ihluke kakhulu kwi-nivolumab okanye i-pembrolizumab ngo-anti-PD1 L1. Ngamanye amagama, ijolise ngokukodwa kwi-PD-L1, iprotheni ebophelela kwi-PD-1 (i-receptor kwiiseli ze-T), ekuthintela ukuba bahlasele iseli somhlaza. Njengazo ezinye izidakamizwa ezimbini, i-atezolizumab inikwe njengengeniso.
Ngophando luka-2017 eLancet, abantu abaye bafumana i-chemotherapy ephezulu ye-platinum ye-NSCLC ephakamileyo yayingenakulinganiswa ukufumana i-atezolizumab okanye i-docetaxel.
Ezinye iziphumo eziphawulekayo zibonise ukuba izinga lokusinda liye laphuculiswa kubantu abafumana i-atezolizumab kunye ne-docetaxel, kungakhathaliseki ukuba iisensi ze-tumor okanye iiseli ze-immune ngaphakathi kwimizimba ye-tumor zenzekile kwi-PD-L1 (i-median eyi-13.8 iinyanga kunye ne-atezolizumab kunye ne-9.6 iinyanga kunye ne-docetaxel ).
Ukongezelela, iimpembelelo ezinzulu ezichaphazelekayo zonyango ziye zabonwa ngaphantsi kweqela le-atezolizumab, xa kuthelekiswa neqela le-docetaxel (iipesenti ezili-15 ukuya kuma-43 ekhulwini).
Oko kwathiwa, iimpembelelo eziqhelekileyo eziqhelekileyo kubantu abafumana i-atezolizumab zi:
- Ukukhathala
- I sizathu
- Ukunciphisa ukutya
- Ubuthathaka
I-pneumonitis yenzeka kwi-1.6 ekhulwini yezigulane kwiqela le-atezolizumab, eliphantsi, kwaye ngaphantsi kweepesenti ezi-1 zazinzima (ibakala 3 okanye 4) i-pneumonitis.
Immunotherapies kwi-Horizon
Kubalulekile ukuba uqaphele ukuba kukho ezinye iziganeko ezininzi zokukhusela i-immune check-inhibitors. Isitshixo ekunqumeni indima yabo ekunyangeni okanye umhlaza wakho wamapayipi omthandayo uchazwe ngokwenene ngokuchanekileyo kwezi zonyango kwizifundo zesigaba III.
Ngokomzekelo, enye i-immunotherapy kwipayipi ebizwa ngokuba yi- ipilimumab ifumaneke ukuba ilondoloze ukusinda kubantu abane- melanoma ye-metastatic . Le nkunkuma ijolise i-cytotoxic T-lymphocyte antigen (i-CTLA-4), eyona mlawuli oyintloko wendlela iiseli zeT ezisebenza ngayo kwisistim somzimba. Ipilimumab ifundiswa njengonyango lwe-NSCLC ehambelana kunye ne-chemotherapy.
ILizwi
Akunakho ukukholelwa ukuba ezinye iintsholongwane (njengomdlavuza wamaphaphu) azikhuli nje ngokukhawuleza kwaye zingalawuleki kodwa zingaphawule okanye zikhohlise, ngoko kuthetha, inkqubo yomntu ozikhuselekileyo, isimiso sawo sokuzivikela.
Oko kwathiwa, iingcali zengqungquthela zineengxaki zokufumanisa i-immunotherapies-inguqu yoluguquko eya kuqhubeka ukuguqula indlela esiphatha ngayo umdlavuza esikhathini esizayo.
Ekugqibeleni, ukugqiba indlela yokuphatha umhlaza wakho wemiphunga yinkqubo eyinkimbinkimbi kunye nokukrhafisa, kwaye ngamanye amaxesha, amayeza amaninzi ayisoloko ayiphendule kakuhle. Nceda qiniseka ukuba uxoxe ngeemfuno zakho, ukwesaba, kunye neengxakini kunye nosapho lwakho kunye nodokotela.
> Imithombo:
> I-American Cancer Society. (2017). I-Immunotherapy ye-Can-Small Small Lung Cancer.
> I-Gettinger S. (ngoJuni 2017). I-Immunotherapy ye-non-encinci yesifo somhlaza wamaphaphu kunye nomngcipheko wokuhlola umzimba. Ku: U-UpToDate, uJett JR, uLilenbaum RC, iSchild SE (Eds), UpToDate, Waltham, MA.
> Reck M et al. I-Pembrolizumab ngokumalunga ne-chemotherapy kwi-PD-L1 I-Can-Small-Cell-Lung Cancer. N Engl J Med . 2016 uNgo-10; 375 (19): 1823-33.
> Rittmeyer A et al. I-Atezolizumab kunye ne-docetaxel kwizigulane ezinomdlavuza ongasetyenzana wesifo samangqamuzana ngaphambili (i-OAK): isigaba sesi-3, i-ilebula evulekileyo, isilingo esilawulwa ngokulandelelanisa. Lancet . 2017 Jan 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. I-Nivolumab kwi-NSCLC: ubungqina bwakutshanje kunye nekhliniki. UTher Adv Med Oncol . 2015 Mar; 7 (2): 85-96.