Ziziphi Iindlela Eziphambili Zonyango NgeSigaba 4 I-HER2-Positve Cancer Breast?
Ukuba uye wafumanisa ukuba unomdlavuza webele we-HER2 ye-metastatic, kungenzeka ukuba ininzi yolwazi oyifumayo ibhekisela kumanqanaba omhlaza wesigaba okanye isigaba se-4 somhlaza wesibeleko ngokubanzi. Yintoni oyifunayo ukuba uyenze malunga nokunyangwa kwesigaba se-4 somhlaza wesifuba esiyi-HER2?
I-Metastatic HER2 I-Cancer Positive Cancer
Usenokuba ufunde ukuba unesifo somhlaza wesibeleko se-4 (metastatic) somhlaza xa uqala ukufumanisa ukuba unesifo, kodwa ngokuqhelekileyo, izidumbu ezikude zivela ngokuphindaphindiweyo kwe-tumor eyayisisithuba sokuqala se-tumor ngaphambili.
Ngaloo ndlela, ukuxilongwa ngokuthe rhoqo kuvela kukutshatyalaliswa kwaye kunokuziva kunzima.
Akunjalo nje kuphela ukuba isifo sengqondo asikho kakuhle xa umdlavuza webele usasazeka, kodwa umcamango wokuba unyango kwakhona unokushiya uzive udimazekile. Ngelixa isigaba 4 i-HER2 isifo somhlaza wesifuba esihle asiphilwanga, sonyango, kwaye unyango olujoliswe ekujoliseni i-HER2 luyaqhubeka nokwandisa nokuphucula. Ezi zonyango ziba neziphumo ezincinci kakhulu kunezilwanyana zamachiza.
Phantse i-one-five in cancer isifuba se- HER2-positive . Kuthetha ukuthini ukuba ezinye i-cancer zebele zineenjenge-HER2 ezithintela iiprotheni ezingama-HER2. Ezi iiprotheni zibophelela kwiiseli zomhlaza zesisu, ezibangela ukukhula kwezinto ezi zikhuhlane. Ngokuqhelekileyo, i-HER2 isisu se-tumors sinobudlova kwaye sikhula ngokukhawuleza.
Kuze kube ngo-1998, xa i-Herceptin ivunyiwe, i-HER2 i-HER2 i-tumorors positive, i-HER2 i-prognosis ehlwempuzekileyo, ingakumbi kulawo ayenayo i-estrogen kunye ne-progesterone receptor negative tumors.
Ukususela ngelo xesha ezinye iziyobisi ezijoliswe kuzo zijolise ku-HER2, zishiye ukhetho nangona iyeza elithile, okanye ezimbini, lihluleka.
Iinguqu zeRejeor Changes
Abantu abaninzi bayothuka xa befumanisa ukuba imeko ye-receptor yomhlaza wabo yatshintshi emva kokuba iphinde ibuye. Ukuba unesifo se- estrogen se- tumor esilungileyo xa ufumene ukuba unesifo somhlaza wesifuba sokuqala, ukuphindaphinda kungenayo i-estrogen receptor.
Ngokufanayo, ukuba unesifo se-HER2 / neu esingaphambi kwexesha, kungenokuba kungenjalo ngoku kwaye ngokukodwa.
Yingakho i-biopsy kunye nokujonga i-receptor status kubaluleke kakhulu ukuba unokuphindaphinda kude kwesifo sakho.
Ulawulo jikelele
Ulawulo oluqhelekileyo lomhlaza wesifuba se-metastatic efika ngokumangalisa kulabo abaye baphinda baphinda emva kokuba sele benomdlavuza webele wexesha elidlulileyo. Ngethuba lokuqala lomdlavuza webele, unyango luqhelekile. Injongo yonyango olunefuthe kunye nokuhlinzwa, i-chemotherapy, unyango olujoliswe kuyo, kunye / okanye imisebe yokhuseleko ukukhusela ukuphindaphinda xa kunokwenzeka.
Ngesigaba se-4 umhlaza wesifuba indlela yokunyanga yinto ehluke ngayo, kwaye abantu abaninzi bayazibuza ukuba kutheni indlela leyo ingabi yintlanu (kwaye iziva ixhala ngenxa yale nto). Injongo ngesifo somhlaza wesifo se-metastatic isisetyenziswa ukusebenzisa imithi encinci yonyango efunekayo ukulawula eso sifo. Ngokona nxalenye enkulu, unyango olunzima kakhulu lwesigaba 4 somhlaza wesifuba aluphuculanga ukusinda kodwa luyakwandisa imiphumo emibi. Kuthetha ukuthini ukuba udidi olulodwa kuphela lonyango ngexesha lusetyenziswa (ukuba luthintela ukukhula komhlaza) kuneendlela ezininzi ezidibeneyo kunye nezifo zokuqala.
Izinyango Zonyango
Unyango lokuqala lomhlaza wesibeletho se-metastatic uxhomekeka kakhulu kwi-receptor status, kwaye ukuba ukuphindaphinda, i-esrogen kunye nesimo se-receptor yesimo kunye ne-HER2 / neu imeko kufuneka ihlolwe (njengoko kuchaziwe ngasentla, oku kungatshintsha.)
Ukuba i-tumor yakho i-receroor receptor efanelekileyo kunye ne-HER2 enokuthi, unyango lokuqala lungaquka unyango lwe-hormonal, unyango olujoliswe ku -HER2, okanye zombini. Esi sigqibo siya kuxhomekeka kumachiza owaphathwe ngawo ngaphambi kokuphindaphinda kwakho (ukuba umhlaza wakho uphinda ubuyekelele kunokuba uhlambele isigaba 4 ngexesha lokuxilongwa.) I-Chemotherapy ingasetyenziselwa iinyanga ezine ukuya ezintandathu .
Ukuba awuzange uphathwe ngepilisi ejoliswe ku-HER2, unyango luvame ukuqala kunye no- Herceptin (trastuzumab) okanye iPerjeta (pertuzumab). Kulabo baye baphathwa ngeHerceptin, esinye isiyobisi esijoliswe kuHER2 singasetyenziswa, njengePerjeta (pertuzumab). Kwabantu abaye bathuthuka kwiimviwo ezimbini ezidlulileyo ze-HER2, unyango kunye ne-trastuzumab emtansine (TDM1) luphuculwe ngokubanzi ukuphila kunokuba ukhetho lwe-oncologist lwezinye iirimim zikhoyo (kubandakanywa nezidakamizwa ezininzi ze-chemotherapy) kwisifundo esinye.
Ukuba umhlaza uphuthukile kwiHerceptin okanye kwiinyanga ezili-12 zokumisa isiza, iT-DM1 (trastuzumab emtansine) yindlela ekhethiweyo yomgca wesibini.
Iinqunto zomgca weesithathu ziyahlukahluka ngokuxhomekeke kunyango lwangaphambili. Kwabo abangazange baphathwe nge-T-DM1, oku kukhetho. I-Perjeta ingasetyenziselwa abo abangakayifumana kunye noHerceptin. Kwabo baphathwa ngePerjeta kunye ne-T-DM1 kwaye baqhubekile, ukhetho lubandakanya ukuhlanganiswa kwe-Xeloda (capecitabine) kunye neTykerb (lapatinib), unyango lwe-hormonal kulabo abane-tumoror receptor positive tumors, kunye nezinye i-regimens ze-chemotherapy kunye ne-HER2 iziyobisi.
Ulwaphulo olulodwa lweMetastasis
Uthe unyango oluqhelekileyo lwe-metastas (ukusasazeka) lomhlaza wesifuba kunoma yiyiphi indawo edlalwa ngamachiza e-hormone, ii-HER2 ezijoliswe kuzo, okanye i-chemotherapy. Oku kunokudidanisa abanye abantu. Kutheni ukuba umhlaza wesifo kwimiphunga, umzekelo, unyango lwe-hormonal treatments?
Kubalulekile ukuqaphela ukuba xa umdlavuza webele usasazeka kwezinye izitho, ezifana namathambo, ubuchopho, isibindi kunye nemiphunga, yintsholongwane yomhlaza wesifo somhlaza esasasazeka kulezo zitho.
Unyango oluthi "uhlobo oluthile lweemetastasis" lungasetyenziselwa kwakhona. Ezi zonyango zijongana ngqo nommandla weemitha zesistim, ezifana neetasastases zethambo. Isibindi kunye neengqondo ze-metastases ziqhelekileyo kubasetyhini abane-HER2 / neu yesifo sengqondo somhlaza kunabo abano-HER2 ababi.
I-Bone Metastases
I-Boneastas i-Boneastases kunye nomhlaza wesifuba ixhaphake kakhulu, ifunyenwe kuma-70 ekhulwini abantu abanesifo se-metastatic. Ukongezelela kwindlela yokwenza unyango lwe-systemic ejongene nomhlaza wesifuba ngokwawo, unyango oluthile lwe-metastasis for bone metastases lunokunciphisa intlungu kwaye luphucule nokuphila, kunye ne-boneastases ye-bone ine-prognosis engcono kunezinye iziza zesifo se-metastatic. Ingqalelo kukuba iingxaki zethambo zesifo, ezifana neziqhekeza, zibaluleke kakhulu kuninzi lwezonyango zomhlaza wesisu zingakhokelela ekulahlekelweni kwethambo.
Khetha ziquka:
- Amatshini okuguqula amathambo kubandakanya i-bisphosphonates, njengeZometa (zoledronic acid) inokunciphisa iingxaki ezinjengeziqhekeza kunye neempembelelo ezinamandla ezichasayo. I-Xgeva (denosumab) yenye enye inketho ebonakala ibinempawu zokulwa nomhlaza.
- Ukunyanga kwamayeza kunokunciphisa intlungu kwaye kunokunciphisa ingozi
- I-Radiopharmaceuticals inokunceda abo banamathemasi amaninzi, njengamaqhezu emisebe ehlanganiswe kwenye ikhemikhali ifakwe kwigazi kwaye ithathwa amathambo kuwo wonke umzimba.
Liast Metastases
Ubunzima besifo esivela emdlalweni wesibeleko sesifuba yisona sesibini kwindawo eqhelekileyo yeemetastases kwaye iqhubela ngokuphindaphindiweyo phakathi kwabantu abane-HER2 positive tumors. Ulwaphulo lwe-radiation lisetyenziselwa ukongeza kwezinye iindlela zokwelapha umhlaza. Olunye unyango olunjengeembolization lungasetyenziselwa.
Ukuba kukho iindawo ezimbalwa zeemetastasis (i-oligometastase) ukususwa ngokugqithisileyo okanye umzimba we-stereotactic radiotherapy inokuphucula ukuphila. Ukuxhamla kwesibindi kubangelwa ukuba i- ascites (ukuvuvuka kwesisu) kunye neparacentesis (ukususa umkhuhlane esiswini ngesaliti esincinci esilula) kudla ngokufunekayo ukunciphisa ubunzima. Ukutshabalala kuqheleke kakhulu kwi-metastases yesibindi kunye nokunyanga ukuxubusha kunokuphucula umgangatho wobomi.
Brain Metastases
Nangona i-metastases evela kumdlavuza webele isoloko iphathwe njengenxalenye yonyango lwe-metastatic breast, i-metastases yengqondo ingaba ngumngeni onzima. Umqobo we-blood-brain is a collection of capillaries eziqinileyo ezinqande amayeza amaninzi, kuquka a machiza amaninzi e-chemotherapy, ukusuka ekufikeleleni kwengqondo. Ngombulelo, ezinye iziyobisi ziyakwazi ukuwela i-barr
Ukuhlaziywa kwe-2017 kwincwadi efumene ukuba i-Herceptin (trastuzumab) ngokucacileyo iphucula indlela yokuphila kwabo banesifo somhlaza wesibeleko se-HER2 nesifo sengqondo se-metastases. I-Trastuzumab emtansine (T-DM1) kunye ne-Perjeta (pertuzumab) nazo zi thembisa. Ngokwahlukileyo, iTykerb (lapatinib) ibonakala ingenayo impembelelo kwingqondo ye-metastase (njengezifundo ze-2017) kunye neprofayili ephezulu yezobisi. Xa i-lapatinib idibene ne-chemotherapy, kunjalo, amazinga okuphendula aycono.
I-Lung Metastases
Iimitha zesisu ezisuka kumdlavuza webele ziphethwe ngokubanzi ngamanyathelo aqhelekileyo wokunyanga umdlavuza webele, njengezonyango ze-hormone, izidakamizwa ezijoliswe ku-HER2 kunye ne-chemotherapy, kunokuba kukho naziphi na unyango oluthile. Xa zikhona ezimbalwa iimastastas zikhoyo, ukuphatha ezi ngophando okanye i-SBRT ingaqwalaselwa, kodwa izifundo azikabonisi ukunyuka kwezinga lokusinda kulo mkhuba.
Ezinye iiMetastases ezide
Umhlaza wesifuba ungasasazeka kwezinye iindawo ezikude zomzimba, kuquka isikhumba, isisundu, izicubu ezinamafutha, umongo wezinto kunye nezinye iindawo. Uninzi lwexesha eli lide lokugulisa i-metastases liphathwa ngonyango jikelele kwi-metastatic HER2 emdlalweni omhle, kodwa xa i-metastase ehlukeneyo ivela, kukho ukhetho olufana nokuhlinzwa okanye unyango lwe-radiation.
Ukujamelana
Ukujamelana nomdlavuza webele we-metastatic kuyinselele kungakhathaliseki ukuba uhlobo okanye iprojekthi ye-molecular. Ukuba uye wafumana unyango ngaphambi kwexesha lokuqala kunye nesifo sakho somhlaza, kwakhona indlela yokwenza umdlavuza we-metastatic ingakwazi ukuphazamisa ekuqaleni, njengoko injongo ekuqhelekileyo isebenzise nje unyango oluncinane ukulawula eso sifo, kunokuba unyango olubi mhlawumbi wayenomdlavuza wesifuba.
Izwi elithi "kuthatha idolophana" alizange lilungele ngakumbi kunokuba kusetyenziswe umhlaza ophezulu. Kukho amaqela amaninzi enkxaso kunye nomdlavuza webele we-intanethi okhoyo, kodwa abaninzi abantu abanomdlavuza webele weemetastatic bakhetha amaqela abandakanya ngokukodwa abo abanomdlavuza webele wesigaba 4 kunezo ziquka abantu abanomdlavuza wesibeleko.
Ukuba ngumthandayo wakho ohlala nomgca wesibeleko sesifuba sesine, uthathe umzuzwana ukuba uzibonele ngezinto ezingathethi kumntu onomdlavuza webele .
ILizwi
Umdlavuza webele we-Metastatic HER2 unokuphathwa unyango lwe-hormonal (kulabo bafumana i-estrogen receptor positive) kunye ne-chemotherapy, kodwa ukhetho lokusebenzisa i-HER2 zonyango olujoliswe kuzo ludibanisa enye indlela yokuziphatha.
I-HER2 izicubu ezintle ziyakwazi ukusasazeka kwingqondo kunye nesibindi kunama-tumors angalunganga a-HER2. Xa ezi zitshatyalalwano zenzeka, zombini unyango jikelele kunye nonyango lwe-metastasis lunokuqwalaselwa. Ngethamsanqa, kwaye ngokungafani namachiza amaninzi, i-Herceptin kwaye mhlawumbi i-pertuzumab ibonakala iwela ingcinezelo yengqondo yengqondo ukuze ilawule ngokuthe ngileyo le mastastas.
> Imithombo:
> Dieras, V., Miles, D., Verma, S. et al. I-Trastuzumab Emtansine neCapeecitabine Plus Lapatinib kwizigulane eziPhezulu zithathwa nge-HER2-Positive Cancer Breast Cancer (EMILIA): Uhlalutyo oluchazayo lweSigqeba sokuPhepha okuPhezulu ngokuSigxina kwiNqaku eli-Rally, Open-Label, isiGaba sesi-3. Lancet Oncology . 2017. 18 (6): 732-742.
> Krop, I., Kim, S., Martin, A. et al. I-Trastuzumab i-Emtansine ne-Treatment of Choice of Physic's Choice in Patients With previous Treated HER2-Positive Canast Metastatic Breast Cancer (TH3RESA): Iziphumo zokugqibela zokuPhumela kwiSigaba esiPhakathi seTrase-Open Phase 3. Lancet Oncology . 2017. 18 (6): 743-754.
> Laakmann, E., Muller, V., Schmidt, M. et al. Izinyathelo zokwelapha eziqhelekileyo kwi-HER2-Positive Cancer Breast Patients with Brain Metastase Beyond Trastuzumab: Ukuhlolwa kweeNcwadi. Unakekelo lwebele . 2017. 12 (3): 168-171.