Yintoni Okufanele Uyazi Nge-Immuotherapy Drug Opdivo?
Ukuba wena okanye othandekayo uye wachazwa i-immunotherapy izidakamizwa i-Opdivo (nivolumab), kuyintoni okufuneka uyifumane? Le nkunkuma isebenza njani? Ziziphi iikritha ezingasabela kwisilwanyana? I-Opdivo isebenza kaninzi kangakanani kunye naziphi na iimpendulo eziye zabakho abantu? Ekugqibeleni, zithini iziphumo eziqhelekileyo?
I-Opdivo (i-Nivolumab) -Ukucacisa
I-Opdivo (nivolumab) ithathwa njengoluhlobo lweziyobisi ze-immunotherapy, isilwanyana sokuqala kuloluhlu oluvunyelwe umhlaza wemiphunga (ngo-2015) kwaye ngoku ivunyiwe ngamanye amaninzi emdlavuza.
U-Immunotherapy luhlobo olutsha olusetyenziswa ngonyango olusebenzisa amajoni omzimba okanye imigaqo yokuphendula omzimba wokulwa nomhlaza.
Zininzi iintlobo ezahlukeneyo ze-immunotherapy. I-Opdivo ithathwa ngokuba yi "checkpoint inhibitor" (esiza kuxoxa ngayo ngezantsi).
I-Opdivo (nivolumab) yongezelele ngakumbi ekuphatheni umhlaza kwiminyaka embalwa edluleyo, kwaye ininzi yolonwabo ayiyinto nje yokuxuba. Abanye abantu baye bafumana iimpendulo kumachiza aphantse atholwa kwiminyaka emihlanu edlulileyo. Ngelishwa, i-Opdivo ayisebenzi kuwo wonke umntu, kodwa xa isebenza ngempumelelo ingabangela impendulo ehlalayo (ichazwe ngezantsi). Iziphumo eziqhelekileyo ziqhelekileyo, kodwa ngokubanzi zinzima kuneemiphumo ezichaphazelekayo ezifumaneka kwiirimimine ezininzi ze-chemotherapy.
Ngaba i-Opdivo (i-Nivolumab) Uhlobo lwe-Chemotherapy?
Abantu abaninzi banokudideka malunga nendlela ikhemotherapy kunye ne-immunotherapy ezihlobene ngayo. Ngaba i-immunotherapy, kunye neyovolumab ngokukhethekileyo, uhlobo lwe-chemotherapy?
Ngamanye amaxesha, i-chemotherapy isetyenziswe ngokungaqhelekanga ukuchaza nayiphi na isilwanyana esinikwe ukulwa nomhlaza. Kule meko, izidakamizwa ze-immunotherapy ngamanye amaxesha zingathunyelwa njenge-chemotherapy. Nangona kunjalo kukho ukubaluleka okubalulekileyo. Igama elithi "i-chemotherapy" ngokuqhelekileyo libhekisela ekusetyenzisweni kweziyobisi ezichaphazela ukwahlukana kweseli kwazo zonke iiseli ezikhula ngokukhawuleza.
Imiphumo eyaziwa kakhulu yechemotherapy ivela ngenxa yokuba, ngaphezu kweseli yokulwa nomhlaza, ezi nkunkuma zichaphazela neeseli eziqhelekileyo ezahlula ngokukhawuleza. Yile nyathelo yokwenza i-chemotherapy kwiiseli ezinempilo, njengalezo ezisetyenziswe ematyeni anesithambo (kubangele inani elincinci lamhlophe kunye nokunye), izinwele zeentloko (ezibangelwa ukulahleka kweenwele), kunye neendlela zokutya (okubangela isicupucu) esiphumela imiphumela.
Ngokwahlukileyo, izidakamizwa ze-immunotherapy zenzelwe ngokukodwa ukuguqula umzimba womzimba okanye ukusebenzisa izinto ezenziwe ngamajoni omzimba wokulwa nomhlaza. Ngenxa yalesi sizathu, izidakamizwa ze-immunotherapy ziba neziphumo ezincinci ezimbalwa kunezidakamizwa zendalo zamachiza.
I-Opdivo (Nivolumab) isebenza njani?
I-Opdivo (nivolumab) iyisisigciwane se-immunotherapy esichazwa njenge-inhibitor yokujonga.
I-inhibitors ye-Checkpoint kulula ukuyiqonda ukuba ucinga ngesistim sakho somzimba njengemoto, kunye ne-checkpoint inhibitors kuba ngamabhuleki emotweni. Amajoni ethu omzimba aklanyelwe ukuhlaselwa ngamagciwane, iintsholongwane, kunye neeseli zomhlaza emzimbeni wethu. Isistim somzimba sethu sele sisazi indlela yokulwa nomhlaza. Njengokuba umzimba wethu ulwa neebhaktheriya kunye neentsholongwane kwimeko yethu, yenzelwe ukulwa namaseli angaphandle angangomzimba weseli.
I-immune system, nangona kunjalo, ihlolisise kunye nezilinganiso. Ezi zitshekisho zisebenzela ukulawula umzimba wokuzikhusela komzimba ngoko ke awukho ngaphantsi okanye kuphezulu. Isistim e-immune sisebenzayo, ngokwenene, ingxaki ngezifo ezizimeleyo njenge-rheumatoid arthritis kunye ne-lupus.
"Iibhethi" zeemoto ezityhutyha inkqubo ziyi-protein ezibhekiselwe kuyo njenge-inhibitors yokujonga. Ezi proteins zokujonga iincinci zinciphisa umyalezo wokuzivikela omzimba ukuze ungasebenzi. Enye yezi proteyini yiPP-L1. I-PD-L1 ibophelela kwi-PD-1 i-receptors kwiiseli ze-T (iiseli ezisistim somzimba ezikhuselekileyo ekuhlaseleni umdlavuza), ubaxelela ukuba bathule.
Iiseli zeCanscer zikhohlisayo. Ezinye iiseli zomhlaza ziye zathola indlela yokuvelisa i-PD-L1 eninzi. Xa oku kubophelela kwi-PD-1 i-receptors kwiiseli ze-T , ivumela iiseli zomhlaza ukuba zikhule zingakhange zihlolwe, phantse nje ukubeka imaski kwiiseli zomhlaza ukuze i-immune system ingaboni kwaye ihlase.
I-Opdivo isebenza ngokuzibophelela kunye nokuvimbela ukusebenza kwe-PD-1 nge-PD-L1, ngokukhululekileyo ukukhulula amabheki emotweni (isistim somzimba) ukuze ikwazi ukulwa nomhlaza. Konke kuzo zonke, i-Opdivo isebenza ngokuthatha imaski ngaphandle kweeseli zomhlaza ukuze bangakwazi ukufihla kwisistim somzimba, kwaye kugqiba ukutshabalaliswa yimpendulo yomzimba wethu.
Ixesha lini kwaye i-Opdivo (i-Nivolumab isebenzisa njani)?
I-Opdivo idla ngokusetyenziswa kwinqanaba le-IV (elingenakusebenza) kanomdlavuza, iisomhlaza ezingakwazi ukunyangwa ngophengululo kwaye zisasazeka kwezinye iindawo zomzimba (ezibizwa ngokuba yimetastatic).
I-Opdivo inikezwa ngumjovo wokungena ngaphakathi kwithuba lokungena kweyure malunga neyure. Idla rhoqo rhoqo kwiiveki ezimbini.
Kuthetha ntoni "Ukunyameka Ukuphendula"?
Ngaphambi kokuxoxa ngezifundo ze-nivolumab, kunceda ukuchaza isigama esisetyenziswe rhoqo xa kuchaza impendulo kwiimithi zonyango: i-term "impendulo ehlala njalo."
"Impendulo eqinile" ibhekisela kwimpendulo enokuhlala ihlala ixesha elide kwisifo. Akukho xesha elichaziweyo, kodwa "ixesha elide" lithetha ngokuncinci lonyaka kwaye ngamanye amaxesha.
Ukuba ubona izifundo zithetha "ngempendulo ehlala njalo," oku kudla ngokungafani noluhlobo oluthile lwempendulo elindelekileyo kwi-chemotherapy. Ngesigaba se-IV sesisu esiqinileyo, i-chemotherapy inokusebenza kodwa i-tumor isoloko iyanqandwa kwi-chemotherapy emva kwexesha elincinci (elidla rhoqo kwiinyanga). Ngeempiliso ezijoliswe kuyo, ixesha lokuphendula lidla ixesha elide, kodwa ukuxhatshaza kudla ngokuqhubekayo ngexesha lonyaka kuxhomekeke kwisichengiselwano esithile, uhlobo lomhlaza, nokunye okuninzi.
Impendulo eqinile ayithethi "ukunyanga" kodwa ichaza impendulo ebonisa ukuba ngeyona ndlela eyona nto esondeleyo ngeli xesha-xa isebenza.
Ngokungafani ne-chemotherapy kunye nonyango olujoliswe kuyo-olusebenzayo kuphela nje ngokuba umntu ethatha inkunkuma-kubantu abathile abathathe i-Opdivo, kubonakala ngathi ingaqhubeka isebenza kakuhle. Ngomdlavuza omninzi wesifo samangcwaba, abanye abantu baye bafumana iimpendulo ezinzima nangona emva kokuyeka unyango.
Ziziphi ii-Cancers ezinokuthi zithathwe nge-Opdivo?
I-Opdivo (nivolumab) ivunyelwe ukonyango lwabantu abane-lungen adenocarcinoma (uhlobo lomhlaza wesifo samangqamuzana), i-squamous cell carcinoma yemiphunga (enye uhlobo lomhlaza wesifo samangqamuzana), i-melanoma ye-metastatic, isifo seHodgkin , umhlaza wesihloko nentamo, i-Merkel cell carcinoma, kunye ne-renal cell carcinoma (umhlaza wesifo).
Ziziphi izifundo kunye novavanyo lwezonyango ezixelayo malunga ne-Opdivo?
Izifundo, ngokuqhelekileyo, zijonge umphumo we-Opdivo kumanqwanqwa athile kumdlavuza.
- Umhlaza wesifo samangqamuzana esingekho encinane - Uhlolo lwe-2017 lwezifundo ezi-9 ezibandakanya abantu abanegca III kunye nesigaba se-IV esingenanto encinci yesifo somhlaza wamaphaphu sithole ukuba i-nivolumab (kunye ne-atezolitumab kunye ne-pembrolizumab) kuphuculwe ngokubanzi ukwanda kwe-chemotherapy xa kusetyenziswa umgca wesibini (kunye ne-pembrolizumab Umgca wokuqala kwi-PDL-1 i-tumors). Ukongezelela, abantu babeneempembelelo ezincinci kwii-inhibitors zokujonga ngaphezu kwe-chemotherapy. I-Opdivo ingasetyenziselwa i- lung adenocarcinoma okanye i- squamous cell carcinoma yamaphaphu . I-Opdivo kufuneka isetyenziswe kuphela kulabo bantu abangenalo ukuguqulwa kwesiginci okanye abazange baphendule kwiyeza.
- I-melanoma ye-Metastatic - i-Opdivo iphakanyisiwe ngoku kuqala (njengolu unyango lokuqala) lwe- melanoma ye- metastatic .
- I-Classical Hodgkin lymphoma - i-Opdivo ingasetyenziselwa abantu abane- classic Hodgkin lymphoma abangaphuculanga emva kokutshintshwa kweesistim ze-stem kunye nokusetyenziswa kweyeza.
- Umkhwa we-squamous cell kunye nomhlaza womhlaza (umetastatic okanye umphindaphinda).
- I-Renal cell carcinoma - I-Opdivo ivunyiwe kumgca wesibini (emva kwe-anti-angiogenesis inhibitor therapy) kwi- renal cell cellcincin , uhlobo oluqhelekileyo lomhlaza wengqondo.
- I-urothelial carcinoma - I-Opdivo ivunyiwe kubantu abanolu hlobo lomhlaza wesibeleko abangakhange baphucule kwi-chemotherapy.
- Merkel cell carcinoma
Usebenze Ngakanani I-Immunotherapy Work Best?
Uphando lwe-Opdivo kunye nezinye izidakamizwa ze-immunotherapy usemncinci, kodwa ngomdlavuza wamaphaphu ubuncinane, kubonakala ukuba abantu abaye baphefumla kwixesha elidlulileyo banokuthi baphendule kwiziyobisi kunabo bangakhange bavume. Oku kunengqondo xa ucinga ngeendlela. Amathumbu omlenze kubantu abaye bavutha "banomthwalo ophezulu wokuguquka." Ngamanye amazwi, iiseli zomhlaza zininzi zenguqu ezifunyanwa kumhlaza weeseli ezenzeka kwinkqubo yeseli eba ngumhlaza. (Oku akuhambelani nobudlova kwaye ezi zinguqu zingaphunyezwa kwiintsapho). Iiseli ezinokuba nezinguqu ezininzi zibonakala zingenangqheleko (ezingaphantsi kweeseli eziqhelekileyo) kumasosha omzimba, okwenza unyango olisebenzisa isimiso somzimba okanye imigaqo yaso ebonakalayo ukuba isebenze.
Iimpembelelo ezingasemva ze-Opdivo (i-Nivolumab)
Njengoko nayiphi na unyango lomhlaza, kukho iziphumo eziqhelekileyo kunye neziphumo ezinokuthi unyango kunye ne-Opdivo.
Iziphumo eziqhelekileyo ezichaphazelekayo (ezo zenzeka kwipesenti ezili-10 okanye ngaphezulu kwabantu) ziquka:
- Ukugqithisa isikhumba
- Ukutshiza (pruritis)
- Izinga eliphezulu le-potassium (i- hyperkalemia ) kunye nezinga le-sodium eliphantsi (hyponatremia)
- Izilingo zomsebenzi zesibindi ezingaqhelekanga ezifana ne-ALT kunye ne-alkaline phosphatase
- Isiqhamo
- Ukuqhawukelwa ngumphefumlo
- Ukukhathala
- Inani elisezantsi legazi lamhlophe
- Intlungu yesisu ngokukodwa ngumhlaza wemiphunga
Iziphumo ezingekho phantsi kodwa ezibi kakhulu zingabandakanya:
- Phantse nantoni na ephelela ngesisombululo "itis" -kuthetha ukuvuvukala; ezifana ne-colitis, i-pneumonitis, i-hepatitis, nephritis, i-pancreatitis, kunye nokunye
- Iimeko zamehlo ezifana ne- uveitis kunye namehlo anomileyo
- Ingxaki ze-endocrine ezibandakanya i-thyroid gland, i-adrenal glands, kunye ne-pituitary gland
Izilumkiso Ngethuba ngo-Opdivo (Nivolumab)
Abantu abasebenzisa i-Opdivo kufuneka babekwe iliso malunga neempawu ezivuthayo, kwaye ukuba zikhona, izidakamizwa zingadinga ukuba zigcinwe okanye zenziwe. Ezi ziquka iimeko ezifana ne-pneumonitis, i-encephalitis, nephritis, kunye ne-colitis. Isiyobisi singabangela uhlobo lwesifo sikashukela, kunye neshukela legazi kufuneka libekwe iliso.
Ukungafezeki kwe-Adrenal okanye ukukhathala kwamadala kunokwenzeka, kwaye abantu bafanele baqaphele amandla okule meko kunye neempawu ezinokwenzeka.
Ingxaki efana ne- Stevens-Johnson isifo esingaba nayo, kwaye kufuneka uxoxe nogqirha wakho malunga naluphi na umonakalo owenzayo.
Kodwa ke, nangona kunjalo, iimpendulo ezingathintekiyo ezifunekayo zifuna ukuyeka ukusetyenziswa kwezidakamizwa aziqhelekanga, zenzeka ngaphantsi kweepesenti ezili-1 zexesha. Qinisekisa ukuthetha ne-oncologist yakho malunga nezinye iimpawu kunye nokuba ufuna ukubiza.
ILizwi
I-Opdivo (nivolumab) isisifo esitsha esichazwa njengoluhlobo lwe-immunotherapy. Kwala manzi amachiza asebenzayo, maxa wambi siye sabona iimpendulo zeengxube eziphambili ezithe zazingalindelekanga kwiminyaka embalwa edlulileyo. Oko kwathiwa, abasebenzeli wonke umntu, kwaye asinayo indlela enhle yokwazi ukuba ngubani oya kuphendula ngokuthe ngqo kunyango.
Iziphumo eziqhelekileyo ziqhelekileyo, ingakumbi iimpawu ezinjenge-rash, itching, kunye ne-thyroid function. Iimpendulo ezingathandekiyo ezinokuthi zingaphinde zenzeke ngokufanayo. Ngokubanzi, ke, i-Opdivo ibekezeleke ngakumbi kunokhemotherapy yendabuko.
Kukho uvuyo olukhulu kuluntu lwezonyango ngezizathu ezimbalwa. I-Opdivo ingasetyenziselwa ukhathaza izicubu ezinamandla kakhulu. Ukongezelela, inokusebenza kwimimandla eyahlukeneyo yomhlaza. Kungenzeka ukuba izitsha ezintsha zokusetyenziswa kweziyobisi ziya kuvunywa kungekudala, kwaye ezininzi izilingo zekliniki ziyaqhubeka ukuvavanya umphumo we-Opdivo kwiintlobo ezahlukeneyo zomhlaza, zombini zodwa, kunye kunye nezinye iziyobisi zonyango.
> Imithombo:
> Abdel-Rahman, O., > Oweira >, H., Petrausch, U. et al. Ukuxhatshazwa kwe-Ocular-Related Related toxicity in Powers Tumor Patients Tracted with Immune Checkpoint Inhibitors: UkuHlola okuHlolo. Ukuphononongwa kobuNtsholongwane kaGawulayo . 2017. 17 (4): 387-394.
> Ellis, P., Vella, E., noY. Ung. I-Inhibitors ye-Immune Checkpoint yezigulane ezine-Advanced-NonSmall-I-Cancer Lung Cancer: Uhlolo lokuHlola. Cancer Lung Cancer . 2017 Feb 16. (Epub ngaphambi kokuprinta).
> Postow >, M., noJ. J. Wolchok. Ietyhefu ezinxulumene ne-Checkpoint Inhibitor Immunotherapy. UpToDate . Ukuhlaziywa 05/31/17.
> Wang, X., Bao, Z., Zhang, X. et al. Impumelelo kunye noKhuseleko lwe-PD-1 / PD-L1 Inhibitors kwiNyango yeziThuthi eziMandla: UkuHlola okuSingqinisiso kunye nokuHlola kweMeta. Oncotarget . Ngo-2017 Meyi 31. (Epub ngaphambi kokuprinta).