Iimithi zokwelapha ze- hormone zihlala ziqala isinyathelo sokunyanga umdlavuza webele we-metastatic, ubuncinci kulabo abaneemvumi ezifumana i- estrogen receptor . Ukukhethwa kwamachiza kuya kuxhomekeka ekubeni ngaba unmenopausal okanye postmenopausal, kunye nokuba umhlaza wakho uphindaphindeka ngelixa usebenzisa enye yeyeza. (Ukuba umhlaza wakho uphindwe ngelixa uthabatha elinye lala machiza kucingwa ukuba umhlaza wakho unokumelana nesichengisi.)
Indima ye-Estrogen
I-esrogen isebenza njengamafutha, ibophelela kwi-esrogen i-receptors kummandla wamaseli omhlaza kwaye ikhuthaza ukukhula kunye nokwanda komdlavuza. Le nyathelo ye-estrogen kumaseli omhlaza angancinci ngeendlela ezimbalwa ezahlukeneyo; ngokunciphisa inani le-estrogen emzimbeni, okanye ngokunqanda i-estrogen receptors ukuze i-estrogen ingakwazi ukukhuthaza ukukhula kweeseli. Ngokuchasene neziyobisi ze-chemotherapy ezibulala ngokuthe ngqo iiseli zomhlaza (ngokulula), imithi ye-hormonal isebenza ngokukodwa "ngokulambile" kwimizimba yesifo se-estrogen.
Ngaphambi kokumiswa kwexesha, ama-ovari akho awona mveliso abakhulu be-estrogen. Emva kokumisa umva, umthombo omkhulu we-estrogen emzimbeni uvela ekuguquleni kwe-androgens ukuya kwi-estrogen. Olu tshintsho luboniswa yi-enzyme aromatase etholakala kwi-fat and muscle. I-Aromatase inhibitors yile mithi evimba i-aromatase ukwenzela ukuba le nguqulelo ye-androgens kwi-estrogens ayikwazi ukuvela, ngokunciphisa amanqanaba e-estrogen ngokufanelekileyo.
Iimithi zokwelapha zaseHormon zisebenzisekile kulabo abane-receptor receptor kunye ne-progesterone receptor negative tumors.
Kwakhona kubalulekile ukuba uqaphele ukuba ezinye iimvumi ezithembekileyo ze-estrogen nazo zi- 2 zenzekile . Kwiimvumi ezithandekayo kuzo zombini ezi zifunyenwe, i-anti-estrogen yonyango ingasetyenziswa kunye okanye ngaphandle kweziyobisi ezisebenza kwi-HER 2.
Unyango lwe-Premenopausal
Ukuba u-foremenopausal, ii-ovaries zakho zisona mthombo omkhulu kakhulu we-estrogen, kwaye ngoko ke uphethiloli, ngomhlaza wesifuba. Injongo yonyango kubasetyhini be-premenopausal ke ukunciphisa ubuchule be-estrogen ukukhuthaza ukukhula komhlaza wakho ngokunciphisa inani le-estrogen (unyango lokunyanzelisa i-ovarian) kunye nokuphazamiseka kwe-estrogen yokuzibophelela kwi-estrogen receptors kumhlaza wesisu iiseli.
Amachiza afana ne- tamoxifen abizwa ngokuba yi-SERMS-selective receptor agents, kunye nokusebenza ngokubophelela kumaseli omhlaza ukuze i-estrogen ikhona emzimbeni ayikwazi ukubopha eseleni kwaye ibonise ukuba iseli ikhule.
Kucingelwa ukuba i-aromatase inhibitors inokusebenza ngakumbi kune-tamoxifen, kodwa oku akukwazi ukusetyenziswa kubasetyhini base-premenopausal ngenxa yomsebenzi wama-ovari. Ukunciphisa i-estrogen eyenziwa ngama-ovari, kwaye kukuvumela ukuba usebenzise i-inhibitor ye-aromatase, i-oncologist yakho inokuncoma ukwelashwa kwe-ovarian.
Ukunyanzeliswa kwe-Ovari kunokwenziwa ngu:
- Ukusebenzisa imithi yeZoladex (goserelinlin) - Le ngonyango enikwe ngaphantsi kwaye ikhuphe umveliso we-estrogen ngumzimba, kwaye iyaziwa njenge-gonadotropic ekhupha i-hormone. Ama-ovari akhiqiza i-estrogen ekuphenduleni i-hormone eyaziwa ngokuba yi-gonadotropin evuselela i-hormone efihliweyo yintsimbi ye-pituitary. I-Zoladex inqanda ikhono le-gonadotropin ekhuthaza i-hormone ukukhuthaza ama-ovari.
- I-Oophorectomy - Ngokuqhelekanga, abanye abafazi bakhetha ukuba banqunywe amaqanda abo (ngokusebenzisa inkqubo ebizwa ngokuba yi-oophorectomy) kunokusebenzisa iZoladex. Lo msebenzi uphelelwe ngaphantsi ngenxa yengozi enkulu ephathelene nokuhlinzwa, kodwa abanye abafazi banokukhetha le ndlela, ingakumbi abo banomdla wokuba nomhlaza wesibeleko kunye nomhlaza wesibele.
I-oophorectomy inokuyenza rhoqo njengendlela ye-laparoscopic kwaye idla ngokuhlinzwa olunye usuku. Kwi-oophorectomy ye-laparoscopic, iimbalwa ezincinci zenziwa kwiisisu kwaye i-ovari zisuswa ngoncedo lwezixhobo ezizodwa.
Ukulandela unyango lwe-ovarian unyango, abafazi be-premenopausal bangaphinda baphathwe ngamachiza njengabasetyhini abasemagxeni abaxoxwa ngezantsi okanye nge-tamoxifen.
I-Postmenopausal Therapy
Emva kokumiswa kwexesha, umthombo omkhulu kakhulu we-estrogen emzimbeni uvela ekuguquleni kwendawo ye-androgen kwi-estrogen. Umhlaza wesibeletho se-Postmenopausal unokuphathwa kunye ne-tamoxifen (ukuvimba le isrogen eguqulwe ngokuthe ngqo kwintsholongwane yesifo somhlaza) kodwa uluhlu lwamachiza abizwa ngokuba yi-aromatase inhibitors lubonakala lusebenza ngakumbi nangemiphumo embalwa.
I-aromatase inhibitors ifumaneka:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (exemestane)
I-Aromatase inhibitors ingasetyenziselwa yedwa, okanye inxulumene nemithi ye-chemotherapy . Ngokomzekelo, ukuhlanganiswa kwe-Femara (letrozole) kunye ne-Ibrance (palbociclib) kunye ne-Aromasin (i-exemestane) kunye ne-Afinitor (everolimus). Kuhlala kulungelelaniso xa ungeze elinye iyeza. Nangona udibaniso lunokusebenza ngakumbi, kukho ukwanda kwimiba emibi xa kudibanisa amayeza angaphezu kweyodwa.
Kukunceda ukuphawula kwakhona ukuba injongo yonyango ihlala ihluke nomhlaza wesibeletho se-metastatic kunokuba isifo somhlaza wesifuba sokuqala. Ngethuba lokuqala lomdlavuza webele, injongo yonyango, kwaye ifilosofi "ukukhupha izibhamu ezinkulu" ukuze uphephe eso sifo. Ifilosofi ngesomdlavuza webele we-metastatic, ngokuphambene, ngokuqhelekileyo ukulawula ukukhula komhlaza kunye nemali encinci yonyango, ukugcina amanye amayeza ngexesha apho iyeza lokuqala zingasasebenzi.
Ezinye iiHormonal Treatments
Ukongeza kwi-tamoxifen kunye ne-aromatase inhibitors, kukho ezinye iimpawu ezinxulumene ne-hormone ezingasetyenziselwa umhlaza wesibeletho se-metastatic. Ukuba umhlaza wesifuba uqhubeka ukhula okanye usasazeka kumayeza angentla apha ngokuqhelekileyo uthathwa ngokungqinelana nala mayeza. Umdlavuza webele we-Metastatic phantse uhlale unganyangeki kule miyeza ngokuhamba kwexesha. Xa oku kwenzeka, ukhetho luquka:
- I-Faslodex (fulvestrant) -Kwabesetyhini abasemasophayo abahamba phambili ngomhlaza wabo kwi-tamoxifen okanye i-aromatase inhibitor, ukhetho lusebenzisa iyeza leFaslodex. I-Faslodex okwangoku iyeza kuphela ezivunywe ngomhlaza wesifuba kwiqela elibizwa ngokuba yi-SERD-selective receptor downregulators.
Eli gciwane libhekiselwe "njenge-antiestrogen ecocekileyo" kwaye ibimbela umphumo we-estrogen kwi-cell cancer eselgen-positive receptor-positive cell cells kodwa ngendlela eyahlukileyo kune-tamoxifen (yi-estrogen receptor antagonist.) I-Faslodex ingasetyenziselwa yodwa okanye idibene kunye Ibrance (palbociclib), iziyobisi zechemotherapy, kwaye zinikezwa njengejoza.
Ukusetyenziswa kwamayeza
Kukho ezinye iindlela zokwelapha eziqhelekileyo ezisetyenziselwa kodwa ngezinye iinkalo zibhekwa njengowomgca we-3 okanye unyango lwe-4. Ezi ziquka:
- I-Fareston (inremifene) - I-Fareston yonyango efana ne-tamoxifen kwaye ikwaqwalaselwa ukuba i-adrogen receptor i-agent adversi ngamanye amaxesha ingathatyathwa ngabasetyhini abasemva kwe-estrogen ne-cancer ye-receptor-positive, ikakhulukazi kwabasetyhini abangenayo i-enzyme eguqula i-tamoxifen kwifomu layo esebenzayo umzimba.
- I- Progestins - i-Megace (megestrol) yindlela yokwenziwa kweprogesterone edlalwa ngamanye amaxesha kubantu abanomdlavuza webele we-estrogen oye waxhathisa i-tamoxifen. Yayisetyenziswe kaninzi kwixesha elidlulileyo ngaphambi kokuba izidakamizwa ezintsha zifumaneke.
- I-hormone ye-sex steroid - iiHormones ezifana ne-estrogen kunye ne-androgens aziqhelekanga zisetyenziselwa umhlaza wesisu se-metastatic, kodwa ngamanye amaxesha isenokusetyenziswa xa ezinye izifo zonyango ziphumelele.
Unyango lwabantu
Amadoda anomdlavuza webele we-metastatic ebizwa ngokuba yi-recemor receptor positive ihlala iphathwa nge-tamoxifen.
Imiphumela
Tamoxifen
I-Tamoxifen ineemisebenzi eyahlukileyo, kokubili ukuxelisa umphumo we-estrogen kwezinye iindawo zomzimba kwaye uyayiphikisa kwabanye. Izimpawu eziqhelekileyo ziquka ukutshisa okutshisayo kunye neengqungquthela zomzimba eziye zaqulunqwa "i-old lady syndrome" nangona le mizimba ihamba ngamandla kunokuba i-aromatase inhibitors.
Iziphumo ezibi kakhulu zibandakanya umngcipheko ophezulu wecala legazi emilenzeni (i-venous thromboembolism) enokuthi ingakhange iphendulwe, inokukwazi ukukhulula kwaye ihambe emiphakeni (ipommonary emboli.) Ngokuhamba kwexesha, i-tamoxifen ingabangela ukuphuma kwamanzi kwaye idibene kunye nokwanda okuncinci ekuphuhliseni umdlavuza wesibeleko.
Abanye abesifazana (kunye namadoda) athatha i-tamoxifen inokuphuhliswa kweempawu zabo (umzekelo, ukwanda okomvu we-skinast metastase okanye ukwanda kweentlungu zethambo kwi-boneastases) kwiintsuku ezimbalwa zokuqala imithi.
Ukuba uhlakulela le mpawu, bahlala becombulula kwisithuba seveki ezine ukuya ezintandathu, nangona amaxesha amayeza kufuneka apheliswe. Isilivere yokulala xa unempendulo yinto yokuba ukuphendulwa komsindo kuthathwa njengesigqirha sokuba unyango lusebenza kwaye luya kusebenza. I-Zoladex inokubangela ukuphendula okufanayo.
Qaphela ukuba i-Tamoxifen inokubangela iimvavanyo zesibindi esingaqhelekanga, i-anemia, kunye neeplatelet eziphantsi kwaye zidibene nomngcipheko okhulayo womhlaza we-endometrial. Xoxa nodokotela wakho ukuba olu khetho lungcono kuwe.
Aromatase inhibitors (AI)
I-AI inokubangela ukuba i-body aches, ibe malunga neepesenti ezingama-40 zabantu abaqaphela isantya esithile semisipha kunye nokuqhayisa ngokubambisana. Ukulahleka kwethambo kuyisiphumo esisecaleni, kwaye i-oncologist yakho iyakutyala ukuxinwa kwethambo ukuba ikuhlolisise i-osteoporosis, kokubili ekuqaleni kwonyango kunye nexesha emva koko. Iingxabano zingenzeka ngenxa yokulahleka kwethambo, nangaphandle kweethambo zesifo. I-AI inokunyusa ingozi yesifo senhliziyo.
Faslodex
I-Faslodex ivame ukunyamezela kakuhle, kunye nemiphumo echaphazelekayo yokutshisa kunye nokuphakama kwezilingo zomsebenzi wesibindi.
Zoladex (goserelin)
Enye yeempembelelo eziqhelekileyo eziqhelekileyo zalo myeza empeleni iyimpembelelo efunwayo. Injongo yokonyango kukuphelisa ii-ovari, ngamanye amazwi, mayeke ii-ovari ukukhupha i-estrogen. Ukwenza oku kubangelwa ukunyuka kwexesha lokunyanga kwemithi kwaye, ngoko ke, iimpawu eziqhelekileyo zokuziyeka komzimba ezifana nokutshisa okutshisa kunye nokomama wesisu kuyaqhelekile.
Njengoko i-tamoxifen, abanye abantu banokuba neempendulo zokuqala xa kuqala ukuqala imishanguzo, umzekelo, ukwanda kwintlungu yeethambo kulabo abaneethambo zesifo.
Oophorectomy
Iziphumo eziphambili ezinxulumene nokususa ii-ovari zifana ne-hormone yokunyanzelisa i-hormone yokunyanga, iziganeko eziqhelekileyo eziqhelekileyo kunye nokuphuma komzimba ezifana nokutshisa okutshisa kunye nokomama wesisu. Kukho iziphumo ezibi kunye nomngcipheko ophathelene nokuhlinzwa. I-oophorectomy inokuthi yenziwe ngokuhlinzwa okwexeshana (i-laparcopha) ngokucutshulwa okumbalwa kwesikhumba kwaye idlalwa njengenkqubo efanayo yokuhlinzwa.
Faslodex (fulvestrant)
Ekubeni eli liyeza elichasene ne-estrogen, ezininzi iimpawu zifana nezo zifunyenwe nokuphuma kwindoda, njenge-tamoxifen kunye ne-aromatase inhibitors. Ingxenye yesithathu yabantu bafumana isicupunu esichukumisayo, kodwa ngenye indlela, eli gama livame ukunyamezela.
> Imithombo:
> I-American Society of Clinic Oncology. Cancer.Net. Iingonyama zeHormonal zeMetastatic Cancer Breast. Updated 05/2016. https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommended-patients/hormonal-therapy-metastatic-breast-cancer
> UMartin, M., Lopez-Tarruella, S., noY. Gilarranz. I-Endocrine Therapy yeHormone Treatment-Naïve Advanced Breast Cancer. Isisu . 2016. (Epub ngaphambi kokuprinta).