Izinzuzo kunye neempembelelo zecala le-Tamoxifen kwi-Premenopausal Breast Cancer
I-Tamoxifen, eyaziwa ngokuba negama legama elithi Nolvadex, yenye yeemithi eziqhelekileyo eziqhelekileyo zokukhusela ukuphindaphinda umdlavuza webele. Iyintoni inzuzo yokusebenzisa eli lonyango emva kokuba unyango lokuqala lusetsholweni lomhlaza webele , zithini iziphumo eziqhelekileyo, kwaye ziziphi iingozi?
Sibanzi
I-Tamoxifen yipilisi ene-anti-estrogen kunye neziphumo ezinjenge-estrogen, ngokuxhomekeka kwintlobo ethile yesikhumba emzimbeni apho yenza khona.
Ikwahlulelwa njengesimodorator esecgen receptor (SERM) kunye neyeza uEvista (raloxifene).
Kukho ezintathu ezisisiseko ezisetyenziselwa i-tamoxifen:
- Abasetyhini kunye nabesilisa abafumene isifo se- estrogen-positive , isifo somhlaza wesifuba sokuqala emva kokuhlinzwa, i- chemotherapy okanye i-radiation ukunciphisa umngcipheko wokuphindaphinda.
- Abasetyhini kunye nabesilisa abafumene isigaba esiphambili okanye umhlaza wesibeletho se-metastatic esiyi-hormone receptor-positive
- Ukuthintela umdlavuza wesibeleko seprayimari kulabo abasengozini yokukhula kwesi sifo.
I-Tamoxifen ayinakucingelwa njengenzuzo kulabo abane-estrogen okanye i-progesterone yomhlaza wesifuba.
I-Tamoxifen ifika kwiipilisi ezi-10 mg okanye i-20 mg ezine-dose eziqhelekileyo zibe ngu-20 mg kanye ngosuku. Kukho intsebenziswano ebalulekileyo yeziyobisi ezinokunciphisa ukusebenza kweziyobisi. Ngokuqhelekileyo kuthathwa imihla ngemihla kwiminyaka emi-5 ukuya kwe-10 okanye ade umntu aguqule kwi-inhibitor ye-aromatase.
Izinzuzo
I-Tamoxifen yavunywa ngo-1998 kwaye isekelwe iphumelele ekuphatheni umdlavuza webele ngenxa yezigidi zabantu. Kukwajongwa njengendlela enhle kakhulu ukuba u-foremenopausal okanye u-postmenopausal kwaye awukwazi ukuthatha i-aromatase inhibitor.
Xa isetyenziswe emva kokuba unyango oluphambili lunokunciphisa umngcipheko wakho wokuphindaphinda umdlavuza webele , xa isisu sakho samukeli we-estrogen.
Inganciphisa umngcipheko wokuvelisa omnye umhlaza kwisifuba esifanayo okanye umhlaza omtsha kwelinye isifuba ngamaphesenti angama-50. Lo mngcipheko owenciphekileyo ugcina inyaniso kubini abanomngcipheko we-70-ophezulu.
Kungaba luncedo ukuqaphela ukuba i-tamoxifen iyaqhubeka inenzuzo ekunciphiseni umngcipheko wokuphindaphinda nangemva kokuyeka ukuthatha iziyobisi.
Ukongeza kwimiphumo yayo ekunciphiseni ingozi yomhlaza webele okanye ukuphindaphinda, i-tamoxifen inezinye iinzuzo ngokunjalo. Ngokuchasene nemiphumo yakhe yokulwa ne-estrogen kwiisifuba zesifuba, i-tamoxifen ineempembelelo ezinjenge-estrogen kwithambo. Ngenxa yoko i-tamoxifen (kunye no-Evista) inokunceda ukuphuza okanye ukuyeka ukulahleka kwethambo. (Ngokwahlukileyo, i-aromatase inhibitors ihlala iholele ekulahlekeni kwethambo). I-Tamoxifen inokunciphisa amanqanaba e-cholesterol, ngokukodwa i-LDL cholesterol.
Ingaba isebenza kanjani
Iiseli zomhlaza zesifuba ezifumana i-estrogen receptor ezichanekileyo zondliwa yi-estrogen. I-Estrogen emzimbeni ibophelela kwiiprotheni eziphezulu zala maseli (i-estrogen receptors) ukubonisa ukuba iseli ukwahlula kwaye sikhule. I-Tamoxifen ibophelela kule receptor ukuze i-estrogen ingakwazi, ngokukodwa ilambile iiseli zomhlaza.
Iimpawu eziPhakathi kunye neengozi
Imiphumo eminye yemiphumela eqhelekileyo ye-tamoxifen yimiba echaphazelekayo yokuba ne-esrogen eyancitshiswayo emzimbeni (ukuphuma kwindoda).
Ngako oko ukutshisa okutshisa, ubusuku obusuku, ukukhulelwa kwamanzi kunye nomsele, kunye nokunciphisa i-libido ziqhelekile. Njengengxelo ekhawulezayo, ukuba oku kukukhathaza, ukukhanya okutshisayo kudibene nokusinda okungcono kumdlavuza webele). Iingcatar zingenzeka kwakhona.
Izenzo zikaTamoxifen kwi-uterine (endometrial) izicubu zinokuphakamisa umngcipheko wesifo somhlaza . Lo mngcipheko uxhomekeke kubude bexesha olapha kwiziyobisi. Lo mngcipheko uphezulu kwabasetyhini ngaphezu kweminyaka engama-50 kodwa ungaphantsi kwepesenti enye.
I-Tamoxifen inokunyusa umngcipheko wokuphuhlisa ama-blood clots okanye kwimilenze yakho (inzulu ye-vein thrombosis) okanye imiphunga (i- pulmonary embolism ). Asiqinisekanga ngeli xesha, kodwa i-tamoxifen inokunyusa umngcipheko wokuhlaselwa kwintliziyo okanye ukubetha.
Nini ukubiza uDokotela wakho
Kubalulekile ukubiza ugqirha wakho ukuba unayo nayiphi na impawu enokukhathazeka ngayo, kodwa ngokukodwa, kufuneka ubize ukuba uhlakulela naziphi na ezi zilandelayo:
- Ukuphuma kwamanzi ngokwesisu
- Ubuhlungu kwi-pelvis yakho
- Ukuvuvuka komlenze
- Iintlungu zesifuba
- Ukuqhawukelwa ngumphefumlo
- Ubuthathaka, ukuphazamiseka okanye ukubetha
- Imiba yembono
Tamoxifen vs. Aromatase Inhibitors
I-Tamoxifen kunye ne-aromatase inhibitors ziyahluka uma kuziwa kuzo zombini inzuzo kunye nobungozi. Kubasetyhini abathumela i-postmenopausal okanye abo bangama-premenopausal kwaye baye bafumana unyango lwe-ovarian threating, i-aromatase inhibitor ingaba neenzuzo ezinkulu ekunciphiseni umngcipheko wokuphindaphinda. I-Aromatase inhibitors ibangela iimpawu ze-menopausal kodwa ikwazi ukuphazamiseka kwethambo kwenyameko kunokunciphisa itamoxifen. Intlungu kunye nentsebenziswano inokuthi ivele kunye neklasi yeziyobisi kodwa ixhaphake kakhulu kwi-aromatase inhibitors.
Izilumkiso
Ukusebenzisana kweziyobisi
Ngenxa yendlela echanekileyo ngayo, i-tamoxifen inokusebenzisana kunye nomyalelo wokubhaliweyo kunye neyeza-anti-counter. Thetha ugqirha wakho malunga nayiphi na imichiza oyisebenzisayo kwaye uqiniseke ukuba wakho uphemistri uyazi kakuhle. Ngokukodwa, iintsholongwane ezixinzelelekileyo, kunye ne-anti-anti-allergies, ziya kunciphisa ukuphumelela kwe-tamoxifen.
Ukukhulelwa
Ngenxa yesilinganiselo esiphezulu seziphene zokuzalwa, i- tamoxifen ayifanele isetyenziswe ekukhulelweni , kwaye isilwanyana kufuneka simiswe ubuncinane ubuncinane kweenyanga ezimbini ngaphambi kokuzama ukukhulelwa.
Kude Kufuneka Uwuthabathe
Ngokusekelwe kubungqina obucacileyo obuvela kwizifundo ezimbini zesiganeko esikhulu se-phase III (ATLAS kunye ne -TTom), unyaka ongama-10 kunokuba unyango olune-five adjuvant kunye neTamoxifen ludibene nomngcipheko omncinci wokuphindaphinda kunye nokunciphisa ukubulawa komdlavuza webele.
Ukunciphisa ukuphindaphindwa komhlaza wesifuba kufuneka kulinganiswe nemiphumo engamandla kumntu ngamnye njengomntu ngamnye. Ukuba u-premenopausal, ugqirha wakho unokuncoma i-tamoxifen iminyaka engama-3 ukuya kwe-5 ngaphambi kokutshintshela kwi-inhibitor ye-aromatase iminyaka engama-5.
Kubalulekile ukunamathela kumachiza akho. Ngelishwa, abantu abaninzi baphoswa amaxabiso okanye bayeke la mayeza ngokukhawuleza, kubangele ingozi ephezulu yokuphindaphinda.
Ngaphantsi
I-Tamoxifen inokunciphisa kakhulu umngcipheko wokuphindaphinda umdlavuza webele emva kokuba unyango oluphambili kunye nokuhlinzwa, i-chemotherapy kunye / okanye unyango lwe-radiation. Njengawo nawaphi na amayeza, i-tamoxifen inobungozi kunye nemiphumo emibi kunye neenzuzo zonyango kufuneka zilinganwe nale mngcipheko. Qiniseka ukuba uxoxe ngezilwanyana zakho kunye noogqirha uze uthethe naye xa unamava. Gcina imizila yoqhagamshelwano evulekileyo ukuqinisekisa ukuba i-tamoxifen isebenza kuwe ngaphandle kokungaphumeleli okukhulu.
> Imithombo:
> INational Cancer Institute. Ukwelashwa kweNtsholongwane kaBestile (PDQ) -Ingxelo yeNgcali yezobuNtu.
> Sahebkar, A., Serban, M., Penson, P. et al. Iimpembelelo zeTamoxifen kwiPlasma Lipoprotein (a) Iingqwalasela: UkuHlola ngokuSingqinisiso kunye nokuHlola kweMeta. Zi yobisi . 2017. 77 (11): 1187-1197.
> Yu, Z., Guo, X., Jiang, Y. et al. I-Adjuvant Endocrine Monotherapy kwi-Postmenineus Early Breast Cancer Izigulane ezineHormone-Receptor Positive: UkuHlola okuHlolo kunye ne-Network Meta-Analysis. Ngomhlaza webele . 2017 Julayi 28.