Ulwaphulo olulindelekileyo lonyango olutsha lomhlaza wesifuba olungasetyenziselwa yedwa okanye luhlangene nezinye izibonelelo. Ngokungafani nekhemotherapy yendabuko ehlasele nayiphi na iseli ekhula ngokukhawuleza, iipilisi ezijoliswe ngqo zijolise ngqo kumaseli esifo somhlaza okanye ukutshintshela iindlela ezifaka isandla ekukhuleni kwamaseli omhlaza. Ngenxa yoko, ezininzi iziyobisi zingenokuba nemiphumo emibini ngaphandle kwe-chemotherapy.
Iipilisi ezijoliswe kuzo zifumaneka kulabo abanomdlavuza webele we- estrogen, abane - CAN 2 positive breast cancer , kunye nomhlaza wesibeleko wesithathu.
Ezi ziyobisi zingasebenza kakuhle ngamanye amaxesha, kodwa njengamanye amayeza asetyenziswa ukuphatha umdlavuza webele we-metastatic, ukuxhathisa ngokuqhelekileyo kuqhubeka ngexesha elide. Ezinye zala machiza zisetyenziselwa isigaba sokuqala kunye nomhlaza wesibeletho se-metastatic, kanti ezinye zisetyenziselwa abantu abanomdlavuza webele we-metastatic.
I-HER2 Cancer Positive
Njengoko kuphawuliwe kwangaphambili, malunga neepesenti ezingama-25 zeengcingo zesifuba, umgubo obizwa ngokuba yi-epidermal growth receptor 2 (okanye i-HER 2 / neu) iziphumo ekugqithiseni okukhulu kwiprotheyini ye-HER 2 (receptors) ephezulu kumaseli omhlaza wesifuba.
Ngokufanayo, ngendlela, kwindlela abafumana ngayo i-estrogen receptors abanomthwalo wokutshintsha iseli somhlaza ukuba likhule kwaye liqhubeke, i-receptors i-HER 2 ingabangela ukukhula kunye nokwanda kwee-2 ze-cancer ezilungileyo.
Amachiza aphazamisa aba bamkeliyo awanokuphazamisa umqondiso kula maseli omhlaza, ukunciphisa ukukhula kwawo.
Amachiza ajoliswe ku-HER 2 aquka:
- I-Herceptin (i-trastuzumab) - i- Herceptin inikwa iVV ngokuqhelekileyo kanye ngeveki okanye kanye emva kweeveki ezintathu. Imiphumo emibi ibandakanya umkhuhlane kunye nokukhawuleza kwangaphambili. Ukungaphumeleli kwintliziyo kunokukhula kwiipesenti ezintathu ukuya kwiingama zabantu abaphathwa ngayo kunye neziyobisi, kodwa ngokungafani nokuhluleka kwentliziyo ehambelana neziyobisi ze-chemotherapy ezifana ne-Adriamycin (doxorubicin), le ntliziyo ingaphumeleli xa unyango lugqityiwe. Iziphumo ezivela kwi-Herceptin zidla ngokuphucula emva kwexesha.
- I-Kadcyla (ado-trastuzumab) - UKaydcyla yinkonzo ebandakanya zombini i-Herceptin kunye neyeza ezinamandla kakhulu ze-chemotherapy ezibizwa ngokuba yi-emtansine. Inxalenye ye-Herceptin yesichengiso esithinta i-2 yesifo somhlaza wesifo, kodwa endaweni yokukhusela i-receptor ukukhusela i-hormone yokukhula ekuhambeni, inika "inkokhelo" yayo-i-chemotherapy drug-right to the cells of cancer.
U-Herceptin uvumela i-chemotherapy ukuba ingene kwiiseli zomhlaza, apho i-emtansine ikhutshwa khona. Ngelixa i-agent ye-chemotherapy ekhutshwa ngokufanelekileyo kumaseli esifo somhlaza, kukho kwakhona ukutyunjwa ngokubanzi kwesilwanyana kwi-systemic circulation.
Ngenxa yesi sizathu, isilwanyana sinokuba nemiphumo emibi eqhelekileyo kwiziyobisi zamakhemikhali zibandakanya ukunyuswa komnyoba we-bone kunye ne-peripheral neuropathy. I-Kaydycla inokusebenza nakubantu abantu abaye bangabonakali kuyo uHerceptin. - I-Perjeta (pertuzumab) - I-Perjeta yayisigunyaziwe yi-FDA kwisifo somhlaza wesifuba se-metastatic ngo-2013 kwaye uphando luye lwafumana ukwanda kwinqanaba lokusinda kwabasetyhini abanomdlavuza wesibeletho (i-HER 2 positive) abaphathwa ngayo neziyobisi. Ingasetyenziselwa yedwa okanye inxulumene noHerceptin okanye i-chemotherapy.
- I-Tykerb (lapatinib) - iTykerb iphinda ihlasele i-HER 2 yesifo somhlaza wesisu esifanelekileyo, kodwa ngeendlela ezahlukeneyo ngaphandle kwe-Herceptin. I-Tykerb, engafaniyo no-Herceptin ayikho into echasayo, ingasetyenziselwa yedwa, okanye inxulumene no-Herceptin okanye i-chemotherapy. Iziphumo eziqhelekileyo ezichaphazelekayo ziyimpuphu ebonakala efana ne-acne (kodwa ayiphathwa njenge-acne) kunye nehudo.
Imiphumo emibi yale Milwa
U-Herceptin, uKaydcyla, kunye nePerjeta baneendlela ezifanayo zokusebenza kwaye ngenxa yoko, iziphumo ezifanayo ezifanayo. Enye malunga nemiphumo yempembelelo yalezi yobisi yonakalisa intliziyo. I-oncologist yakho inokuncoma iimvavanyo zokuhlola i-heart yakho ngaphambi kokuba uqale la mayeza kwaye uza kukucebisa ngeempawu ezibonisa ukuba kufuneka ubizele.
I-Estrogen Receptor Positive Cancer
Kwabafazi abanomhlaza webele we-hormone-receptor-positive, iitharityhulam ezijoliswe kuzo ziyafumaneka kwakhona. Ezi zi yobisi zisetyenziswa kubasetyhini abasemasophosi (okanye ngubani ongu-premenopausal kwaye baye bafumana unyango lwe-ovarian threating treatment) ukuze benze i-hormonal therapies isebenze ngakumbi.
Iziyobisi ziquka:
- Ibrance (palbociclib ) - Le nkunkuma igimbela ii-enzyme ezibizwa ngokuba yi-cyclin-dependence kinases (CDK4 kunye neCDK6) kwaye isetyenziswe emva kwesifo somhlaza wesisu se-receptor-positive kwinkosikazi ye-postmenopausal iyaxhatshazwa kwi-hormonal therapy. Ingasetyenziselwa kunye ne-aromatase inhibitor efana ne-Femara (letrozole) okanye ne-anti-estrogen izidakamizwa iFaslodex (fulvestrant.)
- Afinitor (everolimus) - Esi sicikisi sivalela iprotheni emzimbeni owaziwa njenge-MTOR. I-Affinitor isetyenziselwa ukufumana i-estrogen receptor efanelekileyo kunye ne-HER 2 i-tumor ye-tumor emva kokuba inokumelana ne-aromatase inhibitor njenge-Aromatase (exemastine).
I-Cancer Breast Negative Breast Cancer
Iimvumi ezingenayo i-estrogen receptor engafanelekanga, i-progesterone receptor negative, ne-HER 2 negative (umhlaza wesibeleko wesifuba esintathu) ingaba nzima kakhulu ukuyiphatha, njengemithi yokwelapha ye-hormones kunye ne-HER 2 zokwelapha zivame ukungasebenzi. Nangona kusetyenziswa ngokungaqhelekanga ngeli xesha, i-Avastin yonyango ejoliswe kuyo ingacingelwa kwabanye abantu.
- I-Avastin (bevacizumab) - Le nto ayisetyenziswanga ukuphelisa umdlavuza webele ngenxa yezinye iziphumo eziphambili zegazi. Ikwahlula njenge-angiogenesis inhibitor. Igama elithi angiogenesis lithetha "igazi elitsha" kwaye libhekiselele kwimithambo yegazi entsha efunekayo ukuba ifake ukuvumela ukuba i-cancer ikhule.
I-Angiogenesis inhibitors isebenza ngokuthintela umdlavuza we-cancers ekuveleni imithana yegazi entsha, kwaye ngokuyinhloko "ilambile" ngumhlaza.
> Imithombo:
> DeVita, Vincent., Et al. I-Cancer: Imigaqo kunye nokuSebenza kwe-Oncology. Ngomhlaza we Breast. Wolters Kluwer, 2016.
> Liedtke, C., noH. Kolberg. Ulwaphulo lwe-Systemic lwe-Advanced / Metastatic Breast Cancer-Ubungqina Bokukhoyo kunye Neengcinga Zomso. Unakekelo lwebele . 2016. 11 (4): 275-281.