Ziziphi iziphumo zogqirha ugqirha ugqirha?
Njengawo nawaphi na unyango, kukho umgca kunye nomgca. Umgca wukuthi i- immunotherapy isetyenziselwa ukuphucula ukuhlaselwa kweentlobo ezithile zomhlaza njengomdlavuza ongaphantsi we-cell ummangcu, i-melanoma, umhlaza wesiliva, umhlaza wesi-colon kunye ne-Hodgkin's lymphoma. Ngamanye amazwi, abantu banikezwa ithuba lesibini ekuphileni ubomi obude kunye nobomi obukhulu-into eyenziwa ngokutshintsha ngokubhekiselele kwindlela yokwelashwa komhlaza.
Enyanisweni, ukuhlalutya kwi-immunotherapy kuqale nje, kwaye le yindawo ekhuthazayo kwaye enomdla kakhulu kuphando lomhlaza kunye nokunakekelwa kwangoku.
Ngaloo ndlela, njengoko abantu abaninzi bebaninzi baphathwa nge-immunotherapy, ngokukodwa i-checkpoint inhibitors (ipilimumab, nivolumab, kunye ne-pembrolizumab), oogqirha babona iingxaki ezizodwa ezinokuvela ngenxa yokuthatha ezi zonyango.
Ubume bemiSebenzi yokuHlola
Ukuze uqonde imiphumo emibi okanye inetyhefu ye- inhibitors yokujonga , kubalulekile ukuqonda indlela olu hlobo luni lwe-immunotherapy lusebenza.
Ngamafutshane, izixhobo zokujonga izixhobo zokuzivikela eziqhelekileyo zihlala zihlala kumanqanaba omzimba omzimba (okubizwa ngokuba ngama-T cells). Le mileksi yechungechunge isebenza ngendlela eyinkqubo yokumisela ukuyeka iiseli zomntu we-T ekuhlaseleni iiseli ezisempilweni-ezimbi kuphela, iiseli zangaphandle (umzekelo, iiseli ezinentsholongwane).
Ngelishwa, iiseli zomhlaza zikhohlisayo xa zenza kwaye zivakalise iimoli zazo zokujonga, kwaye yingakho umzimba wakho ungahlaseli isifo esibi, njengoko ucinga ukuba kuya kwenzeka.
Noko ke, izazinzulu ziye zalwa ngokudala izifo ezithintela izi ngqungquthela ezifumaneka kumaseli esifo somhlaza esithemba ukuba umzimba womzimba uya kuqonda umhlaza njengomzimba wasemzini, uqalise ukuhlaselwa, kwaye uyicacise.
Utyhefu lwee-Inhibitors zokuHlola
Enyanisweni, iingxaki zingaphakama xa isistim somzimba somntu sididekile kwaye siqala ukuhlaselwa ngokuqhelekileyo, iiseli ezinempilo ngokubhekisele kumaseli omhlaza omhlaza.
Ngamanye amagama, ukuvuvukala okukhulu, ukulimala komzimba, kunye nezifo ezizimela ngokuzenzekelayo zingenzeka ngokusetyenziswa kwezi zixhobo zokungena kwi-checkpoint.
Enyanisweni, uphando lubonisa ukuba ezi ziyobisi, ezibizwa ngokuba yimpembelelo enxulumene nomzimba, zenzeka kuma-85 ekhulwini labantu emva kokuba unyango kunye ne-check inhibitor ipilimumab. Zenzeka kuma-70 ekhulwini kubantu emva kokuba unyango lwe-check inhibitors nivolumab okanye ipembrolizumab.
Njengengxenyana, i-ipilimumab inqanda ukuhlolwa kwe-immune CTLA-4 (iprotheni ehambisana ne-cytotoxic T- i-lymphocyte 4) kwaye isetyenziselwe ukuphatha i- melanoma .
I-Nivolumab kunye ne-pembrolizumab ekujoliswe kuyo kwi-PD-1 (i-receptor-1 ye-death receptor) kwaye isetyenziselwe ukunyanga iisomhlaza njenge-melanoma, umhlaza wesangqumbo wesangqumbo, umhlaza wesifo somnxeba ongaphantsi, kunye ne-Hodgkin's lymphoma.
Ukubuyela kwizinto ezinobungozi, nangona kunjalo, iinkqubo ezijoliswe ekujoliswe kuyo ezi ngqangi zokuhlaselwa "ngokungafanelekanga" emzimbeni yilephu, isisu, isisu kunye neenkqubo ze-endocrine.
Utyhefu
Iingxaki zesikhumba yinto echaphazelekayo echaphazelekayo ye-immune ehlobene nokuthatha i-inhibitor ye-check-in, kwaye bavame ukuvela kuqala kunyango.
Imizekelo yeengxaki zesikhumba zibandakanya ukukhawuleza, ukubetheka, i-alopecia (ukulahleka kweenwele) kunye ne- vitiligo .
Iingxaki zomlomo zinjengomlomo owomileyo kunye nomlomo we-mucositis (xa izilonda zenziwa emlonyeni) nazo zinokwenzeka.
Uphulo lwe-rash ngokuvamile luquka ukusebenzisa i-cream corticosteroid cream. Nangona ukuba ukugqithisa kunzima, i-corticosteroid yomlomo ngamanye amaxesha iyadingeka. Ukuthatha i-antihistamine yomlomo njengoBenadryl (diphenhydramine) inokuba luncedo ekubambeni.
Ngokuqhelekileyo, ukuba ukukhawuleza kunzima, oku kuthetha ukuba iquka ngaphezulu kweepesenti ezingama-30 zomzimba, umntu uya kufuneka afune i-steroids enesiswini (nge-intravenously) elandelwa ngumbonakalo we-oral steroids.
Kwakhona kubalulekile ukuba uqaphele ukuba izilonda ezinzima ezifana ne- Stevens-Johnson syndrome azizange zibikwe ngabantu abathatha i-inhibitor yesheke.
Yingakho wena okanye ugqirha wakho omthandayo umhlaza uza kubeka iliso ngononophelo ngelixa uthabatha i-immunotherapy kwaye ngokukhawuleza ubona i- dermatologist ukuba i-rash yakho ibonakala ingxaki (njengokuba yenza i-blister) okanye ukuba awufumani ukuphucula ngamanyathelo alula ngathi i-corticosteroid cream.
Iingxubevange zoTywala
I-diarrhea kunye ne-colitis, ebangela iintlungu zesisu nangamaxesha athile igazi kwi-stool, ziingxaki ezimbini zamathumbu ezinokuthi zenzeke ngenxa yokuthatha i-inhibitor ye-checkpoint. Ukuba ezi ziphumo zivela, zibonisa ngokubanzi iiveki ezintandathu okanye emva koko emva kokuqala i-immunotherapy.
Oko kwathiwa, le miphumo emibi ibonakala iyinto eqhelekileyo kulabo bathola i-CTLA-4 yokukhusela i-antibodies (umzekelo, i-ipilimumab ye-melanoma ephezulu), xa kuthelekiswa nalabo bathola i-PD-1 inhibitors (umzekelo, i-nivolumab ye-cell squamous esephambili nomhlaza wamaphaphu).
Ukunyangwa kwesifo sohudo esilula kunye nangokokuqala kubandakanya ukungena kwamanzi amanzi, ukutya okunomdla wokurhoxisa , kunye nokuba mhlawumbi iyeza-anti-diarrheal efana ne-Imodium (loperamide). Kodwa ukuba isifo sohudo siyaqhubeka kwiminyaka engaphezu kweyesibini okanye ezintathu, nangona le miyeza elula, okanye ukuba isifo sohudo sinzima kakhulu (ukuhamba kwesine okanye ngaphezulu kwamathumbu ngosuku). isifo sisifo, kungekhona isicatshulwa.
Ukuba isifo siphelelwe ngaphandle, kwaye isizathu sithathwa njengento enxulumene nonyango, i-corticosteroids iyadingeka kwaye ngamanye amaxesha unamayeza anamandla anqanda ukukhusela umzimba wokuzikhusela njenge- Remicade (infliximab) iyadingeka.
Enye yezinto ezisongela ubomi, nangona ziqhelekileyo, iingxaki ze-colitis ukuba oogqirha baqaphele ngenxa ye- intestinal perforation (apho imingxuma ibonakala eludongeni lwamathumbu ukusuka ekuvukeni okukhulu).
Utywala obuyingozi
I-inhibitors ye-Checkpoint ingakhokelela ekuphakanyeni kwe-enzyme yesibindi, isifo sesibindi sokuvuvukala kwesibindi. Ezi ziphezulu zibonwa ngokubanzi malunga neenyanga ezimbini ukuya kwethathu emva kokuqala unyango.
Ngokuqhelekileyo, ugqirha uya kubeka iliso kwiimvavanyo zegazi , ikakhulukazi phambi kweyodwa umthamo we-immunotherapy, kwaye ukuba i-enzymes yonyuka, kuya kwenziwa umsebenzi oza kwenziwa ukuqinisekisa ukuba ngaba imbangela ihambelana ne-immunotherapy okanye enye into (umzekelo, elinye iyeza okanye usulelo lwe-virus).
Njengeminye imiphumo echaphazelekayo ekukhuselaneni nomzimba, ukuba isizathu sinqunywe ukuba sihambelana ne-immunotherapy, i-corticosteroids iya kunikwa. Ukuba isifo sobungozi sinzima, unyango kunye ne-immunotherapy lungafuneka luyekeke ngokupheleleyo.
I-Endocrine System Toxicities
Iziganeko ezintle ezichaphazeleka ngumzimba zingenzeka ngaphakathi kwenkqubo ye-endocrine yomzimba, equka i-pituitary gland, i-thyroid gland, kunye neengqungquthela ze-adrenal. Ngokomyinge, iimpawu zibonakala malunga neeveki ezi-9 emva kokuqala unyango kwaye zingaquka:
- Ukukhathala
- Ubuthathaka
- I sizathu
- Ukudideka
- Intloko
- Ukuphelelwa kwesidlo
- Ingxaki zo mbono
- Fever
Enye yeempembelelo eziphambili ze-endocrine ziyimpembelelo ye- hypothyroidism , okuyiyo xa umntu edala i-thyroid engasebenzi.
Kuye kwabikwa i-thyroid egwenxa engapheliyo, ebizwa ngokuba yi-hyperthyroidism. Zombini iimeko zilawulwa yi-endocrinologist kwaye ifunyanwe ngeemvavanyo zegazi, ngokugqithiseleyo i-hormone ye-thyroid (TSH) yokuhlolwa kwegazi. I-Hypothyroidism idinga unyango nge-thyroid hormone, ebizwa ngokuthi i-Synthroid (levothyroxine).
Ukongezelela kwi-hypothyroidism, enye ingxaki eqhubekayo ye-endocrine engaphuhliswa ngenxa yokuthatha i-checkpoint yokuvimbela i-immunotherapy yi-hypophysitis, okuyi-inflammation ye-pituitary gland-ekubhekiswe kuyo njenge-master gland kuba ikhupha ama-hormone amaninzi emzimbeni.
I-hypophysitis inokubangela ukukhathala kunye neentloko kunye nokuhlolwa kwegazi kubonisa amanqanaba amancinci amancinane. Ukuphonononga iimvavanyo kungabonakalisa ukuvuvukala kwegciwane le-pituitary. Ukuba ifunyenwe kungekudala, i-high-dose ye-corticosteroids inganciphisa ukuvuvukala ngokwaneleyo ukukhusela imfuno yezidakamizwa ezithatha ixesha elide.
Ukuba izilonda ze-adrenal zichaphazelekayo, umntu unokuhlakulela uxinzelelo lwegazi oluphantsi, ukucinywa kwamanzi kunye neengxaki ze-electrolyte ezifana namazinga aphezulu e-potassium kunye namanqanaba e-sodium aphantsi kwigazi. Le ngxamisekileyo yonyango kwaye idinga ukuba umntu abe esibhedlele aze athole i-corticosteroids.
Ekugqibeleni, uhlobo olusandul 'utsha lwesifo sikashukela aluzange ludibaniswe ngokuthatha iP-1 inhibitor. Yingakho oogqirha baya kuhlola i-glucose (ushukela kumanqanaba akho) xa uqala unyango.
Utywala
I-immunotherapy nayo ingabangela ukuvuvukala emphumputheni, kwaye oku kubizwa ngokuba yi-pneumonitis, nangona kungabonakali, xa kuthelekiswa neetyhefu ezikhankanywe ngasentla. Esi siphumo esibi sibuhlungu ngakumbi kubantu abanomdlavuza omkhuhlane ophezulu ongena kwi-immunotherapy, njengoko umsebenzi wabo wamaphaphu usuphelelwe ngumhlaza. Kungabangela iimpawu ezifana nokukhwehlela okanye ubunzima bokuphefumla.
Ngexesha eliqhelekileyo elichaphazelayo, i-pneumonitis ingasongela ubomi. Ukuba ukrokrelwa, ugqirha wakho uya kulawula ezinye izizathu zesifo sokuphuza imiphunga njengentsholongwane yomphunga (ebizwa nge-pneumonia) okanye ukunyuka komhlaza. Ugqirha uya kudlalela i-CT scan yesifuba ukuncedisa ekuxilongweni.
Uphulo luvame ukuquka ukumisa i-immunotherapy ngexesha elithile elikhethiweyo ngelixa umntu ejongene nokubeka esweni imiphunga. I-Corticosteroids nayo idlalwa rhoqo, kwaye kwiimeko ezinzima, i-immunosuppressant efana ne-Remicade (infliximab) ingafuneka xa umntu engaphuculanga nge-steroids.
Ekugqibeleni, ezinye iimpembelelo ezinqabileyo ezinxulumene nomzimba zichazwe njengeengxaki zesifo okanye iso. Kulo mzekelo, ugqirha uya kukuthumela kwi-ingcali, i- neurologist okanye i- ophthalmologist , ukufumana isifo esifanelekileyo kunye nesicwangciso soonyango.
ILizwi
Ukuba wena okanye othandekayo uthatha i-check inhibitor, kukulungele ukuba nolwazi malunga nobutyhefu obunxulumene nayo, njengoko behlukile kwizinto ezinxulumene ne-chemotherapies zendalo.
Ngamanye amazwi, iimpawu eziqhawulayo kunye neempawu zale miphumo emibi ziyinto enomdla kumagqirha emhlaza. Nangona kunjalo, musa ukwesaba ngabo. Kunoko, fundiswa kwaye uqaphele, baninzi baya kuxazulula ukuba babonwa ngokukhawuleza.
> Imithombo:
> Kroschinsky F et al. Iziyobisi ezitsha, iziyobisi ezintsha: iziphumo eziphambili zogxininiso lwezigulana kunye ne-immunotherapy yanomdla kunye nolawulo lwabo. Crit Care. 2017; 21: 89.
> Linardou H, Gogas H. Ukulawulwa kobutywala kwe-immunotherapy kwizigulane ezine-melanoma ye-metastatic. Ann Transl Med . 2016 Julayi; 4 (14): 272.
> Michot JM et al. Iziganeko ezichasene ne-immune ezinxulumene nomzimba kunye nokukhuselwa kwe-immune check blockkade: ukuhlaziywa okubanzi. Eur J Cancer . 2016 Feb; 54: 139-48.
> I-Postow M, iWolchok J. Inetyity ezinxulumene ne-inhibitor immunotherapy. Ku: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, Amin A. i-immune checkpoint inhibitors kwisenzo sezonyango: ukuhlaziya ngokulawulwa kwezidakamizwa ezichaphazelekayo. Shintsha i-Lung Cancer Res . 2015 Oct; 4 (5): 560-75.