Iziyobisi ezivimbela iindlela ezikhohlisayo zomhlaza
Umhlaza wesifo se-squamous entloko nentamo ngumsi wesithandathu oqhelekileyo umdlavuza emhlabeni kwaye ulandelelanisa malunga neyodwa ukuya kweebini kweepesenti yazo zonke izifo zomhlaza. Enye ingxaki enkulu ilapha kunyango lwabantu abanomdlavuza wentsimbi okanye umva nomhlaza, njengokuba ithuba lokuphila lisoloko libi.
Iindaba ezilungileyo kukuba uphando luyaqhubeka, kwaye oogqirha baqala ukusebenzisa i-immunotherapi kule ndawo yezigulane.
I-Immunotherapy yonyango lwenveli ebonakalayo ikhuselekile kwaye iphucula iimpawu kunye nenkqubela yokuhlala kwabanye abantu, ngokusekelwe kwizifundo zenzululwazi zakudala.
Ukuqonda iZiseko zeNtloko kunye neCeck Cancer
Ngaphambi kokuba ukwazi ukuqonda indlela ezi zi-immunotherapi zisebenza ngayo, kulungile ukufumana intambo kwizinto ezithile "intloko nentamo" ethile ithetha ngayo.
Yisiphi iSagamous Cell?
Amaseli e-Squamous anamahlunu, amangqamuzana ahlala ekhanda, emagqabini kunye nokuphefumula, kunye namalungu athile emzimbeni.
Imizekelo yeendawo apho i-squamous cell carcinoma (umhlaza) ingahlakulela zibandakanya ezi ndawo:
- Intloko nentamo
- Isikhumba
- Cervix
- Vagina
- Lung
- Anus
Yintoni Eyichaphazelayo?
Isifo esibuhlungu (ngokuchasene nesifo esinomdla, esingengomhlaza) esifundeni nasentanyeni ummandla ubhekisela kwiqoqo leeseli zomhlaza ezikhulayo ezingalawulekiyo kwaye mhlawumbi zingangena kwiiyunithi eziqhelekileyo ezinempilo.
I-Immunotherapy kunye nezinye iindlela zokwelapha ezinjenge- chemotherapy zisetyenziselwa ukuphatha izibilini ezimbi, njengoko ezi nengozi kwaye ziyabulala.
Kuphi Intloko kunye neCeck Cancer?
Igama elithi "intloko nentamo" linokuphazamiseka, njengoko lihlanganisa indawo enkulu yomhlaba. Ngamanye amagama, unokuzibuza ukuba kuthetha ukuthini xa umntu efunyaniswa nalo hlobo lomhlaza.
Umdlavuza weNtloko nentamo ubhekisela kwizihlamba eziphuhliswa kwenye yezi ndawo ezininzi:
- Umlomo / umlomo
- Emuva emlonyeni okanye emqaleni (obizwa ngokuthi oropharynx)
- Inxalenye engaphantsi komhombo ongasemva kunye nebhokisi yezwi (ebizwa ngokuba yi-hypopharynx)
- Ingxenyeni ephezulu yomqala emva kwempumlo (ebizwa ngokuthi i-nasopharynx)
- Ibhokisi yezwi (ebizwa ngokuba yi-larynx)
Yintoni Ebangelwa YiNtloko kunye neCeck Cancer?
Kwixesha elidlulileyo, ukuphuhliswa komhlaza wesihloko nentamo kuhlanganiswe nocuba nokusetyenziswa kotywala. Kodwa kwiminyaka elishumi edlulileyo okanye kunjalo, ukuphuhliswa kweentloko zentloko kunye nentamo ye-khancer idibene nentsholongwane ngeentlobo ezithile ze-papillomaviruses yabantu ( HPV ). Ngokomzekelo, iinkcukacha zenzululwazi zibonise ukuba uhlobo lwe-HPV olubizwa ngokuba yi-HPV-16, olubangela umdlavuza wesibeleko kunye nomhlaza womhlaza kumadoda nabasetyhini, unxulumene nomdlavuza we-oropharynx.
Usulelo lwe-HPV luqhelekileyo, kodwa kuphela ipesenti yabantu bahlakulela umdlavuza kuwo. Oku kungenxa yokuba amaninzi omzimba omzimba acima intsholongwane.
Unomdla ngakumbi kunokuba ufumanise ikhonkco phakathi kwe-HPV kunye nomhlaza nomsi weentamo, kukufumanisa ukuba iziganeko zentsholongwane yentloko nentamo ezithathwa yi-HPV zandile. Ngakolunye uhlangothi, iziganeko zentsholongwane yentloko nentamo ezithatyathwa ngutshwala nokusetyenziswa kotywala kuye kwehla. Kutheni lo tshintsho? Iingcali zikhankanya ukuba zingabangelwa utshintsho loluntu kwimisebenzi yesondo-ngokukodwa, ukuba ubulili bomlomo sele buqhelekile.
Okwangoku, kunomdla othile kwiindlela zokuphatha kakuhle i-HPV-positive head and cancer neck, njengoko i-biology yabo ihluke kwiimvumba ze-HPV-negative. Ngaloo ndlela, iingcali zijonga ngokuthe kratya kwiinkqubo ezahlukeneyo ze-immunotherapy zokuphatha i-HPV-echaphazelekayo.
Ziziphi Iimpawu zokuHlola eziMzimba?
Iimpawu zokujonga i-immune system ziyi-proteins eziqhelekileyo ezifumaneka kumaseli omzimba omzimba (okubizwa ngokuba ngama-T cells). Iiseli ze-T zinjengepolisa efuna ingxaki (umhlaza okanye intsholongwane) ngaphakathi komzimba. Xa i-T yeseli idibana nesinye iseli, ihlola iiseli zisebenzisa iiprotheni ezisemgangathweni ukuze zichonge ukuba iseli "siqhelekile" okanye "ayiqhelekanga." Ukuba awuqhelekanga, i-T yeseli iya kuqalisa ukuhlaselwa kweseli.
Kodwa ngexesha lokuhlaselwa, iimeko eziqhelekileyo, iiseli eziphilileyo zikhuselwe njani? Yilapho iiprotheni zephenyi ziza kudlala khona. Iiprotheni ze-Checkpoint zihlala phezu kwee-T zeeseli kwaye ziqinisekise ukuba amaseli enempilo ashiywe yedwa.
I-Cancer iyakhohliswa kukuba ngokwenene yenza iiprotethini zepokethi (i-copycat yangempela) ukuphepha ukuhlaselwa kumzimba womzimba womntu. Elinye iprotheni elibhekiselele kummandla weeseli zeengqungquthela ukuguqa ngamasosha omzimba yi-PD-1.
Kodwa ngoku izazinzulu ziye zafumanisa ukuba zinokubamba i-PD-1 kumaseli omhlaza, ukwenzela ukuba umdlavuza ufumaneke ngokwenkqubo yomzimba womntu. Le yilapho i-immunotherapy iqala ukudlala, kwaye le nkunkuma ye-PD-1 ibingelwa ngokuba yi-immune system checkpoint inhibitors.
Immunotherapy Ukuphatha iNtloko kunye neCeck Cancer
Kukho amabini omzimba omzimba wokuhlola i-inhibitors eyayiyi-FDA evunyiwe ngo-2016 ekuphatheni abantu abaneentloko kunye / okanye ephindaphindiweyo nentloko ye-squamous cell carcinoma.
Umdlavuza weMetastatic ubhekisela kumdlavuza wesihloko nentamo oye wasasazeka kwezinye iindawo zomzimba, ngelixa umhlaza wesiqhelo kunye nomhlaza wentamo ubhekisela kumhlaza oye waphucula nangona unyango nge-platinum-based based chemmetic regimen (umzekelo, i-cisplatin).
Ezi zimbini ze-immunotherapi zibizwa ngokuba yi-Keytruda (pembrolizumab) kunye ne-Opdivo (nivolumab).
Pembrolizumab
Izifundo zakuqala zibonisa i-pembrolizumab ineprogram efanelekileyo yokukhusela kwaye inokusebenza ngokunciphisa umdlavuza othile.
Kwisifundo esinye sesigaba II, abantu abayi-171 abanomdlavuza wesihloko nentamo oqhubekela phambili nangona bebephathwa ngaphambili nge-chemotherapy kunye ne-cetuximab ( unyango lwama-antioclonal antibody ) bafumana ukunyuka kwe-pembrolizumab rhoqo kwiiveki ezintathu.
Izinga lokuphendula elipheleleyo lalingama-16 ekhulwini, kwaye ubude bompendulo obuphakathi buyiinyanga ezili-8. Inqanaba lokuphendula libhekisela kwipesenteji yabathathi-nxaxheba abanomdlavuza wehla okanye oyekeka ngokuphendula kwonyango.
Ngokuphathelele ukhuseleko, ama-64 ekhulwini abathathi-nxaxheba bafumana impembelelo echaphazelekayo yonyango, kodwa kuphela i-15 ekhulwini yabona isiganeko sesithathu okanye sesine siganeko esibi (ubunzima okanye obungozi bokuphila).
Iimpembelelo eziqhelekileyo eziqhelekileyo zi:
- Ukukhathala
- I-Hypothyroidism (isifo se-thyroid esingasebenzi phantsi)
- I sizathu
- Ukuphakama kwe-enzyme yesibindi
- Uhudo
Ngokubanzi, iimpembelelo ezichaphazelekayo zesistim e-immune zichaphazela i-hypothyroidism, i-hyperthyroidism kunye ne-pneumonitis.
Kwinqanaba elikwinqanaba, ukuxilongwa kwe-immune system effects effects are a big concern for immunotherapies, njengoko kukho inkxalabo yokuba isistim somzimba somntu siza kuhlasela kungekhona nje iiseli zomhlaza kodwa nezicubu ezinempilo. Kwimeko ye-pneumonitis, imiphunga yomntu ijoliswe kuyo, enokubangela ukuphefumula nzima.
Umfanekiso omkhulu kukuba ukufumana i-immunotherapy yinkqubo ebucayi, njengoko umzimba kunye namachiza basebenzisana ndawonye ukuba banqume into embi (umhlaza) nokuba yintoni eqhelekileyo kwaye enempilo.
Izifundo zeSigaba III ze-pembrolizumab ziyaqhubeka. Ucwaningo lwesigaba III luthetha ukuba i-pembrolizumab iya kuqhathaniswa nxamnye nemilinganiselo yonyango lokunakekelwa ukuze ubone indlela ehamba ngayo, ngathi ingaba iyasebenza.
Nivolumab
Kwisifundo se-III, abantu abangaphezu kwama-350 abane-squadous cell squinous cell head and neck, abanesifo esaphumelele kwiinyanga ezintandathu zokufumana i-platinum-based chemotherapy, babenomdla wokufumana i-nivolumab nganye iveki ezimbini ngokusebenzisa i-vein) okanye unyango oluqhelekileyo (methotrexate, docetaxel, okanye cetuximab ).
Iziphumo zityhila ubomi obude ngokubanzi kubantu abafumene i-nivolumab ngokumalunga nalabo bafumene unyango oluqhelekileyo (ukusinda komlambo we-7.5 ukuya kwinyanga ezili-5.1, ngokulandelanayo).
Ukongezelela, izinga lokusinda komnyaka omnye lalingama-36 ekhulwini kwiqela le-nivolumab ngokumalunga nama-16.6 ekhulwini kwinqanaba leyeza. Ngamanye amazwi, izinga lokusinda komnyaka owodwa liphindwe kabini.
Ngokuphathelele ukhuseleko, umphumo webanga lesi-3 okanye we-4 waba nemiphumela emibi kwi-13 ekhulwini yeqela le-nivolumab ngokumalunga nama-35 ekhulwini leqela eliqhelekileyo leyeza. Kwiqela le-nivolumab le miphumo eyingozi kakhulu yile:
- Ukukhathala
- I sizathu
- Rash
- Ukunciphisa ukutya
- Ukutshiza
Ngokuqhelekileyo, iziphumo ezimbi ezinxulumene ne-thyroid zaziqheleke kakhulu kwiqela le-nivolumab (i-7.6 ekhulwini yavelisa i- hypothyroidism ngokumalunga ne-0.9 ekhulwini kwiqela elinokoqobo lonyango).
I-pneumonitis yenzeke kwi-2.1 yepesenti yabantu abaphatha ngayo i-nivolumab, kwaye abantu ababini bafa (enye esuka kwipneumonitis kunye nomnye ukusuka kumazinga aphezulu e-calcium egazini). Umntu oyedwa kwiqela eliqhelekileyo lonyango lafa ngokusuleleka kwintsholongwane echaphazelekayo.
Okuthakazelisayo, i-questionnaire eyavavanya umgangatho wobomi ekupheleni kwesifundo, ayifumananga ukuhla kwexabiso lokuphila emva kokunyanga nge-nivolumab. Ngakolunye uhlangothi, kwakukho ukuhla kwexabiso lokuphila kwimimandla emininzi (umzekelo, intlungu, ukusebenza ngokomzimba kunye nentlalo, iingxaki zengqondo) emva kokunyanga ngekhemotherapy.
ILizwi
I-Immunotherapy isele ishintshe ubuso bonyango lomhlaza. Kusemthethweni, "kunengqiqo," kwaye uthembisa.
Khumbula ke, ukuphatha umhlaza wesihloko nentamo yinkqubo eyinkimbinkimbi. Kukho izinto ezininzi ezenza isigqibo ngokucacileyo ukuba ugqirha ufuna ukuphatha njani i-tumor yakho, njengembali yakho yezokwelapha kwangaphambili, nokuba unayo nezinye iingxaki zonyango, kunye neetyhefu ezinxulumene nesinye isiyobisi.
Hlala ulwela impilo yakho yomhlaza ngokufumana ulwazi. Uhambo lude kwaye lunzima, kodwa zama ukufuna uxolo kunye nenjabulo endleleni.
> Imithombo:
> Bauml J et al. I-Pembrolizumab yeplatinum- kunye nomhlaza wesiqalo kunye nomhlaza womsi we-thisuximab: Iziphumo zisesandla esinye, isigaba II sifundo. J Clin Oncol . 2017 Meyi 10; 35 (14): 1542-49.
> Brockstein BE, Vokes E. Ukonyangwa komhlaza wesifo semetrasi kunye nentloko yomhlaza. Ku: U-UpToDate, uMnu Posner (Ed), UpToDate, Waltham, MA.
> I-Economopoulou P, i-Perisanidis C, i-Giotakis I-EI, i-Psyrri A. Indima ekhulayo ye-immunotherapy entloko nasentanyeni i-squamous cell carcinoma (i-HNSCC): ukukhuselwa kwe-tumor kunye nezicelo zeklinikhi. Ann Transl Med. Ngo-2016 ngoMeyi; 4 (9): 173.
> Ferris RL et al. I-Nivolumab ngokuphindaphindiweyo-squamous-cell carcinoma yentloko nentamo. N Engl J Med . 2016 uNgo-10; 375 (19): 1856-67.
> INational Cancer Institute. (2017). Intloko kunye neCeck Cancer. Inkcazelo Yezobugcisa: Uphando.