Amajoni ethu omzimba ayimimangaliso-ayigcina i-bacemia yethu emathunjini ekhulayo; balwa ne-virus ehlaselayo, kwaye baphumelela ekupheliseni amaninzi emdlavuza ekuqaleni ixesha elide ngaphambi kokuba babe yingxaki. Ukufunyaniswa okubalulekileyo kwintsimi ye- immunotherapy kwiminyaka engama-20 edlulileyo kuye kwabangela ukuphuhliswa okwenziwe kwintsholongwane ekwandisa umsebenzi we-immune system.
Ukuguquka kwe-Immunotherapy
Ngaphambi kokuphonononga ukukhethwa kwe-immunotherapy kumdlavuza we-prostate, phawula ukuba kukho iziqalo ezininzi zobuxoki kunye nokuvakalisa kwangaphambi kokusindiswa kwindlela eya kwi-immunotherapy esebenzayo. Ngokomzekelo, i-FDA ivunyelwe i-interleukin 2 ye-melanoma iminyaka engama-20 edlulileyo. Nangona i-10 kuphela yesilinganiso sempendulo kunye nemiphumo enobungozi obukhulu, i-interleukin 2 yanikezela i-hope ngexesha apho i- melanoma ye- metastatic yayingenathemba kwaye ingaphepheki. Isilwanyana sasincinci kodwa sikhuthazwa ngekamva, sisebenza kakuhle, unyango.
Ngoku siva malunga nokuguquka okuphawulekayo kwinkqubo yokunyangwa kwe-melanoma. Ngokomzekelo, kutshanje amajelo asitshilo ukuba silungiselele ukuphela kukaMongameli uJimmy Carter-i-melanoma yakhe yayisasazeka kwingqondo. Emva koko imbonakalo emangalisayo-into entsha ye-immunotherapy-yayimnike umhlaza. Iindaba zobuxoki? Hayi akunjalo. I-immunotherapy yanamhlanje ingakwazi ukuguqula amatyala angenasiphelo.
Inkqubela phambili eyenzeka ngayo? Kuye kwaba nokunyaniseka okukhulu ekuqondeni kwethu ukusebenza kwangaphakathi komzimba. Ngendlela elula, ngoku siyazi ukuba i-immune system inezigaba ezintathu ezinkulu:
- Iiseli ezilawulayo, ezibizwa ngokuba yi-TRegs, zigcine ngokuqhubekayo umsebenzi we-immune system ukusuka ekulawuleni.
- Amaseli e-Killer-T ahlasela amaseli omhlaza aze awabulale.
- Iiseli ze-Dendritic zisebenza njengeseli zechungechunge, zikhupha kwaye zifumana umdlavuza kwaye ziqondise umzimba wokuzikhusela ukuze ikwazi ukuba yiliphi iiseli ukuba lichithe. Amaseli e-Dendritic, emva kokufumana umdlavuza, khokela iiseli zokubulala ukuba "zifike ekhaya" kwaye zihlasele umhlaza.
Ukubonelela ngeCarstate Cancer
Umhlaza wesifo seprotate wawusandul 'inxaxheba kwinqanaba le-immune xa i-Provenge ivunyiwe yi-FDA ngo-2010. Imvume ye-FDA isekelwe kwimiphumo yolu vavanyo olulinganisekanga, oluphindwe kabini, oluyi-placebo, olubonisa ukuba ukubonelela ngethuba lokuphila eliphuculweyo Amadoda anomdlavuza ophezulu weprotate ngama-22,5 ekhulwini.
Ukubonelela kusebenza ngendlela entsha eyenza umsebenzi weseli we-dendritic uphucule. Njengoko kuphawuliwe kwangaphambili, iiseli ze-dendritic "zi-bloodhounds" zesistim somzimba, ziyakwazi ukukhangela kunye nokufumana iiseli zomhlaza. Inkqubo yeMveliso incike kwi-extraction yegazi kunye neukapheresis ukususa iiseli ze-dendritic. Ezi iiseli zenziwa kwibhuyibhile, zibenza bakwazi ukuqaphela i-prostatic acid phosphatase (PAP) -yinto eqhelekileyo ye-molecule esekelwe kwi-cell cancer cells. Xa sele iqhutywe, iiseli ze-dendritic zifakela kwigazi legulane apho zivuselela iiseli ze-killer ukuba zichonge ngakumbi kwaye zihlasele iiseli zomhlaza, kuba ziye zanikwa amandla okuchonga indawo yePAP kunye nokuyisebenzisa njengejolise.
Ukubonelela kunokuba kuthathelwe ingqalelo ekugqibeleni ukhathazwa ngumhlaza wesifo somzimba ngenxa yokuba iseli e-dendritic icutshungulwa kwigazi lesigulane ngasinye, kuphuculwa kwibhubhoratri ukulwa neeseli zomhlaza zesifo seprotate, kwaye iphinda ibuyiswe kwakhona kwisigulane esifanayo. Njengolonwabo njengoko le teknoloji itywina ingamangalisa ukuva ukuba oogqirha kunye nezigulane ziye zafudumala ngokukhawuleza kwingcamango yokusebenzisa izibonelelo. Isimo sengqondo esibukhali ngokubhekiselele ekutholeni iMpahla ayengalindelekanga xa i-Provenge ifika kuqala kwimarike, inikwe ukuthandwa kwamanyango amaninzi okukhusela umzimba okufana ne-Graviola, ama-mushroom ama-shiitake, i-pau de arco kunye netiyi-Essiac.
Kutheni kufuneke kubekho ukunganqikazi ukusebenzisa i-FDA evunyelwe uhlobo lolwaphulo lwe-immune?
Iingcamango
Abagxeki baphakamise ukuba iMpahla iyabiza kwaye ummkeli oqhelekileyo uhlala kuphela kwiinyanga ezintathu okanye ezine. Nangona kunjalo, kwilizwe langempela lomhlaza wonyango (kungekhona ihlabathi lezilingo zamachiza), oku kucinga okungalunganga. Amadoda athatha inxaxheba kwiimvavanyo zeekliniki azimeleli izigulane zomhlaza zesifo se-prostate ezifumana i-FDA ezivunyiweyo. Ngokuqhelekileyo, amadoda aphantsi kovavanyo lweekliniki anesifo esiphezulu kakhulu. Oku kungenxa yokuba izigulana zilibazise ukungena kwilingo leklinikhi de emva kokuba unyango oluqhelekileyo luphumelele.
Ngoko ke, ukusinda kwamadoda kwilingo lonyango luba lufutshane, kungakhathaliseki ukuba lunjani unyango olwenziwa. Nangona kunjalo, nayiphina imithi eqinisekisiweyo yokulondoloza ukusinda phantsi kwezi meko ezingalunganga kufuneka ibe nefuthe. Yingakho imishanguzo ebonisa ulondolozo lokusinda ifumana imvume ye-FDA. Ingongoma kukuba iyeza ziza kubonisa iziphumo ezingcono xa zisetyenziselwa ukuphatha abantu kumgangatho wangaphambili.
Unyango kwiiNqanaba ezahlukeneyo
Isiseko sokuthi iMibonelelo inefuthe elikhulu xa isetyenziselwa ukhathaza umdlavuza wesifo seprotate kwinqanaba eliphambili laphandwa ngokusebenzisa i-reanalysis yedatha yasekuqaleni eyakhokelela ekuvunyelweni kokuqala kwe-FDA. Ukuhlaziywa kwakhona kwabonisa ukuba amadoda anesifo esisisigxina esineziphumo ezona zininzi kakhulu zokuphila. Enyanisweni, isixa sokulinda sisinde saqhubeka sikhula xa i-Provenge iqalile ngokukhawuleza.
Kule reanalysis, amaqela amane amadoda, ahlukaniswe ngamanqanaba ahlukeneyo e- PSA ekuqaleni kokunikezelwa ngonyango, ahlolisiswa: amadoda anamazinga angama-PSA angaphantsi kwe-22, amadoda anePSA phakathi kwama-22 no-50, amadoda anama-PSA phakathi kwama-50 no-134, kunye namadoda kunye ne-PSA enkulu kune-134.
Itheyibhile ingezantsi ifingqa ukusinda kwamadoda aphathwayo ngeMpahla, xa kuthelekiswa namadoda aphathwa nge placebo, ahlulwe yinqanaba le-PSA ekuqaleni kweNkxaso. Uhlu lokulondolozwa kwenetha (kwiinyanga) phakathi kweMpahla kunye ne-placebo ludweliswe ekugqibeleni.
PSA Level | ≤22 | 22-50 | 50-134 | > 134 |
|---|---|---|---|---|
Inani lezigulane | 128 | 128 | 128 | 128 |
Pro venge | 41.3 | 27.1 | 20.4 | 18.4 |
Plabobo | 28.3 | 20.1 | 15.0 | 15.6 |
Ukusinda | 13.0 | 7.1 | 5.4 | 2.8 |
Njengoko ithebhile ibonisa, inzuzo yokusindisa ikhona kuwo onke amaqela athathwe ngamalungiselelo athelekiswa namadoda aphathwe nge-placebo. Nangona kunjalo, umlinganiselo wokuphucula uphuculo lukhulu kunamadoda aqala ukunikezela xa i-PSA yayisezantsi. Amadoda aqala ukunikezela xa i-PSA yabo ingaphantsi kwe-22 ihlala iinyanga ezili-13 ubude kunamadoda kwinqanaba elifanayo abaye baphathwa nge-placebo. Amadoda aseziphambili kakhulu, kunye namazinga e-PSA angaphezu kwe-134, kuphela ahlala ixesha elide kuneenyanga ezithe zafumana indawo ye-placebo.
Isicelo
I-Naysayers umbuzo Ukubonelela ngokuphumelela kwesinye isizathu. Uninzi lweentlobo zonyango olusebenzayo lwe-prostate, olunjenge-hormonal therapy kunye ne-chemotherapy, lubangela ukuncipha kwezinga le-PSA. Kodwa ngeNkxaso, oku akusoloko kunjalo. Abantu bayazibuza ke ngoko, njani Unokulondoloza ixesha lokusinda?
Bayakulibala ukuba ukuphumelela kwemithi yesifo somhlaza yesifo somhlaza, njengokhemotherapy kunye ne-hormone blockade, igcinwa kuphela ngumsebenzi oqhubekayo. Xa unyango lugqityiwe ukupheliswa komdlavuza kunye nomhlaza uyaqala ukukhula.
I-immune system, ngakolunye uhlangothi, xa iqalile ukusebenza, inomphumo oqhubekayo oqhubekayo. Ngako oko, nangona ukuba ukubonelela kuphela kubangele ukukhawuleza okukhawulezileyo ekuqhubekeni kwezifo, kuba umphumo uyaqhubeka kukho umphumo wokunyuka kwixesha lokuphila kwesigulane. Kwaye umntu uphila ixesha elide, enkulu enkulu inzuzo.
Tracking Cancer Metastases
Ngokusekelwe kwidatha eboniswe kwithebhile engenhla, ngokugqibeleleyo kugqibezela ukuba iMpahla kufuneka iqaliswe ngokukhawuleza kunoma yimuphi umntu ofunyaniswe ukuba enekliniki ephawulekayo yomhlaza wesibeletho . Ngelishwa, iinkampani ze-inshorensi zikhawuleza zinikezela unyango emva kokuba amadoda ahlakulele ukumelana ne-hormone (Lupron) kunye nomhlaza wesifo somhlaza. Ekubeni iimeko ezininzi zokuxhatshazwa kwe-hormone zenzeka ngaphambi kokuba i-metastases, amadoda aphethwe ngumhlaza womhlaza wesifo seprotate abalawule iPSA yabo kunye ne-Lupron kufuneka bajonge nayiphi na ukunyuka kwe-PSA. Ukuxhatshazwa kweHormone kuchazwa njengokunyuka kwe-PSA ngelixa kuLupron okanye nasiphi na izidakamizwa ezifana neLupron.
Ekuboniseni kokuqala ukuba i-PSA iqalile ukunyuka, amadoda kufuneka aqale ukukhangela ngamandla kwiimitha zesistim. Okwangoku, i-PET yokujonga yindlela efanelekileyo yokufumana i-metastases ngelixa i-PSA isasetyenziseni, phantsi kwembini. Kukho iintlobo ezahlukeneyo ze-PET esicinga ukucinga ngokusebenzisa: i-F18, i-Axumin, i-acetate ye-C11, i-C11 choline, okanye i-Gallium68 PSMA. Ukuba ezi ziphumo zihluleka ukufumana izifo zesifo se-metastatic ekuqaleni, kufuneka ziphindwe ngokuphindaphindiweyo kwinyanga nganye ezintandathu ukuya kube sezifo zesifo se-metastatic, emva koko iMbuyekezo kufuneka iqaliswe ngokukhawuleza.
Olunye uhlobo lwe-Immunotherapy
Kule minyaka engama-30 edlulileyo, iinzame ezininzi zokubamba iistim e-immune ziye zahluleka. Siqala ukuqonda ukuba ezi zintlupheko zibangelwa ngaphezulu kwezenzo zecandelo lolawulo lwe-immune system. Nanini na xa umzimba uvelisa nantoni na yomsebenzi omtsha omzimba, umsebenzi ngokwawo uvuselela umyalelo wokuzilawula ukuphelisa ukuphendula kwamagciwane omzimba. Oku kukuthintela ukuphuhliswa kwezifo ezikhuselekileyo zokuzivikela njenge-lupus, i-rheumatoid arthritis, okanye i-multiple sclerosis.
Ngoku abaphandi baye bafunda ukuba iiseli zeengomhlaza zixhaphaza eli candelo elilawulayo le-immune system ngokuvelisa ama-hormone ekunciphisayo omzimba. Ezi hormone zikhusela isimiso somzimba sokuzivikela ukuba silale, ngaloo ndlela ukuvumela iiseli zomhlaza ukuba zanda ngokugcina ii cell cell T killer. Iiseli ezilawulayo, iiseli zeTreg, zithi "zithunjwa" kwaye zisetyenziswe njengekhusela ukunciphisa umsebenzi we-antibody's system. Ukuhluleka kwe-immune system ukuhlasela umhlaza akubangelwa ubuthathaka obumzimba; kunoko, ukukhutshwa komzimba kumsebenzi ophezulu wokulawula obangelwa ngamaseli omhlaza. Ngolu qonde olutsha, amajelo athile achaziweyo ayenzelwe ukuhlawulela le ngxaki.
I-Yervoy yile myeza, enye i-FDA evunyelwe ukunyanga i-melanoma. Imisebenzi ye-Yervoy ngokuthintela i-CTLA-4, "ishintsho" esilawulayo kwi-Treg yeseli. Xa lo tshintshi "uqhubeka," umsebenzi olawulayo ukwandiswa kwaye isistim somzimba siyasuswa. Xa i-Yervoy ishintshela i-CTLA-4 "isuswe," isenzo esinqandekileyo seeseli zeTreg siyancitshiswa kwaye umphumo wenetha uphuculo lomsebenzi womzimba.
Uphando lokuqala okokuhlola i-Yervoy kumadoda anomdlavuza wesifo somzimba uveza isithembiso, ngokukodwa xa kudibaniswa ne-radiation (jonga ngezantsi). Nangona kunjalo, uphando olutshanje lubonisa ukuba enye imithi ekhuselayo ebizwa ngokuba yiCkeytruda ingasebenza kangcono.
I-Keytruda ibhalela enye inguqu yokulawula ebizwa ngokuba ngu-PD-1. Izifundo zesandulela kwizonyango zomhlaza zesifo seprotate zibonisa ukuba i-Keytruda inokubangela ukuba i-anticancer iphumelele kakhulu kune-Yervoy, kwaye ibangele imiphumo embalwa yokuqala. Ukuba ezi ziphumo zokuqala kunye ne-Keytruda ziqinisekisiwe, unyango oluhlanganisiweyo kunye ne-Keytruda kunye neNkxaso lunokuba yindlela efanelekileyo yokuphucula umsebenzi we-antiticancer of system immune system.
I-Absffal Effect
I-radiation, ejoliswe kwisifo se-metastatic efunyenwe ngokuskena, yindlela enye enokuthi ivuselele i-immune system ngokusebenzisa inkqubo ebizwa ngokuba yi-abscopal. Xa i-ray ye-radiation ilimaza iiseli ze-tumor, iiseli zamasosha ethu omzimba zisondela kwi-tumor efa kwaye zisuse i-debris ephumayo. Umphumo we-abscopal uqulethe iiseli ze-immune kuqala ukuchonga ama-molecule athileyo kwi-cell tumors kwaye uzingela iintsholongwane zomhlaza kwezinye iindawo zomzimba usebenzisa loo malekyuli afana neentlanzi.
Kukho iinkalo ezininzi ezinomtsalane kumathambo omzimba okhuselweyo ngamayeza:
- Xa kulawulwa ukhetho kunye nobuchule kukho imiphumo engundoqo.
- Unyango luhlanganiswa yiyo zonke iinshorensi.
- Umbane udla ngamandla ngokwaneleyo ukuphelisa i-tumor ejoliswe kuyo.
- Kulula ukudibanisa i-radiation yamabala kunye ne-Provenge, Keytruda okanye zombini.
ILizwi
Ukuqonda kwethu unyango lomzimba we-prostate umdlavuza luqhubekela phambili ngokukhawuleza kodwa lusengumntwana. Nangona kunjalo, kuyonwaba ukubona ukuba sele sele sinezixhobo ezinobuninzi esisebenzayo. Umngeni oqhuba phambili ukufunda indlela ezi zixhobo ezinokusetyenziswa ngayo ngokufanelekileyo, mhlawumbi ngokwazo okanye ngokudibanisana nomnye. Gcina ingxoxo evulekileyo nodokotela wakho malunga nokukhetha i-immunotherapy ukukhetha ukuba ngaba kunjalo.
> Imithombo:
> Higano, Celestia S. "I-Sipuleucel-T: I-Autologous Cellular Immunotherapy ye-Metastatic Can-Resistant Prostate Cancer." Ukulawulwa Kweziyobisi Zomhlaza Weprostate , iphe. 321-328. Springer New York, ngo-2010.
> Kantoff, Philip W., Celestia S. Higano, Neal D. Shore, E. Roy Berger, uEric J. Small, uDavid F. Penson, uCharles H. Redfern et al. "I-Sipuleucel-T immunotherapy ye-cancer-resistant cancer prostate". I-New England Journal of Medicine 363, hayi. 5 (2010): 411-422.
> Lipson, uEvan J., uPatrick M. Forde, uHam-Joerg Hammer, uLeisha A. Emens, uJanis M. Taube kunye noSuzanne L. Topalian. "I-antagonists ye-PD-1 kunye ne-PD-L1 kwonyango lomhlaza." Kwiimviwo kwi-oncology , vol. 42, akukho. 4, iphe. 587-600. WB Saunders, 2015.
> Silvestri, Ida, uSusanna Cattarino, uSabrina Giantulli, uCristina Nazzari, uGiulia Collalti kunye no-Alessandro Sciarra. "Umbono we-immunotherapy yomhlaza wesibeletho." Cancer 8, akukho. 7 (2016): 64.