Yintoni i-EGFR Positive Lung Cancer?

by Lynne Eldridge, MD

Ulawulo lwe-EGFR Positive Lung Cancer

Yintoni ukuguquka kwe-EGFR kwaye kutheni kubalulekile ngomhlaza wemiphunga? Le nto ihlolwa njani kwaye iphathwa njani? Ngubani odla ngokuguquguquka kwe-EGFR kwaye kuthetha ukuthini ngokuphathelele ukuxela kwakho?

Sibanzi

I-EGFR imiphunga yomhlaza yemiphunga ibhekisela kumanomdla emiphunga eemiphunga ezi vavanyo ezintle zokuguquka kwe-EGFR. I-EGFR imele i-receptor ye-epithelial growth receptor, iprotheyini ekhoyo kumgangatho wesibini somhlaza wesifo somhlaza wesifo somhlaza wesifo somhlaza.

Iinguqulelo ze-EGFR zixhaphakileyo kubantu abane-lung adenocarcinoma (uhlobo lomhlaza wesifo somhlaza wamangqamuzana,) luqhelekileyo ngomhlaza wemiphunga kubantu abangabhemi , kwaye baqhelekile kubafazi ngaphandle kwamadoda.

Ukuguqulwa komzimba kwi-EGFR yinto eqhelekileyo "yothathekayo" phakathi kwabantu abanomdlavuza wamaphaphu, oku kuthetha ukuba yinguqu yendalo yezona zonyango ezikhoyo ezijoliswe ngqo kumaseli omhlaza wamaphaphu. Intuthuko ephawulekayo yenziwe kunyango lweengqungquthela zeemiphunga kunye nale projekthi yamathambo kwiminyaka yamuva. Ukuqala ngokuvunyelwa kwe-Iressa (gefitinib) ngo-2003-ngelixa sasiyiqonda kangako malunga ne-EGFR-malunga nesiqingatha samachiza amasha avunyelwe unyango lomhlaza wamaphaphu ngo-2016 ukujongana nale projekthi ye-molecular.

Yintoni i-EGFR Mutation?

Uguquko lwe-EGFR lubhekisela ekutshintsheni (umonakalo) kwisahlulo se-DNA kumaseli omhlaza wemiphunga ophethe "iresiphi" yokwenza i-EGFR (i-epidermal growth factor receptor).

I-nucleus nganye yeeseli zethu iqukethe i-DNA yethu, ebuye yenziwe ngamagciwane. Ezi zakhi zegesi zenza iprogram yazo zonke iiprotheni eziveliswe kumzimba wethu. Ngamanye amazwi, iigesi zethu zifana namagama kwincwadi yokufundisa echaza indlela yokwakha zonke izixhobo zomzimba wethu.

Ezinye zeeprotheyini eziveliswe ngokusebenzisa le miyalelo yemfuza zibandakanyeka kwinkqubo yokulawula ukukhula kunye nokwahlukana kweeseli.

Xa umzi ophethe imiyalelo yokudala i-EGFR yonakalisiwe-iguqulwe-iguqulelwe kwiiprotheni ezingavamile.

Kule meko, i-receptor ye-epithelial growth (EGFR). Ezi proteins ezingavamile, zenzeke, zenze "umsebenzi ongaqhelekanga" ekulawuleni ukukhula kweseli. Kukho iindlela ezahlukeneyo apho lo mzimba ungatshintshwa (jonga ngezantsi).

Yintoni eyiyo i-EGFR?

Iiseli zethu zinama-antigen amaninzi (amaprotheni ayingqayizivele) ephezulu. I-EGFR (i-epidermal growth factor receptor) yenye yeeprotheni ezitholakala kummandla weeseli zomhlaza kwakunye neeseli eziqhelekileyo. I-EGFR inokucingwa njengenguqu yokukhanya. Xa izinto zokukhula (kule tyrosine kinase) zifakela kwi-EGFR ngaphandle kweseli, kuphumela kwisibonakaliso esithunyelwa kwinucleus yesisele esichazela ukuba sikhule size sihlule.

Kwezinye iiseli zomhlaza, le protoyinti igxininisekile. Isiphumo sifana nesitshixo sokukhanya esishiye kwindawo "kwi", etshela iseli ukuba iqhubeke ikhula kwaye idibanise nangona ifanele iyeke. Ngale ndlela, ukuguquguquka kwe-EGFR ngamanye amaxesha kuthiwa "ukuguqulwa komsebenzi."

Ngoku sinamachiza atholakalayo-i-tyrosine kinase inhibitors-eyona "ijolise" le protein kwimizimba ethile yomhlaza.

Ezi zi yobisi zivimba izibonakaliso eziya ngaphakathi kweseli, kwaye ukukhula kweeseli kuyayeka.

Izinto zobungozi kunye nokukhula

Uguquko lwe-EGFR lukho malunga nama-15 ekhulwini labantu abanomdlavuza wamaphaphu eMelika, nangona le nani inyuselwa kuma-35 ukuya kuma-50 ekhulwini kubantu baseMpuma Asia.

Ngokuqhelekileyo kufumaneka kubantu abanomdla wesifo somhlaza wesifo samangqamu omnxeba obizwa ngokuba ngumphunga adenocarcinoma. (Ezi ngqamana nazo zibizwa ngokuba "ngumhlaza wesifo somhlaza wamangqamuzana ongeyena omncinci.) Ngeli xesha, malunga neepesenti ezingama-85 zamanomdlavuza emiphunga amancinci amancinci amancinci amancinci, kwaye kulawa, ngaphezulu kwama-50 engama-lung adenocarcinomas.

Iinguqu ze-EGFR zi:

Okuqhelekileyo kubasetyhini kunamadoda. (Kukho eminye iminyehluko phakathi komdlavuza wamaphaphu kwabasetyhini kunye nomdlavuza wamaphaphu kumadoda ,)
Eyona nto ixhaphakileyo kubantu abane- lung adenocarcinoma (kodwa ingafumaneka kubantu abanamanye amaninzi omhlaza wesifo somhlaza wamangqamuzana).
Ngokuqhelekileyo kufumaneka kubakho ababhemayo okanye abantu abavuthayo kuphela. (Umntu ongabhiyozeli uchazwa njengomntu oshiye i-cigarettes ezili-100 okanye ezimbalwa ngaphezu kobomi babo.) Nangona i-15 ekhulwini yamanomdla emiphunga e-EGFR, i-cancer yemiphunga kubantu abangabhemi banakho amathuba okuguquka.
Okuqhelekileyo kubantu abadala abasemdlavuza womphunga. (Iinguqu ze-EGFR zikhoyo malunga neepesenti ezingama-50 zomdlavuza wamaphaphu kubantu abadala .)
Ziqhelekile kwiAsia, ngakumbi abantu belifa leMpuma Asia.
Engaqhelekanga kwi-Afrika yaseMerika kuneCaucasians.

Uvavanyo lweGenes

Ngoku kucetyiswa ukuba wonke umntu onomdlavuza wesifo samangqamuzana ongasetyenzana-ikakhulukazi umphunga adenocarcinoma- unokufumana uprofayili (iimvavanyo zemizimba) ezenziwe kwiimvumba zabo ukuba zikhangele ubukho bezinto ezingalunganga kumaseli omhlaza wamaphaphu.

Kudideka ukuva malunga nokuguquka kwemfuza kumaseli wakho omhlaza kunye nento yonke ngeengqungquthela kunye nomhlaza wesifuba. Ngokuphambene nokuguquka kwemfuyo yezinto eziphilayo, ezo zinto uhamba nazo ngokuzalwa, nangona kunjalo, utshintsho oluthile olufunyenwe ngeprofayili yamathambo lufumene ukuguqulwa kwesiginci (ukuguqulwa kwamanzi.) Ezi zinguqu azikho ngexesha lokuzalwa kodwa ziphuhlise kamva ebomini kwinkqubo iseli yaba ngumhlaza weseli.

Iiseli ze-Cancer zinokuguquka kwezinto ezininzi, kodwa kuphela ezimbalwa zazo ezibandakanyeke ngqo kwinkqubo yomhlaza. Ezi zinguqulelo zikhokelela ekuvelweni kweeprotheni ezingaqhelekanga ezikhokela ukukhula nokuphuhliswa kweseli yomhlaza. Ezi proteins ezingaqhelekanga "ziqhubela phambili" ukukhula nokusabalalisa umhlaza kwaye ngoko ke ukuguqulwa kwemizimba ejongene nemveliso yabo kuthiwa "ukuguqulwa komqhubi." Ezinye, kodwa akuzona zonke "utshintsho lomqhubi" nazo zitshintshiweyo "okanye" ukuguqulwa kwamanyathelo "okubhekiselele ekubeni banokujoliswa yiziyobisi.

Kuqikelelwa ukuba utshintsho lomqhubi lukhona kuma-60 ekhulwini labantu abane-lungen adenocarcinoma, kwaye le nombolo, kunye nokuguqulwa komqhubi kwezinye iindlela zomhlaza wemiphunga, kulindeleke ukuba ikhule njengoko ukuqonda kwethu kwe-biology yomhlaza kwanda. Ukuguquka komqhubi oqhelekileyo kubandakanya:

EGFR utshintsho
Ukulungiswa kwe-ALK
ROS1 ukulungiswa kwakhona
MET amplification
Iinguqu zeKRAS
HER2 utshintsho

Kule mininzi yezinto ezingaqhelekanga, iipilisi ezijoliswe kuzo zikhoyo ngoku. Ezi zintsholongwane zengqambela zesifo somhlaza ngokuthe ngqo kwaye zisoloko zineempembelelo ezimbalwa kunezidakamizwa zendalo zonyango-iziyobisi ezijolise kuzo zonke iiseli ezikhula ngokukhawuleza.

Ukongezelela, ukuhlolwa kweeklinikhi kusetyenziswe ezinye iindidi zokutshintshwa kweenguqu kunye nokutshintsha kwemizimba kunye neentlobo ezahlukeneyo zomhlaza wemiphunga. Ngokuqhelekileyo, abantu abaqhelekanga baninzi ngaphezulu kwezi ziguquka. Ngokomzekelo, akunakwenzeka (kodwa kungenakwenzeka) kumntu onokuguquguquka kwe-EGFR ukuze abe nokulungiswa kwe-ALK okanye ukuguqulwa kwe-KRAS kumaseli omhlaza wamaphaphu.

Ukuxilongwa

I-Tissue Biopsy

Ukuze uvavanyo lwemizimba luyenziwe, isampuli yesisu sakho siya kufunyanwa. Uninzi lwexesha, uvavanyo ludinga isampula yeetyhubhu ezifunyenwe ngexesha le- biopsy yamaphaphu . Oku kunokwenziwa ngenaliti ye-apiop, ngexesha le-bronchoscopy, okanye nge-biopsy evulekile. Ngamanye amaxesha uvavanyo luyenziwa kwi-tumor ekhutshwe ngokupheleleyo ngexesha lotyando lomhlaza wamaphaphu.

Utywala lweNkunkuma

NgoJuni ka-2016, uvavanyo olutsha lwe-biopsy lwavunywa ukuba lufumene utshintsho lwe-EGFR. Ngokungafani ne-biopsies ezingakumbi ezingenayo, olu vavanyo lunokwenziwa ngokuhlolwa kwegazi olulula. Ngexesha langoku, le mvavanyo iyakucingwa njengophando kwaye ayisebenzisi yedwa ukukhokela ukuxilongwa kunye nokunyangwa komhlaza wemiphunga, kodwa unikele ngesithembiso esikhulu. Kuthemba ukuba le mvavanyo iza kunika ithuba lokubeka iliso kubantu abane-EGFR yomhlaza wemiphunga emihle ngexesha langempela kwixesha elizayo. Ngexesha langoku, sifunda nje ukuba i-tumor iyanqandwa kwizonyango ezijolise ku-EGFR xa ihluleka ukuphendula (iqala ukukhula okanye isasazeka) kwimilinganiselo yemiphunga. I-biopsies yotywala iya kunika oogqirha ithuba lokufunda i-tumor iye yaxhathisa-kwaye ke itshintshe kwipilisi efanelekileyo ngakumbi kunoko ngoku kunokwenzeka.

Iinguqu ze-Genetic kwiCells Cells

Ukuqonda ngokucacileyo ukuprofayili ye-molecule kunye neengxaki ezijoliswe kumdlavuza wamaphaphu, kunceda ukuchaza imigaqo embalwa yezofuzo. Kukho iintlobo ezahlukeneyo zokuguqula izityalo ezingenzeka kumaseli omhlaza. Ezi ziquka:

Iinguqulelo - Utshintsho olutshintsho kwi-DNA ngokulandelelana eyenza i-gene.
Ukulungiswa kwakhona - Ukulungiswa kwakhona, ukulandelelana kweDNA kulungiswa kwakhona.
Ukutshintshwa kwezinto - Ezi tshintsho zenzeka xa inxalenye yomthwalo kwi-chromosome enye idluliselwa kwingingqi eyahlukileyo ye-DNA.
I-Gene fusion - I-gene "fusion" iyenzeka xa i-translocation idibanisa iimbini ezimbini eziqhelekileyo ezingekho kunye.
Ukupasa ukubhekiselele kubhekiselele ekuveliseni iikopi ezininzi ze-gene kwaye kuqhelekileyo kumaseli omhlaza.

Kukho iintlobo ezahlukeneyo zenguqu. Ezinye zazo, ngokulula, ziquka:

Ukutshintshiselwa kweengongoma - Ukuguqulwa kwamanqaku kubhekisela ekutshintsheni apho esinye isiseko sithatha indawo enye.
Ukucinywa - Xa kususwa, isiqwenga sezinto eziphathekayo kulahleka okanye sisusiwe kwi-gene
Ukufakelwa - Ngokufakelwa, ucezu lwezinto eziphathekayo zofuzo luyongezwa kwi-gene.

Iintlobo

Uguquko lwe-EGFR alubhekiseli kwizinto ezingaqhelekanga. Kunoko, kukho ezininzi iintlobo ezahlukeneyo zeinguqu ze-EGFR eziguqukayo zombini ngohlobo lokuguquka (njengoko kuchaziwe ngasentla) kwaye kwindawo yokuguqulwa komzimba. Ngamanye amazwi, kukho iindlela ezininzi apho i-EGFR ingatshintshwa ngokwemizimba

Utshintsho kwi-EGFR lunokuvela kwiindawo ezahlukeneyo kwi-exon 18 ukuya kwe-21. Iinguqu eziqhelekileyo ze- EGFR (malunga neepesenti ezingama-90) zidlulileyo kwiingu-19 (izinto ezingafaniyo zofuzo) okanye i-exon 21 i-L858 iinguqu zenguqu. (Jonga iinguqulelo ze-T790 ezingezansi ezidla ngokukhawuleza.)

Unyango

Kukho imithi emithathu evunyiweyo ye-FDA efumanekayo ukunyanga i-EGFR emihle ye-adenocarcinoma, kunye nesinye se-squamous cell carcinoma kunye ne-EGFR yomdlavuza wamaphaphu. Ezi zonyango zibizwa ngokuba yi-tyrosine kinase inhibitors. Bavala umsebenzi weprotein ye-EGFR.

Amachiza avumelekileyo ye-lung adenocarcinoma ziquka:

ITarceva (erlotinib)
Gilotrif (afatinib)
Iressa (gefitinib)

Amachiza avumelekileyo atshintsho lwe-T790 aquka:

Tagrisso (osimertinib)

Unokuva i-oncologist yakho ngentetho nge "zizukulwana" zala mayeza. I-Tarceva yi-EGFR isizukulwana sokuqala, iGilotrif isizukulwana sesibini, kunye noTagrisso, isizukulwana sesithathu se-EGFR inhibitor.

I-EGFR Inhibitors ye-Lung Adenocarcinoma

Ngamachiza amathathu atholakalayo umgca wokuqala we-EGFR emihle ye-adenocarcinoma, oogqirha bakhetha njani ukuba yeyiphi yale tyrosine kinase inhibitors engasebenza ngokusemandleni kumhlaza wakho othile?

Ukukhethwa kwe-EGFR ye-inhibitor ethile kuxhomekeke ngokukhethekileyo kwi-oncologist yakho (kunye nendawo yakho) Kukho ulwahlulo oluncinci . U-Iressa unomdla wokuba nemiphumo embalwa engundoqo kwaye unokuqwalaselwa kuqala kukhetho lomntu oneminye imichiza enkulu okanye ekhulile. Ngokwahlukileyo, iGrolotrif inokuba nemiphumo embi kakhulu (ikakhulukazi izilonda zomlomo) kodwa ingaba nenzuzo enkulu yokuphila jikelele. I-Gilotrif ingaphinda isebenze kangcono kubantu abane-exon 19 yokususwa kwegazi. Kukho, nangona kunjalo, ezinye izinto ezininzi i-oncologist yakho iya kufuna ukuyiqwalasela nomhlaza wakho.

I-EGFR ne-Squamous Cell Carcinoma yamaLung

Indlela ye-EGFR ingajoliswa kwakhona kubantu abane-squamous cell carcinoma yemiphunga abangenayo iinguqulelo ze-EGFR, kodwa ngeendlela ezahlukeneyo.

Esikhundleni soguqulelo lwe-EGFR oluqhuba la ma-cancer, ukukhula kunxulumene nokuphakanyiswa kwe-EGFR . Kwaye endaweni yokusebenzisa i-tyrosine kinase inhibitors ukujolisa ukuguqulwa kwe-EGFR, iintsholongwane ze -EGFR zididi lweemithi ezisetyenzisiweyo ezibophelela kwi-EGFR ngaphandle kweseli (kwiisifo ezingenayo i-EGFR mutation) ukuphazamisa indlela yokubonisa.

I-Portrazza (necitumumab) yavunywa ngo-2015 kunye ne-chemotherapy kubantu abane- squamous cell carcinoma yamapayipi abangayifumana unyango lokuqala. I-Portrazza yi- antibody ( anti -made antibody) eyenza umsebenzi we-EGFR. I-Anti-EGFR yonyango lweziyobisi-njengamachiza e-Erbitux (cetuximab) kunye neVectibix (panitumumab) -yasetyenziswa kunye nezinye i-cancer.

Ngokungafani neziyobisi ezisetyenziselwa i-adenocarcinoma ezingentla apha zinikwe ngomlomo, i-anti-EGFR yonyango i-Portrazza inikwe i-intravenously.

Ukunganyangeki kunyango

Ngelishwa, nangona umdlavuza wamaphaphu ungaphendula kakuhle kwi-tyrosine kinase inhibitors ekuqaleni, phantse ihlale inganyangeki ngexesha. Isixa sexesha ngaphambi kokuba ukunganyangeki kuqhubeke, nangona kunjalo, kuyahluka kakhulu. Nangona ixesha eliphakathi kwexesha lokuqala leyeza kunye nokuphuhliswa koxhatshazo luyiinyanga ezili-9 ukuya kwezi-13, la mayeza ahlale esebenzayo kubantu abathile iminyaka emininzi.

Ngexesha langoku, sivame ukufumanisa ukuba i-tumor iyanqandwa xa iqala ukukhula kwakhona okanye isasazeka. Ukuphindaphinda i-biopsy, elandelwa ngeprofayili yeeyunyuli idlalwa ngelo xesha. Njengoko kuphawuliwe ngasentla, ithemba ukuba i-biopsies yamanzi iya kuba yindlela yokuqaphela xa i-tumor ikhuseleka kwixesha elizayo.

Unyango lwe-EGFR yokuLungisa i-Lung Cancer

Kanye njengokuba kukho iintlobo ezahlukeneyo zeenguqulelo ze-EGFR, kukho iindlela ezininzi apho i-cancer ingakwazi ukumelana nayo. Iiseli ze-Cancer zihlala ziguquka, kwaye zihlala zihlakulela utshintsho olwenza ukuba zichasene neziyobisi ezisetyenziswayo.

Kwesiqingatha sabantu, ukuguqulwa kwesibini-ukuchithwa kwe-exon 20 ebizwa ngokuba ngu-EGFR T790. Olu tshintsho luchaphazela ummandla we-EGFR owokuqala kunye nesibini kumgca we-tyrosine kinase inhibitors (ezifana neTarceva) abophelela, ukwenza zonke iilwimi ezingentla ngaphezulu (iTarceva, Gilotrif, ne-Iressa) zingasebenzi. Kwabo abane-metastatic EGFR T790 yokuguquka komtsalane ongeyomncinci wesifo somhlaza wamaphaphu, iyeza iTririsso okanye i-AZD9291 (osimertinib) sele ivunyiwe. Sekunjalo, njengoko nje ukuchasana kukhula kunye neyeza zokuqala, ukufumana ukuxhatshazwa kunokukhula kuze kube kwisizukulwana sesithathu isi-tyrosine kinase inhibitors ngokunjalo. Ngethemba, iziyobisi ziya kuqhutyelwa ukuphuhliswa ngenxa yezifo ezixhatshazelayo, ukuze abantu abaninzi bakwazi ukuhlala nomhlaza wemiphunga njengendlela yesifo esingapheliyo-esinganyanga, kodwa elawulwa ngala mayeza.

Xhuma kwiBra kwiMetastase

Ngelishwa, ngenxa yobuninzi be-brain-brain barrier-indawo yeeseli eziqinileyo ezinomgca we-capillaries kwingqondo-amaninzi ala mayeza ayakwazi ukufikelela kumaseli omhlaza aye aye kwiingqondo. Umqobo we-brain-brain is designed to limit the ability of thexins to access the brain, kodwa ngelanga, ukukhusela i-chemotherapy kunye neengcaphephe ezijoliswe kuzo ukufikelela kwingqondo. Ekubeni umdlavuza wamaphaphu unomdla wokusasazeka kwingqondo, oku kube yinkinga ebalulekileyo kulabo abanomdlavuza wamaphaphu kunye nesifo sengqondo .

Olunye unyango oluye lwafundiswa kwizilingo ze-kliniki - i-AZD3759 yenzelwe ukungena kwi-barrier-brain obstruction, kwaye ithemba ukuba le nkunkuma, okanye abanye bavavanywa, inokunceda abo abanomdlavuza omhle we-EGFR kunye nomhlaza we-leptomeningeal .

Imiphumo Yecala Lonyango

Impembelelo yecala eliqhelekileyo le-tyrosine kinase inhibitors, elikho malunga nama-80 ekhulwini labantu, yinto yokukhwabanisa kwesikhumba. Ngaphantsi kancinci, i-diarrhea ingenzeka.

I-Tarceva (erlotinib) i-skin rashes (kunye neengqungquthela ezivela kwezinye i-tyrosine kinase inhibitors) zifana ne-acne, eyenzeka ebusweni, esifubeni esiphezulu, nangemva. Ngokubhekiselele kwimpembelelo ye-rash, ukuba akukho zikhwebu ezimhlophe zikhona, i-cream corticosteroid cream (i-hydrocortisone cream), isetyenziswe. Ukuba iintloko ezimhlophe zikhona kwaye ukugqithisa kubonakala kwintsholongwane, i-antibiotic yomlomo iyasetyenziswa. Olunye ixesha idosa lemilisi liya kuyancitshiswa.

Uvavanyo lweZliniki

Njengoko kuphawuliwe kwangaphambili, inkqubela phambili eyenziwe kwimbini yokuchongwa kwemizimba yomhlaza nomphunga wamaphaphu kunye neengxaki zonyango ekujongeni olo tshintsho. Kukho izilingo ezininzi zeekliniki ngoku zijonge ezinye iyeza ukunyanga ukuguqulwa komhlaza womphunga we-EGFR, kwakunye nokunyanga kwezinye iinguqu zamangqamu kumaseli omhlaza.

Ngokutsho kweNational Cancer Institute, abantu abanomdlavuza wemiphunga kufuneka bathabathe inxaxheba kwiimvavanyo zonyango. Uninzi lwamachiza asetyenziswa ngoku lufunyenwe nje njengenxalenye yesilingo sekliniki nje ngexesha elifutshane elidlulileyo. Uninzi lwemibutho yomdlavuza yemiphunga sele isebenzisene kunye nokwenza isilingo somhlaza wesifo semiphunga. Ngolu msebenzi wenkonzo, iikliniki zinokufanisa umdlavuza wakho wamaphaphu ukuya kwizilingo zeklinikhi ezenzeka naphina kwihlabathi.

Inkxaso kunye nokuKhekana

Ukuba usandul 'ukuba unomdlavuza wamaphaphu, wenza enye yezinto ezilungileyo kakhulu ozenzayo-kuthatha ixesha lokufunda ngomhlaza wakho. Nazi iingcebiso ezimbalwa malunga nendlela yokufumana ulwazi olungumhlaza lomnatha kwi-intanethi, kunye namanye amanyathelo okuqala ukuba uthathe xa usandululwazi olutsha .

Ukongezelela ekufundeni ngomhlaza wakho, ukufunda indlela yokuzixhasa njengomhlaza wesigulane wenza ukubahluko kubantu abaninzi. Ngelixa unokuba ujwayele iirebhoni zepinki ngaphezu kweembalo zomhlaza zomphunga wamhlophe, ummandla wenkxaso yomhlaza wamaphaphu, unamandla kwaye unamandla. Abantu abaninzi bakuthola kuncedo ukubandakanyeka kula maqela nenkxaso kunye noluntu kungeyona nje indlela yokufumana inkxaso evela kumntu "oye wahlala khona" kodwa njengendlela yokuhlala ehambelanayo nophando olutsha kweso sifo.

Amanqanaba okunyanga-kunye nokubulela ngokunyanisekileyo-umhlaza wemiphunga uphucula, kwaye kukho ithemba elininzi. Kwakukho unyango olutsha olwamkelwa phakathi kuka-2011 no-2015 kunokuba ludlulileyo lwangama-40 kunyaka owedlule ngo-2015. Sekunjalo, umhlaza ngumqhudelwano, kungekhona i-sprint. Ukuba ujamelana nomhlaza, fikela kwintsapho kunye nabahlobo uze ubavumele ukuba bancede. Ukugcina isimo sengqondo esifanelekileyo ngomdlavuza kunceda ngamanye amaxesha, kodwa qi ni sekise ukuba unobungane abambalwa osondeleyo ovulekileyo kwaye uvule iimvakalelo zakho ezingenayo kunye nezoyika. Ukuba ngumntu wakho othandekayo oye wafunyaniswa, hlola ezi ngcamango kwizinto ezithandekayo ukuhlala nomhlaza .

_Imithombo:

_{Greenhalgh, J., Dwan, K., Boland, A. et al.} _{Ulwaphulo lokuqala lwe-epidermal growth factor receptor (EGFR) ukuguqulwa kwesimo sengqondo esingenasigamme esingekho encinci yomhlaza wamaphaphu.} _{I-Cochrane Database yeeNkqubo eziPhezulu .} _{2016. 5: CD010383.}

_{Hasegawa, T., Ando, M., Maemondo, M. et al.} _{Inendima yokubhema kwimeko yokungena-ntliziyo yezilwanyana zesifo somhlaza wesifo samagciwane emiphunga emagqabini e-lung e-activation epidermal factor receptor (EGFR) ukuguqulwa kwe-EGFR i-tyrosine kinase inhibitor kunye ne-platinum doublet chemotherapy: uhlalutyo lweemeta olulandelayo .} _{Oncologist .} _{2015. 20 (3): 307-15.}

_{Tan, C., Cho, B., kunye no R. Soo.} _{Isizukulwana esilandelayo ukukhula kwe-epidermal factor receptor tyrosine kinase inhibitors kwi-epidermal ukukhula kwe-factor receptor -mantant non-small cell cell cancer.} _{Cancer Lung .} _{2016. 93: 59-68.}

_{I-Tan, D., Yom, S., Tsao, M. et al.} _{I-International Association yoFundo lweNgqungquthela ye-Lung Cancer ekuqinisekiseni ulawulo lwe-EGFR ukuguqulwa kwesimo sengqondo esingenanto esincinane somhlaza wamaphaphu: isimo ngo-2016.} _{Umbhalo we-Thoracic Oncology .} _{2016 Meyi 20. (Epub ngaphambi kokuprinta).}

_{I-Cancer Centre.} _{MyCancerGenome.org.} _{I-EGFR kwi-Non-Small Cell Lung Cancer (NSCLC).} _{Ukuhlaziywa 06/18/15.} _{https://www.mycancergenome.org/content/disease/lung-cancer/egfr/}