Izidakamizwa ze-osteoporosis zingasiza kanjani iZometa noma Bonefos?
Nakuba imithi ye-osteoporosis isetshenziselwe abantu abanomdlavuza webele we-metastatic ne-bone metastases, iziqondiso ezintsha zika-2017 ezivela ku-American Society of Clinical Oncology zincoma ukusebenzisa i-bisphosphonate izidakamizwa zeZometa kwabanye besifazane abanomdlavuza webele wesandulela. Yini ngempela i-bisphosphonates futhi isebenza kanjani? Ingabe zinganciphisa amathuba okuba umdlavuza wakho webele uzosakazeka emathanjeni akho futhi uthuthukise ukusinda?
Ungazi kanjani ukuthi le mithi ingakulungela wena?
I-Cancer Isifo Nengozi Yokuphindaphindiwe
Umdlavuza webele wesifuba ususelwa kakhulu, futhi izinga lokusinda liye lathuthuka ngokungezwa kwe-adjuvant chemotherapy kanye nokwelashwa kwe-hormonal kulabo abathintekayo kulezi zindlela zokwelashwa. Kodwa ngisho nangomdlavuza webele wesifuba ( isigaba I , isigaba II , nesigaba III ), ukuphindaphindiwe kuvamile kakhulu.
Ingozi yokuphindaphinda ihlukahluka ngezici eziningana ezingenayo isiteleka somdlavuza wakho, iminyaka yakho, ukwelashwa okutholayo, nezinye izici. Asazi ukuthi kungani umdlavuza wezinye izikhathi uphindela emuva eminyakeni eminingi noma amashumi eminyaka kamuva, nakuba imibono yokuthi kungani ukuphindaphinda umdlavuza webele kuhlanganisa nomqondo wokuthi kukhona ubukhulu bomdlavuza wamangqamuzana, futhi ukuthi amangqamuzana omdlavuza (abaphathi) angase alale emangeni kuze kube yilapho isimo siqala ukukhula futhi.
Ukuphindaphinda komdlavuza webelevuza kungaba izinhlobo ezintathu:
- Ukuphindaphinda kwendawo , lapho i-tumor ibuyela khona esifubeni eduze nesayithi se-tumor yangempela.
- Ukuphindaphinda kwesifunda , lapho umdlavuza uphindela khona eduze kwezitho zamagciwane noma izakhiwo eziseduze.
- Ukuphindaphinda okude, lapho umdlavuza ubuya esifundeni esikude somzimba njengamathambo, isibindi, amaphaphu, noma ubuchopho. Kulawa, amathambo yiyona indawo evamile kakhulu ye-metastases.
Kuyindlela yomdlavuza webele we-breast-metastatic ekude (umdlavuza wesifuba wesigaba se-4) -wubhekene namaphesenti angu-90 okufa okuhlobene nomdlavuza webele.
Ubani Ongengozini Ye-Metastases Ye-Bone Kusuka Emdlalweni We-Cancer?
Cishe noma ubani oye waba nomdlavuza webele angase abe engozini yokuthuthukisa amathisaseli we-bone, kodwa kunezilungiselelo lapho kunokwenzeka khona amathuba amaningi.
I-metastases ye-Bone ivame kakhulu kubantu abanomdlavuza wesifuba we- estrogen we-receptor-positive . I-Estrogen receptor tumorous positive futhi kungenzeka ukuthi ihlotshaniswe nokuphindaphinda kwesikhathi, isibonelo, iminyaka eminingi noma amashumi eminyaka emva komdlavuza wangempela watholwa futhi uphathwa. Ezinye izinto ezandisa ingozi yokuthi umdlavuza webele uzophinde uhlanganise nesifo se- lymph node-positive .
Cishe amaphesenti angu-70 abesifazane abanomdlavuza wesifuba we-metastatic (isigaba somdlavuza wesifuba se-4) bazoba nama-boneastases.
Indima yeBisphosphonates e-Breast Cancer
Ama-bisphosphonates aqale asetshenziswe ngawo-1990 lapho avunyelwe ukwelashwa kwe- osteoporosis . Kusukela ngaleso sikhathi nabo baye bavunyelwa ukwelashwa kwamathambo ayisifo somdlavuza webele (nezinye izifo zomdlavuza) kanye ne-hypercalcemia ehambisana nomdlavuza.
Izindlela eziningana ezingenzeka ukuthi i-bisphosphonates ingaba usizo kubantu abanomdlavuza webele kubandakanya:
- Kulabo besifazane abanomdlavuza wesifuba osakazeke emathanjeni ( umdlavuza webele ne-metastases amathambo ), ama-bisphosphonates njenge-Zometa anciphisa ingozi yezinkinga ezifana ne-bone fractures. Njengoba ukuphuka kwamathambo kuyimbangela enkulu yobuhlungu nokukhubazeka, le mithi ingathuthukisa kakhulu izinga lempilo yabesifazane abanesifo sesigaba 4.
- I-Aromatase inhibitors, ukwelashwa kwe - hormonal yomdlavuza webele ngokuvamile owawusetshenziswa kuma-postmenopausal abesifazane, kungaholela ekulahlekelweni kwethambo okuholela ekutheni i-osteoporosis ivele. Lokhu kulahlekelwa kwethambo kungaholela ekuqhekekeni kwedwa, kodwa kungandisa ukwanda kwezinkinga lapho i-metastases ye-bone ikhona.
- Ezicwaningweni, ukusetshenziswa kweZometa emdlalweni we-metastatic breast
- Iningi lwakamuva, ukusetshenziswa kwe-bisphosphonates kwisifo somdlavuza webele wesisu ekuqaleni kwe-receptor-positive kwahlanganiswa nomngcipheko ophansi wokuthuthukisa amathisaseli we-bone endaweni yokuqala kanye nesilinganiso esiphakeme sokusinda (bheka ngezansi).
Izinzuzo zeBisphosphonates njenge-Adjuvant Treatment for Cancer Stage Cancer Stage
Ezingxenyeni ezibheke emathisini emdlavuza webele webele, itholakala ukuthi ama-bisphosphonates awanciphisi nje kuphela ingozi yezinsalela ngenxa ye-metastase kodwa yabonakala ekuvimbeleni ukusakazeka komdlavuza emathanjeni kuqala.
Ngenkathi singazi ngokuphelele ukuthi basebenza kanjani, lezi zidakamizwa zibonakala zithonya i-microenvironment yethanga ngendlela amangqamuzana omdlavuza wesifuba angenayo amathuba okuhlala.
Njengoba i-metastases ye-bone iyimbangela ebalulekile yokufa ngomdlavuza wesifuba, ukunciphisa ingozi yalezi zindlela zokuphucula izidakamizwa kungenzeka zithuthukise ukusinda kwabesifazane abanesifo sokuqala.
Ucwaningo olulandelayo luqinisekisile ukuthi le mibono yayilungile. Uma kunikezwa ngemuva kokuhlinzwa kanye ne-chemotherapy kanye ne-therapy ye-hormone ukusetshenziswa kwe-bisphosphonates kumdlavuza webele wesandulela-ntathu kwabesifazane abakwa-postmenopausal batholakala ukunciphisa ingozi yokuthuthukisa amathisaseli we-bone ngomunye wesithathu nokunciphisa ingozi yokufa komunye -sixth. Nakuba lezi zinombolo zibukeka zihlaba umxhwele, ukwehliswa kwangempela kwengozi enkulu kuncane uma ubheka isithombe esikhulu, ngama-bisphosphonates enikeza ukunciphisa cishe 1 kuya kwezingu-2 ukunciphisa inengozi yokufa kwabesifazane abafuna ukwelashwa.
Ngaphezu kokunciphisa ubungozi bokutholakala kwemithi kanye nokwenza ngcono ukusinda, ama-bisphosphonates angasebenza nenye indima. I-Aromatase inhibitors, uhlobo lwe-adjuvant hormonal treatment olwenzelwe abesifazane abesilisawase (noma abesifazane base-premenopausal ngemuva kokukhipha ukwelashwa kwe-ovarian) kungaholela ekulahlekelweni kwethambo kanye ne-osteoporosis. Lokhu kukukhathazeka nakakhulu manje ukuthi le mithi iyanconywa isikhathi eside noma ngemuva kokwelashwa nge-tamoxifen. I-Zometa itholakale ukunciphisa ingozi ye-osteoporosis ehambisana ne-aromatase inhibitors. Izidakamizwa ezihlukaniswe njenge-aromatase inhibitors zihlanganisa i-Aromasin (i-exemestane), i-Arimidex (i-anastrozole), ne-Femara (i-letrozole).
Imihlahlandlela ye-Bisphosphonate Ekuqaleni Kwesifo Sebelevuza Sebele
Iziqondiso zamanje zincoma ukusetshenziswa kwemithi emibili ehlukene kulokhu kulungiselelwa:
- I-Zometa (i-zoledronic acid): i-Zometa ifomu lokubamba i-bisphosphonate. Umthamo onconywe ngokuthi ukwelashwa kwe-adjuvant kumdlavuza webele wesandulela-ngculaza u-4 mg IV njalo ezinyangeni eziyisithupha iminyaka emithathu kuya kwemihlanu.
- I-Bonefos (i-clodronate): I-Bonefos iyi-bisphosphonate yomlomo engase isetshenziswe njengenye indlela eya ku-Zometa uma kudingeka. Umthamo we-adjuvant therapy ungumshini we-tablet we-1600 mg uthathwa kanye nsuku zonke iminyaka emibili kuya kwemithathu. I-Bonefos ayiyona i-FDA evunyelwe e-United States.
Umthamo weZometa osetshenziselwa umdlavuza webele wesandulela-ngculazi uhlukile (okuncane kakhulu) kunalokho okusetshenziselwa umdlavuza webele we-metastatic.
Ubani Ongasebenzisa iZometa noma Bonefos for Treatment Cancer Treatment?
Ama-Zometa (noma i-Bonefos) anconywa ukwelashwa kwe-adjuvant yesifo se-introductal se-estrogen se-receptor-positive. Kumelwe isetshenziswe kuphela kwabesifazane abangama-postmenopausal ngesikhathi sokuxilongwa noma abangama-premenopausal kodwa bathole ukwelashwa kwe-ovarian .
Abesifazane abaningi abaphethwe umdlavuza webele wesandulela ngaphambi kokuncoma bangase bazibuze ukuthi kufanele baqale yini isidakamizwa noma cha. Impendulo yukuthi kuncike, futhi kunezici eziningi okufanele zicatshangelwe. Ucwaningo lwalwenziwa nabesifazane abaqala ama-bisphosphonates ngemuva kokuqeda ukuhlinzwa kanye ne-chemotherapy, futhi asinayo idatha enhle ekwehliseni ama-metastase noma inzuzo yokuphila kubantu abaqala lezi zidakamizwa kamuva.
Siyazi ukuthi ama-bisphosphonates anganciphisa ukulahleka kwethambo kubantu abane- osteopenia kanye ne-osteoporosis, kanti i-aromatase inhibitors ihlotshaniswa nokulahlekelwa kwethambo elibalulekile kwabanye abantu. Abanye odokotela batusa ama- bisphosphonates ye-osteopenia uma kulindeleke ukuthi ukulahlekelwa kwamathambo okulindelekile (nakuba ukulinganisa okuhlukile kungahle kusetshenziswe) noma uma umuntu enezizathu eziyinhloko ezingozini zokuhlukumeza. Ungase ufise ukukhuluma ne-oncologist yakho ngokwenza ukuhlolwa kwethambo ngaphambi kokuba wenze isinqumo sakho. Uma usuvele unayo noma usemngciphekweni we-osteoporosis, kungase kube nenzuzo ecacile yokusebenzisa le mithi.
Izingozi nemiphumela emibi yeBisphosphonates
Umphumela ovamile kakhulu we-Zometa wu-syndrome efana noketshezi oluhlala izinsuku ezimbalwa emva kokumnika.
Imiphumela emibi ye-Bonefos yomlomo ingafaka futhi ukuqubuka kwenhliziyo, indigestion, nokuvuvukala kokungapheli. Imithi yomlomo kufanele ithathwe ngamanzi futhi abantu bafundiswa ukuba bahlale beqondile imizuzu engama-30 kuya kwengu-60 ukunciphisa ingozi yokucasula ukukhathazeka.
Imiphumela emibi engavamile ye-bisphosphonates engasetshenziswa ngomlomo noma nge-intravenously ifaka izinga eliphansi legazi le-calcium (hypocalcemia), ubuhlungu besisindo, ohlangene, kanye / noma amathambo (lokhu kungenzeka nganoma isiphi isikhathi ngesikhathi kusetshenziswa imithi), kanye nokusebenza kwe-kidney ekhubazekile. Abantu abanezinkinga ze-kidney ngaphambi kokuba baxilongwe bangase bangakwazi ukusebenzisa imithi. Eminye imiphumela engavamile engaba khona ihlanganisa ama-femur fractures nama-atypical fibrillation.
Umphumela ongavamile kodwa onzima futhi onzima onzima wama-bisphosphates yi-osteonecrosis yomhlathi. I-Osteonecrosis ibhekisela ekubhujisweni kwethambo futhi ingase ibe khona ku-mandible noma i-maxilla. Izimpawu zivame ukuqala ngobuhlungu bomhlathi noma ukulahlekelwa izinyo. Ezicwaningweni ezibheke ukusetshenziswa kweZometa njenge-adjuvant therapy yomdlavuza webele, i-osteonecrosis yomhlathi ivele cishe ngamaphesenti amabili wabesifazane abasebenzisa iZometa.
Izingozi zokuthuthukisa i-osteonecrosis zihlanganisa isifo segum, ukuhlanzeka kwamazinyo, noma ukusetshenziswa kwemishini yamazinyo. Ucwaningo luye lwabheka izindlela zokunciphisa ingozi. Esicwaningweni esisodwa, ukusungula ukuhlolwa kwamazinyo njalo ezinyangeni ezintathu nokusebenzisa i-antibiotic prophylaxis ngaphambi kwezinqubo zamazinyo kwakuhlobene nengozi ephansi yalesi simo. Lapho i-osteonecrosis yomhlathi iba khona, kungaba yinkinga ukuphatha. Ngokuvamile inhlanganisela yama-antibiotics, ukuhlinza, ukuhlunga emlonyeni, kanye nokwelapha i-hyperbaric oksijeni.
Ngesikhathi i-osteonecrosis yomhlathi ingase ivele nanoma iyiphi i-bisphosphonate, ibonakala ngokuvamile (amaphesenti angu-94 wesikhathi) ene-bisphosphonates engaphakathi.
Ngaphambi kokuthatha iZometa noma i-Bonefos
Ngaphambi kokuba uqale i-Zometa noma i-Bonefos kunconywa ukuba uhlolwe ngokuphelele wamazinyo ngokuqondile ukubuka noma yibuphi ubufakazi besifo sezinsini. Uma udinga noma yimuphi umsebenzi wamazinyo okwenziwe, njengokwenyama kwezinyo, kunconywa ukuthi ugcwalise lezinqubo zamazinyo ngaphambi kokuqala ama-bisphosphonates.
I-Bisphosphonates ne-Canast Metastatic Breast Breast
Ama-bisphosphonates nolunye uhlobo lwemithi, i-denosumab (i-Xgeva noma i-Prolia) ibizwa ngokuthi izidakamizwa eziguqula amathambo. Lezi zidakamizwa ziphumelela kakhulu ekunciphiseni ingozi yezinsalela ezihlobene namathambo emasotini emdlavuza webele. Manje kunconywa ukuba ama-bisphosphonates noma i-denosumab iqalwe lapho ama-metastases e-bone eqala ukutholakala. Uma isetshenziselwa amathambo asetsheni, umthamo weZometa uphakeme futhi unikezwe njenge-infusion ye-4 mg noma amaviki angu-12 noma onke amasonto amathathu kuya kwamane.
Ngaphansi kwe-Adjuvant Bisphosphonates for Stage Early Stage Cancer Breast
I-Bisphosphonates (i-Zometa) yanezelwa emithethweni yomkhuba we-2017 yomtholampilo yokwelashwa kwe-adjuvant yesifo se-estrogen se-receptor-positive esifundeni sabesifazane be-postmenopausal. Akukhona nje kuphela ukuthi lezi zidakamizwa zinganciphisa ingozi yokwelashwa okuphathelene nokuphathwa kwemithi, kodwa kubonakala kunciphisa ingozi yokuthuthukisa i-metastasis yethambo futhi ingathuthukisa ukusinda.
Lezi zidakamizwa ziqaliswa ngemuva kokuqeda ukuhlinzeka nokuhlinzwa kwamakhemikhali futhi ngesikhathi esifanayo ukuthi ukwelashwa kwe-hormonal kuqaliswe.
I-metastases ye-Bone nomdlavuza wesifuba akusho nje ukuthi umdlavuza awusakwazi ukuphulukiswa kodwa ubangele ubuhlungu obukhulu nokukhubazeka. Izinkinga ze-metastases zamathambo zihlanganisa ukuqhuma, ukucindezela komgogodla, nezinga eliphakeme legazi le-calcium, konke okunciphisa izinga lokuphila nokunciphisa ukusinda.
Ama-bisphosphonates, njengemithi yonke, ingaba nemiphumela emibi. I-Zometa ivame ukubangela isifo esifana nesifo sofuba usuku noma amabili emva kokukhipha kanye ne-Bonefos kungaholela ekucaseni kwe-esophagus. Abanye abantu baphinde bahlakulele ukusebenza kwezinso noma izinga eliphansi legazi le-calcium. Imiphumela engavamile kepha eyingozi kakhulu i-osteonecrosis yomsebenzi, isimo esicatshangelwa ukuthi sithinte omunye wabesifazane abangu-50 abasebenzisa lesi sidakamizwa ngale ndlela. Ukuhlanzeka kwamazinyo okuhle nokuhlolwa kwamazinyo ngaphambi kokuqala ukwelashwa kunganciphisa ingozi.
Kulabo besifazane ababenakekelwa isifo somdlavuza webele wezinsana zakuqala esikhathini esedlule kodwa okungenzeka ukuthi babebe ngabafake ukwelashwa kwe-adjuvant, okwamanje akukho izincomo ezikhona. Khuluma ne-oncologist yakho mayelana nemicabango yakhe nokuthi yini ayibheka njengezinzuzo nezinkinga zokwelashwa. Ukwazi amathambo akho futhi ubheka izingozi, noma ukuphindaphinda noma imiphumela emibi yokwelashwa kungasiza ekuqondiseni isinqumo sakho. Njengakho konke ukunakekelwa kwakho, ukuba ummeli wakho siqu ukunakekelwa komdlavuza wakho kwenza umehluko.
> Imithombo:
> Beth-Tasdogan, N., Mayer, B., Hussein, H., no-O. Zolk. Ukungenelela Ukuphatha I-Osteonecrosis Ehlobene NeMithi Yomuthi. I-Cochrane Database yezibuyekezo ezihleliwe . 2017. 10: CD012432.
> Coleman, R. Impact ye-Bone-Targeted Treatments ku-Skeletal Morbidity and Survival in Cancer Breast. I-Oncology (i-Williston Park) . 2016. 30 (8): 695-702.
> Dhesy-Isimpungushe, S., Fletcher, G., Blanchette, P. et al. Ukusetshenziswa kwe-Adjuvant Bisphosphonates nezinye izifo ezithinta izifo e-Cancer CancerCare Ontario naseMelika Society of Clinical Oncology Clinical Practice Guideline. I-Journal ye-Clinical Oncology . 2017. 35 (18): 2062-2081.
> Hadii, P., Coleman, R., Wilson, C. et al. I-Adjuvant Bisphosphonates e-Cancer Early Breast: Isiqondiso se-Consensus for Practice Clinical From the European Panel. Amanothi we-Oncology . 2016. 27 (3): 379-90.