I-Arimidex, i-Femara, ne-Aromasin Ukuqhathanisa nemiphumela emibi
Uma usuqedile ukwelashwa okuyisisekelo ekuqaleni kwesigaba, isifo somdlavuza we- estrogen se-receptor-positive, udokotela wakho cishe uzotusa ukwelashwa kwe-hormonal isikhathi seminyaka emihlanu kuya kwengu-10. Ukuzikhethela kwezidakamizwa kuzoxhomeka esimeni sakho se-menopausal, nge-aromatase inhibitors ngokuvamile ukukhetha kokuqala kwabesifazane be-post-menopausal kanye nabesifazane abathile be-premenopausal kanye ne-ovarian suppression therapy.
Uyini umehluko phakathi kwe-Femara, Arimidex, ne-Aromasin, yimiphi imiphumela emibi ongayilindela, futhi le mithi ihluke kanjani ku-tamoxifen? Ziphumelela kangakanani ekuvimbeleni ukuphindaphinda komdlavuza wesifuba?
I-Aromatase Inhibitors: Incazelo
I-Aromatase inhibitors imithi evimba ukukhiqizwa kwe-estrogen emzimbeni. Ngokwenza kanjalo, bancishisa ingozi yokuphindaphinda umdlavuza webele (futhi ukwandisa ukusinda) kwabesifazane abanesifo somdlavuza webele wesifo se-estrogen-receptor futhi bangama-postmenopausal. Zinganciphisa ingozi yokuphindaphinda kwabanye besifazane abanomdlavuza webele we-premenopausal ngaphezu kwe-tamoxifen. Kukhona imithi emithathu ehlukene kuleli klasi yezidakamizwa.
Ukwelashwa kwe-Aromatase inhibitor kuqalile emva kokwelashwa okuyisisekelo komdlavuza webele. Lokhu kubandakanya ukuhlinzekwa komdlavuza webele kanye nokwelashwa kwamakhemikhali kanye / noma ukwelashwa kwemisebe . Ukwelashwa kuqhutshwa iminyaka engu-5 kuya kwengu-10 kuye ngokuthi kunobungozi bomuntu bokuphindaphinda nokubekezelela imiphumela emibi.
Ukwelashwa kwamaHormon for Cancer Breast
Amagciwane ebeletho ayenayo i-estrogen receptor positive aphethwe kakhulu yi-estrogen. Amaseli omdlavuza wesibeletho, njengamaseli ajwayelekile webele, abe nama-estrogen receptors ebusweni. Amagciwane okubhekwa ngokuthi "amahle" we-estrogen noma ama-progesterone receptors yilawo okutholakala khona kulawa ma-receptor e-estrogen ekukhuleni komdlavuza.
Indima ye-estrogen kulezi zicubu ukubopha izidakamizwa ze-estrogen ukukhuthaza ukukhula nokuhlukaniswa kwamaseli.
Ukuze siyeke noma siyeke ukukhula kwamangqamuzana omdlavuza wesifuba, ngaleyo ndlela sidinga indlela yokunciphisa i-estrogen emzimbeni noma ukuvimbela ama-estrogen receptors ukuze i-estrogen ekhona ingakwazi ukubopha.
Izindlela zokwelashwa kwamaHormonal: Tamoxifen ne-Aromatase Inhibitors
Ngaphambi kokumisa esikhathini, ama-ovari ayindawo enkulu yokukhiqizwa kwe-estrogen emzimbeni. Isidakamizwa i-tamoxifen isebenza ngokuvimbela ama-estrogen receptors kumaseli omdlavuza webele (namanye amangqamuzana) ukuze i-estrogen ingakwazi ukubopha. I-Tamoxifen empeleni inezimpikiswano zokulwa ne-estrogen kwezinye izingxenye zomzimba ezifana nesifuba, kodwa imiphumela ye-pro-estrogen kwabanye, njengamathambo (anganciphisa ukulahleka kwethambo). Okokuqala kuvunyelwe ngo-1998, i-tamoxifen ibe yindlela esemqoka yokwelashwa kwama-hormone yomdlavuza webele iminyaka engaphezu kwamashumi amabili.
Ngemuva kokumisa esikhathini sokuqala, umthombo oyinhloko we-estrogen uvela ekuguqulweni komzimba we-androgens (ama-hormone ohlobo wesilisa etholakalayo kuma-fat cells) e-estrogen. Lokhu kusabela kuhlinzekwa yi-enzyme eyaziwa njenge-aromatase. I-Aromatase inhibitors isebenza ngokuvimbela i-aromatase ukuze i-androgens ingakwazi ukuguqulwa ku-estrogen emzimbeni.
Njengoba umthombo oyinhloko we-estrogen ngaphambi kokuya esikhathini, ama-ovaries, hhayi ukuguqulwa komzimba we-androgens, i-aromatase inhibitors yedwa ayengeke iphumelele kwabesifazane abahlala be-premenopausal (futhi owesifazane angase abe umama we-menopausal ngisho noma izikhathi zakhe zisuka kumakhemikhali).
Ukuqonda i-Aromatase Inhibitors: i-Arimidex, i-Femara, ne-Aromasin
Kukhona okwamanje ama-inhibitors amathathu aromatase ahlukene avunyelwe ukunciphisa ingozi yokuphindaphinda kwabesifazane abanomdlavuza wesifuba we-estrogen we-receptor-positive. Lokhu kufaka:
- I-Arimidex (i-anastrozole)
- I-Femara (letrozole)
- I-Aromasin (i-exemestane)
Lezi mithi zibonakala sengathi ziphumelela ekuvinjeni ukuphindaphinda kodwa zinehlukile. I-Aromasin iyi-steroid, kanti i-Arimidex ne-Femara ayikho. Ubuhlungu bale mithi emithathu bubonakala bufana.
I-Tamoxifen ne-Breast Cancer Recurrence
Sinolwazi oluningi ngalesi sikhathi sibheka ukusetshenziswa kwe- tamoxifen kanye nengozi yokuphindaphinda umdlavuza webele . Ngokuvamile, uma isetshenziselwa ukuqala, isisu se-receptor-positive, lesi sidakamizwa sinciphisa ingozi yokuphindaphinda ngamaphesenti angama-50. I-Tamoxifen iphinde ihlukumeze ukuthi uzozihlakulela esinye isisu esiswini sakho (uma une-lumpectomy) noma ukuthi uzokwakha umdlavuza wesifuba wesibili kwesinye isifuba sakho.
I-Aromatase Inhibitors ne-Breast Cancer Recurrence
I-Aromatase inhibitors ibonakala ukunciphisa ingozi yokuphindaphinda ngisho nangaphezu kwe-tamoxifen futhi manje ibhekwa njengezidakamizwa ezikhethwa ngabesifazane be-postmenopausal noma labo abakwa-premenopausal futhi baye bathola ukwelashwa kokukhipha i-ovarian.
Imihlahlandlela ebuyekeziwe ye-Hormonal Therapy
Kwabesifazane be-postmenopausal bathatha i-aromatase inhibitor, imihlahlandlela ka-2017 manje batusa ukusebenzisa i-bisphosphonate Zometa (zoledronic acid) kanye ne-aromatase inhibitor. Ukuhlanganiswa kwezidakamizwa ezimbili kubonakala kunciphisa ingozi yomdlavuza webele isakaze emathanjeni okungaphezu kwe-aromatase inhibitor yedwa. Funda kabanzi mayelana nokusetshenziswa kwama- bisphosphonates emdlalweni webele wesifuba .
I-Aromatase Inhibitors e-Premenopausal Women With Ovarian Suppression
Umbuzo wokuthi ukufaka ukwelashwa kokukhipha ama-ovarian (ukusebenzisa i-gonadotropins ukuthi idale ukuyeka komuntu) ku-tamoxifen bekuyindaba yempikiswano ethile. Ucwaningo olunyatheliswa eNew England Journal of Medicine ngo-2015, nokho, lubonakala lubonisa ukuthi abesifazane base-premenopausal abaphathwa nge-ovarian suppression therapy ukuze basebenzise i-aromatase inhibitor esikhundleni se-tamoxifen bangase babe namanani angcono okusinda.
Olunye ucwaningo olushicilelwe emaphephandabeni afanayo ngo-2014 lwathola ukuthi i-Aromasin (i-exemestane) ehlangene nokwelashwa kwe-ovarian ukucindezelwa ngokuphuthumayo kukhulisa ukuphila ngokuqhathaniswa ne-tamoxifen kanye ne-ovarian suppression therapy.
Njengoba i-aromatase inhibitors inemiphumela emibi kakhulu ye-musculoskeletal futhi ingaholela ekulahlekelweni kwethambo, abaningi be-oncologists batusa ukugcina le ndlela kubesifazane be-premenopausal abaneSigaba 2 no- Stage 3 kanomdlavuza webele, okungenzeka ukuthi babuyele emuva.
Imiphumela emibi ye-Aromatase Inhibitors
Njengazo zonke izidakamizwa, imiphumela emibi kanye nokusabela okubi kungase kwenzeke kwabanye besifazane kwi-aromatase inhibitors.
Eminye yemiphumela emibi kakhulu yilabo abahlobene nokunciphisa i-estrogen emzimbeni (izibonakaliso ze-menopausal) futhi kufaka ukukhanya okushisayo, ukujula ebusuku, ukumelela kwamasipha, nokusuka kwamagciwane. Nakuba lezi zimpawu zingabacasula, ucwaningo lubonisa ukuthi ukushisa okushisayo kuyisimpawu esihle kubesifazane abanomdlavuza wesifuba, nalabo abathola le miiphumela emibi banemiphumela engcono.
Ubuhlungu obuhlangene nobunzima bomzimba futhi buwumphumela ovamile kakhulu we-aromatase inhibitors. Yilezi zifo zomzimba eziyisizathu esikhulu kunazo zonke zokuthi abesifazane bayeke lezi zidakamizwa.
Esinye sezikhathazo ezingathí sina ku-aromatase inhibitors ukulahleka kwethambo, nokusetshenziswa kwezidakamizwa okungase kuholele ekutheni i-osteoporosis ne-fractures. Abaningi be-oncologists batusa ukuhlola amathambo ngaphambi kokuqala le mithi njengesisekelo, futhi ulandele ngokuya ngemiphumela yaloluhlolo lokuqala.
Ukwengezwa kwe-bisphosphonates (i-Zometa) ku-aromatase inhibitor therapy kunganciphisa kakhulu lo mngcipheko. Ama-bisphosphonates avunyelwe kuqala njengezokwelapha ngenxa ye-osteoporosis, kanti i-Zometa itholakale ukunciphisa ingozi yomgogodla ne-hip fractures (kanye nokukhubazeka okuvame ukuhamba nalezi zintambo). I-Zometa yanconywa ngaleso sikhathi kubantu abanomdlavuza we-metastatic, njengoba kunganciphisa ubuhlungu be-bone kanye nobungozi bokuhlukana okuhlobene nezibalo zamathambo. Ucwaningo oluqhubekayo lubonisa ukuthi i-Zometa iguqula i-microenvironment yamathambo ukuze amangqamuzana omdlavuza webele angakwazi "ukunamathela" kalula. Ekusetshenzisweni kwemitholampilo, kubonakala kunciphisa ithuba lokuthi umdlavuza womuntu uzosakazeka emathanjeni abo.
I-Aromatase inhibitors nayo ihlotshaniswa nengozi enkulu yenhliziyo. Yize lokhu kuyiqiniso, sekutholwe ukuthi izifo eziyingozi nokuphila ezisongela izifo zenhliziyo ezifana nokuhlaselwa kwenhliziyo nokushaywa komzimba akuyona into ejwayelekile kubantu besifazane abathatha i-aromatase inhibitors kunelabo abangathathi lezi zidakamizwa. Izimo zenhliziyo ezenzeka kakhulu kulezi zinkinga zihlanganisa izifo zenhliziyo , izinkinga ze-valve senhliziyo , kanye ne- pericarditis (ukuvuvukala kwamagundane azungeze inhliziyo).
Uma Imiphumela Yomphumela Yenza Ukwenze Ukuyeka Imithi Yakho
Imiphumela emibi ye-aromatase inhibitors, ikakhulukazi i-aches yomzimba, ingaba yinselele ngezinye izikhathi. Ngeshwa, lemiphumela emibi ibangelwa abesifazane abaningi kakhulu abayeka ukwelashwa ngaphambi kwesikhathi futhi belahlekelwa ukuvimbela okuphindaphindiwe (nokusinda okuthuthukisiwe) abanikezayo.
Uma unemiphumela emibi, khuluma ne-oncologist yakho. Ngisho noma ukuphepha kanye nobuthi kwezidakamizwa ezintathu kulezi zigaba zifana, cishe ingxenye yesithathu yabesifazane iyakwazi ukubekezelela imithi ehlukile kuleli klasi.
Ukushintsha kusuka ku-Tamoxifen kuya ku-Inhibitor ye-Aromatase
Abanye abantu abano-premenopausal futhi baphathwa nge-tamoxifen bangase babe ama-postmenopousal ngesikhathi sokwelashwa. Lokhu kuyiqiniso ikakhulukazi kwabesifazane abahlakulela umdlavuza webele nxa isikhathi sokuya esikhathini. Njengoba i-chemotherapy ngokuvamile iholela ku-amenorrhea (ukungabi khona kwezikhathi), ukuhlolwa kwegazi kungadingeka kwenziwe ukuthi kunqunywe ukuthi ukhona yini esikhathini sokuya esikhathini. Ucwaningo luye lwathola ukuthi ukushintshela kwi-inhibitor ye-aromatase elandela iminyaka emibili kuya kwemi-3 yokwelashwa kwe-tamoxifen imiphumela yokusinda okungcono kunokuqhubeka ne-tamoxifen.
Ubude Bokwelashwa Ne-Aromatase Inhibitors
Nakuba kunconywa ukuthi abantu baqhubeke ne-tamoxifen noma i-aromatase inhibitor iminyaka emi-5 esikhathini esidlule, idatha emisha ibonisa ukuthi ukuthatha le mithi iminyaka eyishumi kuyanciphisa ingozi yokuphindaphindiwe. Kuyaziwa kahle ukuthi umdlavuza webele ungase uphinde uqhubeke iminyaka eminingi noma ngisho neminyaka emashumi emva kokuba i-tumor yokuqala iphathwa, futhi lokhu kubungozi ikakhulukazi kwabesifazane abaye baba nezicubu ezinesifo se-estrogen. Asazi ukuthi kungani umdlavuza webele wesifuba ubuya ngemva kweminyaka noma amashumi eminyaka, kodwa siyazi ukuthi lokhu kwenzeka kaningi.
Kokubili i-tamoxifen ne-aromatase inhibitors zibonakala ziqhubeka zisebenza ngemva kokuba ziphelile, nakuba abanye abacwaningi bakholelwa ukuthi ukwelapha okuqhubekayo kwe-hormone kunganwetshwa kuze kube iminyaka engaphezu kwengu-10 esikhathini esizayo. Lokho kusho ukuthi izinzuzo ezidingekayo kufanele zilinganiswe nezingozi.
Izindleko ze-Aromatase Inhibitors
Ngokungafani ne-tamoxifen eveze emashumini ambalwa eminyaka futhi enefomu, ama-aromatase inhibitors angabiza. Amasu omshuwalense ngokuvamile ahlanganisa ingxenye yezindleko, nakuba anganikezela ngokuhlinzekwa komunye wemithi kuleli klasi. Uma unenkinga yokufaka i-AI yakho, hlola la macebiso ekulawuleni izindleko zokwelashwa kwe-hormonal .
Izwi elivela
I-Aromatase inhibitors isebenza ngokuvimbela ukukhiqizwa kwe-estrogen emaqenjini amafutha, umthombo oyinhloko we-estrogen kuma-postmenopausal abesifazane. Siyazi ngamashumi ambalwa eminyaka ukuthi i-tamoxifen inganciphisa kakhulu ingozi yokuphindaphinda umdlavuza webele futhi lezi zinombolo zibonakala zingcono nakakhulu nge-aromatase inhibitors.
Ngeshwa, futhi njenganoma yimiphi imithi, imiphumela emibi iyabonakala, futhi umzimba we-aches ungase ube ucasulayo kakhulu. Uma uhlangabezana nalezi, sebenzisa nge-oncologist yakho. Ngezinye izikhathi kuyasiza ukushintshela kumuthi ohlukile kuleli klasi. Ukwelashwa okudidiyelwe okuvela ekusikeleni ukuhlunga kuya ekuzindleni kungasiza futhi. Kubalulekile ukukhumbuza ukuthi kungani uthatha isidakamizwa. Imiphumela emibi ingabacasula kepha ingcono ukuphindaphindiwe. Manje ukuthi ama-bisphosphonates anconywa kanye ne-aromatase inhibitors, ukukhathazeka kokunciphisa amathambo nesifo se-osteoporosis kungase kube yinkinga encane ngaleso sikhathi.
Khumbula ukuthi wonke owesifazane uhlukile futhi akekho "imilingo" isikhathi esithatha wonke umuntu okufanele athathe le mithi. Ngomuntu ngamunye, kubalulekile ukukala izinzuzo ezingase zibhekane nemiphumela emibi yemiphumela kanye nezingozi ezingenzeka. Qiniseka ukuthi ubuza imibuzo eminingi futhi ube ngummeli wakho siqu ekunakekeleni kwakho. Akekho okhuthazwa kakhulu ukuthi uzophila impilo yakho ngaphandle komdlavuza.
> Imithombo:
> Francis, P., Regan, M., Fleming, G. et al. Ukunciphisa i-Adjuvant Ovarian ku-Premenopausal Breast Cancer. I-New England Journal of Medicine . 2015. 372 (5): 436-446.
> Hague, R., Shi, J., Schottinger, J. et al. Izifo Zezinhliziyo Ngemva Kokusetshenziswa Kwe-Aromatase Inhibitor. I-JAMA Oncology . 2016. 2 (12): 1590.
> Pagani, O., Regan, M., Walley, B. et al. I-Adjuvant Exemestane ne-Ovarian Suppression in Premenopausal Breast Cancer. I-New England Journal of Medicine . 2014. 371 (2): 107-118.
> Tjan- > Hejinen >, V., Hellemond, I., Ontanga, P. et al. I-Adjuvant Extended Aromatase Inhibition Ngemuva kokutheleleka kwe-Endocrine ehlukile (DATA): Isikhathi Esingahleliwe, Isigaba Sesi-3. I-Lancet Oncology . 2017. 18 (11): 1502-1511.