Amasosha ethu omzimba omzimba ayimangalisiso yangempela-aqhubeka nokulawula amabhaktheriya emathumbu emathumbu; bayalwa ne-virus ye-virus ehlaselayo, futhi baqeda ngempumelelo ama-cancer amaningi ekuqaliseni isikhathi eside ngaphambi kokuba babe yinkinga. Ukuthola okubalulekile emkhakheni we- immunotherapy kule minyaka engu-20 edlule kuye kwaholela ekuthuthukiseni okusha okuphawulekayo emithonjeni yokwelapha okuqhubekayo nokuthuthukisa umsebenzi wokuzivikela komzimba.
Ukuguquka kwe-Immunotherapy
Ngaphambi kokuhlola izindlela zokuzivikela nge-immunotherapy yomdlavuza we-prostate, phawula ukuthi kuye kwaba nokuqala kwamanga amaningi kanye nokumemezela kwangaphambi kokunqoba emgwaqweni ukuya empilweni ephumelelayo ye-immunotherapy. Isibonelo, i-FDA ivunyelwe i-interleukin 2 ye-melanoma eminyakeni engu-20 edlule. Naphezu kwezinga elingamaphesenti angu-10 kuphela lokuphendula kanye nemiphumela enobuthi obukhulu, i-interleukin 2 yanikeza ukukhanya kwethemba esikhathini lapho i- melanoma yemetrasi yayingenathemba futhi ingenakuphelelwa amandla. Lesi sidakamizwa sasiyisikhuthazo esincane kodwa esithemba sesikhathi esizayo, esiphuthumayo, ukwelapha.
Manje sesizwa ukuguquka okuphawulekayo emkhakheni wokuphathwa kwe-melanoma. Ngokwesibonelo, maduzane abezindaba basitshele ukuthi silungiselele ukuphela kukaMongameli uJimmy Carter-i-melanoma yakhe isakaze ebuchosheni. Khona-ke isimangaliso esivela kuso-isidakamizwa esisha se-immunotherapy-sasimenzele umdlavuza. Izindaba ze-Fake? Lutho neze. I-immunotherapy yanamuhla ingenza amacala angenathemba aphelelwe amandla.
Inqubekela phambili enkulu kangaka ivela kanjani? Kuye kwaba nokujula okukhulu ekuqondeni kwethu ukusebenza kwangaphakathi komzimba. Ngamazwi alula, manje siyazi ukuthi isimiso somzimba sokuzivikela sinezici ezintathu ezinkulu:
- Amaseli alawulayo, okuthiwa ama-TRegs, aqhubeke nokusebenza komzimba wesimiso sokungasebenzi.
- Amangqamuzana e-killer ahlasela amangqamuzana omdlavuza abulale.
- Amaseli e-Dendritic asebenza njengamaseli e-detector, aphuma futhi athole umdlavuza bese eqondisa amasosha omzimba ngakho azi ukuthi yiliphi amangqamuzana okufanele alibhubhise. Amangqamuzana e-Dendritic, ngemuva kokuthola umdlavuza, aqondise amangqamuzana okubulala ukuba "angene ngaphakathi" futhi ahlasele umdlavuza.
Nikeza i-Prostate Cancer
Umdlavuza we-prostate wawuyingxenye ebambisene neqembu lamasosha omzimba lapho i-Provenge ivunywe yi-FDA ngonyaka ka-2010. Ukugunyazwa kwe-FDA kwakusekelwe emiphumeleni yelingo lokulawulwa kwamakhemikhali okungahleliwe, oluphindwe kabili-blindbo, olwenziwe ukuthi lunikezela ukulindela isikhathi sokuphila esithuthukisiwe amadoda anomdlavuza we-prostate ophakeme ngamaphesenti angu-22.5.
Nikeza imisebenzi yindlela entsha ethuthukisa umsebenzi we-dendritic cell. Njengoba kuphawuliwe ekuqaleni, amangqamuzana e-dendritic "angama-bloodhounds" omzimba omzimba, akwazi ukukhipha futhi athole amangqamuzana omdlavuza. Inqubo ye-Provenge ixhomeke ekwakheni igazi nge-leukapheresis ukususa amaseli e-dendritic. Lawa maseli asetshenziswe kulabhu, abenze bakwazi ukuqaphela i-prostatic acid phosphatase (PAP) -yodwa isici samangqamuzana avamile esibekwe phezu kwamangqamuzana omdlavuza wesibeletho. Uma sekusetshenziselwe, amaseli e-dendritic abuyiselwa emuva egazini legazi lapho evuselela amangqamuzana e-killer ukuze abone kangcono futhi ahlasele amangqamuzana omdlavuza, njengoba anikwe amandla ukukhomba isici se-PAP nesisetshenziswa njengelitshe.
Ukuhlinzekela kungase kubhekwe njengokwokugcina ekwelashweni komdlavuza oyedwa ngoba amangqamuzana e-dendritic ahlungwa egazini lesiguli ngasinye, ethuthukiswa ebhokisithri ukuze ahlasele amangqamuzana omdlavuza we-prostate, bese ephindaphinda abuyele esifundeni esifanayo. Okuthakazelisayo njengoba lobu buchwepheshe buzwakala kungase kusimangaze ukuzwa ukuthi odokotela neziguli baye bafudumala kancane kancane emcimbini wokusebenzisa izibonelelo. Lesi simo sengqondo esibucayi mayelana nokuthola izidingo sasingalindelekile lapho i-Provenge ifika kuqala emakethe, inikezwa ukuthandwa kwemithi eminingi yokwelashwa engasetshenziselwa ukuzivikela njengeGraviola, amakhowa ama-shiitake, i-pau de arco, netiyi le-Essiac.
Kungani kufanele kube khona ukungabaza ukusebenzisa i-FDA kuvunyelwe uhlobo lomuthi wokuzivikela omzimba?
Izikhalazo
Abagxeki babike ukuthi i-Provenge iyabiza nokuthi umamukeli ovamile uhlala kuphela izinyanga ezintathu noma ezine. Kodwa-ke, ezweni langempela lokwelapha umdlavuza (hhayi umhlaba wezilingo zomtholampilo), lokhu kungukucabanga okungalungile. Amadoda abamba iqhaza ekuvivinyweni komtholampilo awafaneli neziguli zomdlavuza zesifo se-prostate ezithola imithi yokwelashwa e-FDA. Ngokuvamile, amadoda awela ezivivinyweni zokwelashwa anezifo eziphambili kakhulu. Lokhu kungenxa yokuthi iziguli ziphuza ukufaka isilingo somtholampilo kuze kube yilapho imithi ejwayelekile ihluleka.
Ngakho-ke, ukusinda kwamadoda esivivinyweni somtholampilo kuvame ukuba mfushane, kungakhathaliseki uhlobo lokwelapha olwenziwa. Noma kunjalo, noma yimiphi imithi eqinisekisiwe yokwandisa ukusinda ngaphansi kwezimo ezingalungile kufanele ibe yinto efanele. Yingakho imishanguzo ebonisa isikhathi sokulondoloza isithola imvume ye-FDA. Iphuzu liwukuthi imithi izobonisa imiphumela engcono uma isetshenziselwa ukuphatha amadoda esikhathini esingaphambili.
Ukwelashwa Ezinyathelo Ezihlukene
Isizathu sokuthi i-Provenge sinomthelela omkhulu uma isetshenziselwa ukwelapha umdlavuza wesicathulo esiteji esingaphambi kwaphenywa ngokusebenzisa i-reanalysis yedatha yasekuqaleni eyaholela ekuvunyweni kokuqala kuka-Provenge yi-FDA. Ukuhlaziywa kabusha kwabonisa ukuthi amadoda anesifo sokuqala esesibhedlela asuke enesisindo esikhulu kakhulu sokusinda. Eqinisweni, isamba sokulondoloza isikhathi sakhula kancane kancane lapho i-Provenge iqalile ngokushesha.
Kule reanalysis, amaqembu amane amadoda, ahlukaniswe amazinga ahlukene e- PSA ekuqaleni kokuhlinzekela ukwelashwa, ahlolwe: amadoda anamazinga e-PSA angaphansi kwezingu-22, amadoda anePSA phakathi kuka-22 no-50, amadoda aphethe i-PSA phakathi kuka-50 no-134, namadoda ne-PSA enkulu kunama-134.
Ithebula elingezansi lifingqa ukusinda kwamadoda aphathwe nge-Provenge, uma kuqhathaniswa namadoda aphathwe nge-placebo, ahlukaniswe ngezinga le-PSA ekuqaleni kokunikezela. Uhlu lokusinda kwenetha (ezinyangeni) phakathi kweMikhawulo kanye ne-placebo kufakwe ohlwini lokugcina.
I-PSA Level | ≤22 | 22-50 | 50-134 | > 134 |
|---|---|---|---|---|
Inombolo yeziguli | 128 | 128 | 128 | 128 |
Pro venge | 41.3 | 27.1 | 20.4 | 18.4 |
I- pla cebo | 28.3 | 20.1 | 15.0 | 15.6 |
Ukusinda Ukuhluka | 13.0 | 7.1 | 5.4 | 2.8 |
Njengoba itafula libonisa, inzuzo yokuphila yayikhona kuwo onke amaqembu aphathelene nokuhlinzekwa ngokuqhathaniswa namadoda aphathwe nge-placebo. Kodwa-ke, inani lokuphulukiswa kokuphila lalikhulu kakhulu emadodeni aqala ukuhlinzeka lapho i-PSA iphansi kakhulu. Amadoda aqala ukuhlinzeka lapho i-PSA yabo ingaphansi kweminyaka engu-22 ehlala isikhathi eside izinyanga ezingu-13 kunamadoda esiteji esifanayo ababethintekile. Amadoda asezingeni eliphezulu kakhulu, namazinga e-PSA angaphezulu kuka-134, ahlala kuphela izinyanga ezimbalwa kunamadoda athola indawo ye-placebo.
Isicelo
Ama-Naysayers umbuzo Ukunikezela ukusebenza ngenye isizathu. Izinhlobo eziningi zokwelashwa kwe-prostate esebenzayo, njenge-hormonal therapy kanye ne-chemotherapy, zenza ukwehla kwamazinga e-PSA. Kodwa ngokunikezela, lokhu ngokuvamile akunjalo. Ngakho-ke, abantu bayazibuza ukuthi banganikeza isikhathi eside sokusinda?
Bayakhohlwa ukuthi ukusebenza kahle kwemithi yokwelashwa ejwayelekile yesifo sofuba, njenge-chemotherapy ne-hormone blockade, kuqiniswa kuphela yi-application eqhubekayo. Uma ukwelashwa kumiswa imiphumela ye-anticancer iphela futhi umdlavuza uqala ukukhula.
Amasosha omzimba, ngakolunye uhlangothi, uma esebenziwe, unomphumela oqhubekayo oqhubekayo. Ngakho-ke, noma ngabe ukuhlinzekela kuphela kubangela ukunciphisa okuncane ekuqhubeleni izifo, ngoba umphumela uyaqhubeka kukhona umphumela wokukhula ngaphezu kwesikhathi esisele sokuphila kwesiguli. Futhi uma umuntu ehlala isikhathi eside, ubukhulu bomzuzwana.
Ukulandela i-Metastases ye-Cancer
Ngokusekelwe kwedatha ekhonjisiwe etafuleni elingenhla, ngokulinganayo kuphetha ngokuthi Isibonelelo kufanele siqaliswe ngokushesha kunoma yimuphi umuntu oye wathola ukuthi unomdlavuza ophawulekayo emtholampilo . Ngeshwa, izinkampani zomshuwalense zihlanganisa kuphela ukuhlinzekwa ngemithi emva kokuba amadoda akhule ukumelana ne-hormone (Lupron) nomdlavuza we-metastases. Njengoba ezimweni eziningi ukumelana nama-hormone kwenzeka ngaphambi kokuba kutholakale izidakamizwa, amadoda aphethwe umdlavuza wesi-prostate aphinde aphinde alawulwa yiwo alawula i-PSA yakhe noLupron kufanele abheke noma yikuphi ukuphakama kwe-PSA. Ukumelana namahomoni kuchazwa njengokunyuka kwe-PSA ngenkathi ku-Lupron noma noma yisiphi isidakamizwa se-Lupron.
Ekubonisweni kokuqala ukuthi i-PSA iqala ukukhuphuka, amadoda kufanele aqale ukusesha ngamandla kwemetastases. Njengamanje, ukuhlola kwe-PET yindlela engcono kakhulu yokuthola ama-metastase ngenkathi i-PSA isesezingeni elincane, kusho ngaphansi kokubili. Kunezinhlobonhlobo zezinhlobonhlobo ezahlukene ze-PET izilinganiso zokucabangela ukusebenzisa: F18 izikhwama zethambo, i-Axumin, i-acetate ye-C11, i-C11 choline, noma i-Gallium68 PSMA. Uma lezi zicabha zihluleka ukuthola izifo zesimiso ekuqaleni, kufanele ziphindwe njalo ezinyangeni eziyisithupha kuze kube yilapho isifo se-metastatic sitholakala, emva kwalokho Isibonelelo kufanele siqaliswe ngokushesha.
Olunye uhlobo lwe-Immunotherapy
Eminyakeni engama-30 edlule, imizamo eminingi yokufaka amasosha omzimba ahlulekile. Siqala ukuzwa ukuthi lezi zinhluleka zibangelwa ukusebenza okwedlulele kwenkampani yokulawula omzimba. Noma nini lapho umzimba udala umsebenzi omusha wokuzivikela omzimba, lo msebenzi uqobo uvuselela ukuzithiba ukuvimbela impendulo yokuzivikela emzimbeni. Lokhu kuvimbela ukuthuthukiswa kwezifo zokuzivikela ezibhubhisa njenge-lupus, i-rheumatoid arthritis, noma i-multiple sclerosis.
Manje abacwaningi baye bafunda ukuthi amangqamuzana omdlavuza asebenzisa lesi sakhi esilawulayo samasosha omzimba ngokukhiqiza ama-hormone okudambisa amagciwane. La mahomoni akhipha isimiso somzimba sokuzivikela sokulala, ngaleyo ndlela ivumela amangqamuzana omdlavuza ukuba aqhubekele ngokugcina ama-cell T killer. Amaseli alawulayo, amangqamuzana e-Treg, ngomqondo othile "athunjwa" futhi asetshenziswa njengesihlangu ukunciphisa umsebenzi we-antiticancer we-immune system. Ukuhluleka kwesimiso sokuzivikela somzimba ukuhlasela umdlavuza akubangelwa ubuthakathaka bempi; kunalokho, ukucindezeleka kokuzivikela komzimba kusuka ekwandeni umsebenzi wokulawula obangelwa amangqamuzana omdlavuza. Ngalokhu kuqonda okusha, ama-ejenti akhethekile wezokwelapha asetshenziselwe ukukhokhela le nkinga.
I-Yervoy imithi enjalo, enye i-FDA evunyelwe ukwelapha i-melanoma. I-Yervoy isebenza ngokuvimbela i-CTLA-4, "ukushintshwa" okulawulayo ebusweni beTreg cells. Uma lo mshini uqhubeka, "umsebenzi wokulawula ukwanda futhi isimiso somzimba sokuzivikela sisuswa. Lapho i-Yervoy ishintsha i-CTLA-4 "ishiya," isenzo sokuvimbela ama-Treg cells sisusiwe futhi umphumela wenetha unomsebenzi wesistimu omzimba omzimba.
Ucwaningo lokuqala oluhlola i-Yervoy emadodeni anomdlavuza we-prostate lubonisa isithembiso, ikakhulukazi uma kuhlangene nemisebe (bheka ngezansi). Kodwa-ke, ucwaningo lwamuva lukhombisa ukuthi omunye umuthi ovimbela ukulawula obizwa ngokuthi i-Keytruda ungase usebenze kangcono.
I-Keytruda ivimbela enye inkinobho yokulawula ebizwa nge-PD-1. Izifundo zokuqala ezigulini zomdlavuza we-prostate ziphakamisa ukuthi i-Keytruda ingase ibangele umphumela omkhulu we-anticancer kune-Yervoy, futhi ibangele imiphumela embalwa kakhulu yokuqalisa. Uma lokhu okutholwa kokuqala nge-Keytruda kuqinisekiswa, ukwelapha okuhlanganiswa ne-Keytruda plus Okunikezwayo kungase kube yindlela enhle yokuthuthukisa umsebenzi we-antiticancer wesistimu yomzimba.
I-Abscopal Effect
I-radiation, eqondiswa isifo se-metastatic esitholwe ngokuskena, ingenye indlela ekhona yokuvuselela isimiso somzimba sokuzivikela ngomzimba okuthiwa yi-Abscopal effect. Uma i-ray ye-radiation ilimaza amangqamuzana e-tumor, amangqamuzana omzimba wethu wokuzivikela omzimba asondela ku-tumor efa futhi asuse ama-debris asele asele. Ngakho-ke, umphumela we-Abscopal uhlanganisa amasosha omzimba okuqala ukukhomba ama-molecule ahlobene nesifo sofuba emangqamuzaneni abulalayo bese ezingela amangqamuzana omdlavuza kwezinye izingxenye zomzimba esebenzisa lezo molekyuli eziqondene ne-tumor njengezinhloso.
Kunezici eziningana ezikhangayo ekwelashweni kwe-immune ekwenzeni imisebe:
- Uma ukhethwe ngokukhetha futhi ngobuchule kunemiphumela emibi kakhulu.
- Ukwelashwa kuhlanganiswa yizo zonke izinhlobo zomshuwalense.
- Imishanguzo ngokuvamile inamandla ngokwanele ukuqeda lesi sifo esihlosiwe.
- Kulula ukuhlanganisa imisebe yendawo ne-Provenge, Keytruda noma kokubili.
Izwi elivela
Ukuqonda kwethu ukuzivikela ngomzimba womdlavuza we-prostate kuyaqhubeka ngokushesha kodwa kusengumntwana. Noma kunjalo, kuyathakazelisa ukuqaphela ukuthi sinezixhobo eziningana eziphumelelayo esinazo. Inselele eqhubekayo ifunda ukuthi amathuluzi amasha angasetshenziswa kanjani ngokuhle, kungaba ngokwabo noma ngokuhlanganisana. Gcina ingxoxo evulekile nodokotela wakho mayelana nezinketho ze-immunotherapy ukunquma ukuthi zilungile yini kuwe.
> Imithombo:
> Higano, Celestia S. "I-Sipuleucel-T: I-Autologous Cellular Cellular Immunotherapy ye-Metastatic Castration-Resistant Cancer Prostate Cancer." Ukuphathwa Kwemithi Ye-Cancer Prostate , iphe. 321-328. I-Springer eNew York, ngo-2010.
> Kantoff, Philip W., Celestia S. Higano, Neal D. Shore, E. Roy Berger, Eric J. Small, uDavid F. Penson, uCharles H. Redfern et al. "I-Sipuleucel-T immunotherapy yomdlavuza we-prostate ongenqamuki." I-New England Journal of Medicine 363, cha. 5 (2010): 411-422.
> Lipson, u-Evan J., uPatrick M. Forde, uHans-Joerg Hammers, uLeisha A. Emens, uJanis M. Taube noSuzanne L. Topalian. "I-antagonists ye-PD-1 ne-PD-L1 ekwelapheni komdlavuza." Ngama- Seminar ku-oncology , vol. 42, cha. 4, iphe. 587-600. I-WB Saunders, ngo-2015.
> Silvestri, Ida, Susanna Cattarino, Sabrina Giantulli, uCristina Nazzari, Giulia Collalti, no-Alessandro Sciarra. "Umbono we-immunotherapy umdlavuza we-prostate." Amanqamu 8, cha. 7 (2016): 64.