Ukwelashwa okuthakazelisayo kulabo abanomdlavuza wamaphaphu ophakeme
Nakuba i- chemotherapy ihlose amaseli afana namangqamuzana omdlavuza ahlukanisa ngokushesha emzimbeni, ama-immunotherapy ahlose amasistimu omzimba omuntu, akhuthaze ukuba aqaphele futhi ahlasele amaseli omdlavuza eyedwa. Ngamanye amazwi, i-immunotherapy ivumela umuntu ukuba asebenzise ithuluzi lakhe elihle kakhulu (impilo yakhe ye-immune) ukulwa nomdlavuza.
Kubantu abanesifo somdlavuza ongasemncane wamangqamuzana wamaphaphu (NSCLC), izindaba ezinhle ukuthi i-novel immunotherapies ibelokhu futhi iqhubeka ithuthukiswa ososayensi.
Lezi zindlela zokwelapha aziphili umdlavuza wamaphaphu ophakeme, kodwa zingakusiza wena noma othandekayo wakho uzizwe kangcono futhi aphile isikhathi eside.
Imigomo ye-Cancer Lung
Ngaphambi kokungena ekusebenziseni izifo zokuzivikela ekusebenziseni ukwelapha i-NSCLC ephakeme, kubalulekile ukuchaza amagama ambalwa ahlobene nomdlavuza wamaphaphu.
Kuyini I-Can-Small Cell Lung Cancer (NSCLC)?
Kunezinhlobo ezimbili eziyinhloko zomdlavuza wamaphaphu : umdlavuza omncane ongewona omncane wamangqamuzana nomdlavuza omncane wamangqamuzana wamaphaphu, kanti iseli elincane elingajwayelekile. Eqinisweni, amaphesenti angaba ngu-80 kuya ku-85 wamaphasitiki emaphaphu angamagciwane angamancane amaphaphu amaphaphu.
Uma uzwa igama elithi "umdlavuza wamaphaphu" lisetshenziswe, umuntu ngokuvamile ubhekisela kumdlavuza ongasona omncane wamaphaphu, nakuba lokhu akulona iqiniso ngaso sonke isikhathi.
Iyini i-Cancer Emulance Lung Cancer (NSCLC) ehamba phambili?
Emdlalweni wesifo samangqamuzana ongewona omncane, amangqamuzana amancane (umdlavuza) akhula ngokushesha futhi angalawuleki ukwenza isisu phakathi kwezicubu zamaphaphu. Njengoba umdlavuza ukhula, ungaqala ukusakazeka kuma-lymph nodes, kanye nezindawo ezikude emzimbeni njengobuchopho, amathambo, isibindi, noma elinye iphaphu.
Ngokusekelwe ezinhlolweni eziningi (isibonelo, i-biopsy ye-tumor nokuhlolwa kwe-imaging njenge-CT scan), isigaba se-NSCLC sinqunywa. I-NSCLC ethuthukile ngokuvamile ibhekisela emdlalweni we-IIIb noma umdlavuza wesigaba se-IV , okusho ukuthi umdlavuza usakaze kwezinye izitho zamagciwane kanye / noma ezindaweni ezikude (lokhu kubizwa ngokuthi i- metastasis ).
Yini Yokuhlola I-Immune System?
Ukuze uqonde ukuvimbela imithi, kubalulekile ukuqonda umqondo wokuthi iziphi zokuhlola izivikeli zamasosha omzimba zikhona, ngoba lezi ziyi-molecule ukuthi umdlavuza we-lungum immunotherapies uhlose.
Amasosha okuhlola amasosha omzimba avame ukutholakala kumasosha omzimba omuntu, futhi avimbela amasosha omzimba omuntu ukuba ahlase amaseli aphilile, ajwayelekile, kuphela amaseli angaphandle, angajwayelekile (njengamaseli agciwane).
Kodwa-ke, umdlavuza uyingozi, ngoba enye indlela okugwema ukuhlaselwa ngayo isimiso somzimba sokuzivikela komuntu ngokukwenza nokuveza lezi protheyini zokuhlola. Kodwa umdlavuza we-immunotherapies usebenza ukuze uvimbele lezi zindawo zokuhlola ukuze umzimba uqaphele ngempela umdlavuza njengangaphandle futhi uqale ukuhlasela kuwo.
Immunotherapy for Cancer Lung: PD-1 Antibody
Isikhathi esikhulu sokuhlola amasosha omzimba esihloselwe yi-NSCLC immunotherapies yilona ukufa okuhleliwe 1 (PD-1), i-receptor evame ukutholakala kumaT cell kepha ingenziwa futhi iboniswe ngamaseli omdlavuza wamaphaphu.
Ngokuvamile, lokhu kuhlolwa kwamagciwane kuboshwe endaweni yesifo se-lung, ngakho-ke isimiso somzimba sokuzivikela sisakuvikela ukulwa nomdlavuza. Kodwa ngezidakamizwa ezivimbela i-PD-1, amasosha omzimba angaphendula futhi ahlasele amaseli omdlavuza.
Kukhona okwamanje izidakamizwa ezimbili ezise-PD-1 antibodies (noma i-PD-1 checkpoint inhibitors), futhi zivunyelwe i-FDA zokwelapha i-NSCLC ethuthukile.
Zombili lezi zidakamizwa zinikezwa njenge-infusions (nge-vein) njalo emavikini amabili kuya kwamathathu. Lezi zidakamizwa ezimbili ziyi:
- I-Nivolumab
- I-Pembrolizumab
Sibutsetelo se-Nivolumab
Njenge-anti-PD-1, i-nivolumab iye yafundwa ezinhlolweni eziningana kubantu abane-NSCLC ethuthukile. Isibonelo, isifundo esisodwa se-III se-III eNew England Journal of Medicine saqhathanisa ukwelashwa nge-nivolumab ngokuphathwa kokwelapha ne-docetaxel kubantu abaqhubekile be-NSCLC abaqhubekile ngenkathi noma ngemuva kokuthola uhlelo lwe-platinum oluqukethe i-chemotherapy. Imiphumela yabonisa ukuthi labo abathola i-nivolumab basinde isikhathi eside kunalabo abathola i-docetaxel-ukusinda okungapheli kwezinyanga ezingu-9.2 eqenjini le-nivolumab phakathi nezinyanga ezingu-6 eqenjini le-docetaxel.
Njengengxenye, i-Taxotere (i-docetaxel) i- chemotherapy enikezwa abantu abaphethe i-NSCLC ephuthumisiwe ngaphambilini, ngakho-ke lolu cwaningo luqhathanisa i-immunotherapy inoveli emkhakheni wamanje wokunakekela i-chemotherapy.
Ngaphandle kwenzuzo yokuphila, i-nivolumab yayibhekwa ngokuphephile kune-docetaxel kulolu cwaningo-okuyinto enhle, ngoba ukukhathazeka okukhulu ngama-immunotherapies ukuthi isimiso somzimba somuntu ngeke sihlasele kuphela amangqamuzana omdlavuza kodwa nezitho ezinempilo futhi.
Enye yemiphumela emibi kakhulu odokotela abakhathazeka ngayo nge ukwelashwa komdlavuza yi-pneumonitis, okuyinto lapho isidakamizwa senza ukuvuvukala kwamapayipi (hhayi ukutheleleka, okubonayo nge-pneumonia). Odokotela bakhathazeka ngokukhethekile nge-pneumonitis ngoba kuthinta umsebenzi wamaphaphu, osevele wehla emdlalweni wamaphaphu. Kulolu cwaningo, i-pneumonitis yenzeke kakhulu eqenjini le-nivolumab futhi yayinamandla obukhulu uma kwenzeka.
Lokho kusho ukuthi ezinye izimo ezimbi (ngaphandle kwe-pneumonitis) ezixhunywe ne-nivolumab ukuthi odokotela abaqaphele bahlanganisa:
- Izinkinga zesikhumba (isibonelo, ukusheshisa nokushaya)
- Izinkinga zokugaya (isibonelo, isifo sohudo)
- Ukuhlolwa kwegazi okungavamile kwe-enzyme
- Izinkinga ze-thyroid
- Ukusabela okuhlobene nokumnika amandla
Sibutsetelo se-Pembrolizumab
I-Pembrolizumab i-FDA evunyelwe ukuphatha i-NSCLC ethuthukile kubantu abangenalo uhlobo oluthile lomzimba lomdlavuza wamaphaphu ( ukuguqulwa kwe-EGFR noma i- ALK translocation ) futhi okungenani isigamu samangqamuzana abo omzimba anesimo esihle se-PD-L1. I-PD-L1 yiprotheni evame ukubopha ku-PD-1 kuma-T, ukuvimbela ekuhlaseleni amangqamuzana omdlavuza.
I-Pembrolizumab nayo ivunyiwe ukuphatha i-NSCLC engapheliyo ( lung lung adenocarcinoma ) kanye ne-chemotherapy, kungakhathaliseki ukuthi amangqamuzana amathumba ahlasela i-PD-L1.
Esifundweni sika-2016 eNew England Journal of Medicine , abantu abane-NSCLC ne-PD-L1 yokukhulumisana okungenani ngamaphesenti angu-50 amangqamuzana abo omzimba babhekene nokuphila okuqhubekayo okuqhubekayo okuqhubekayo (izinyanga ezingu-103 kuya kwezinyanga ezingu-6) nemiphumela emibi embalwa ( ephephile) kunelabo bantu ababenomkhuba wendabuko we- platinum-based chemotherapy.
Ngokuqondile, ukusinda okungaqhubeki kokuqhubekayo kwachazwa njengesikhathi lapho iziguli zenzelwe khona ukuba zithole i-pembrolizumab noma i-chemotherapy, kunoma yikuphi lapho isifo sabo sathuthuka khona noma ukufa kwenzeka.
Kulesi sifundo, imiphumela emibi kakhulu yabonakala ngamaphesenti angu-27 alabo abathola i-pembrolizumab uma kuqhathaniswa namaphesenti angu-53 alabo abathola i-chemotherapy.
Ngokuvamile, imiphumela emibi kunazo zonke kulabo abathintekayo nge-pembrolizumab yilokhu:
- Uhudo
- Ukukhathala
- Fever
I-pneumonitis yenzeke eqenjini le-pembrolizumab ngesilinganiso esiphezulu kuneqembu le-chemotherapy (amaphesenti angu-5.8 aphakathi kwamaphesenti angu-0.7).
Immunotherapy for Cancer Lung: PD-L1 Antibody
I-Atezolizumab imithi evunyiwe yi-FDA yokwelapha abantu abane-NSCLC ehamba phambili isifo sayo siqhubeka siphuthumayo noma ngemva kokuthola i-chemotherapy ene-platinum .
I-Atezolizumab ihluke kakhulu ku-nivolumab noma i-pembrolizumab ngokuthi i-anti-PD-L1. Ngamanye amazwi, ihlose ngqo i-PD-L1, iphrotheni ngokuvamile ebopha i-PD-1 (i-receptor e-T cells), iwavimbele ekuhlaseleni amangqamuzana omdlavuza. Njengezinye izidakamizwa ezimbili, i-atezolizumab inikezwa njenge-infusion.
Esifundweni sika-2017 e- Lancet, abantu ababethole i-platinum-based chemotherapy esekelwe i-NSCLC ehamba phambili babengenakulinganiswa ukuthola i-atezolizumab noma i-docetaxel.
Eminye imiphumela ephawulekayo yembula ukuthi izinga lokusinda liye lathuthukiswa kubantu abathola i-atezolizumab ne-docetaxel, kungakhathaliseki ukuthi amangqamuzana omzimba noma amangqamuzana omzimba omzimba ngaphakathi kwe-tumor ayenayo i-PD-L1 (ephakathi kwezinyanga ezingu-13,8 nge-atezolizumab nezinyanga ezingu-9.6 nge-docetaxel ).
Ngaphezu kwalokho, imiphumela emibi ehlobene nokwelashwa ehlobene nokwelashwa yabonakala ngaphansi kweqembu le-atezolizumab, uma kuqhathaniswa neqembu le-docetaxel (amaphesenti angu-15 ahambisana namaphesenti angu-43).
Lokho kusho ukuthi imiphumela emibi kakhulu evamile kubantu abathola i-atezolizumab yilezi:
- Ukukhathala
- I-nausea
- Ukunciphisa ukudla
- Ukungabi namandla
I-pneumonitis yenzeke ngamaphesenti angu-1.6 eguli esigabeni se-atezolizumab, esincane, futhi ngaphansi kwamaphesenti angu-1 kunesifo esibi (ibanga lesi-3 noma 4) i-pneumonitis.
Immunotherapies on the Horizon
Kubalulekile ukuqaphela ukuthi kunezinhlobo eziningi zokuzivivinya kwamagciwane okuzivikela emzimbeni. Isihluthulelo sokunquma indima yabo ekwenzeni wena noma umdlavuza wamaphaphu wakho omthandayo uchazwa ngempela ukuthi lezi zidakamizwa zenza kahle kangakanani izifundo zesigaba III.
Isibonelo, i-immunotherapy eyodwa emgqeni obizwa nge- ipilimumab itholakale ukuthi ihlale isikhathi eside kubantu abanomcula we-metastatic melanoma . Lesi sidakamizwa sihlose i-cytotoxic T-lymphocyte antigen 4 (CTLA-4), okuyinto engumlawuli oyinhloko wendlela ama-T asebenza ngayo esimisweni somzimba sokuzivikela. U-Ipilimumab uhlolisiswa njengokwelashwa kwe-NSCLC ehambelanayo ngokuhambisana ne-chemotherapy.
Izwi elivela
Akukakholelwa ukuthi ezinye umdlavuza (njengomdlavuza wamaphaphu) awugcini nje ngokukhula ngokushesha futhi ongalawuleki kodwa empeleni angakwazi ukuhlukumeza noma ukukhohlisa, ngokusho, isimiso somuntu siqu sokuvikela, amasosha omzimba.
Lokho kusho ukuthi ochwepheshe bekhanda manje banesandla sokutholakala kwe-immunotherapies-into eguquguqukayo ezoqhubeka nokushintsha indlela esiphatha ngayo umdlavuza esikhathini esizayo.
Ekugcineni, ukunquma indlela yokuphatha umdlavuza wakho wamaphaphu kuyinkimbinkimbi nenqubo yokukhokhisa intela, futhi ngezinye izikhathi, imishanguzo eminingi akuyona impendulo efanele ngaso sonke isikhathi. Sicela uqiniseke ukuthi uxoxe ngezifiso zakho, ukwesaba, nokukhathazeka nomndeni wakho nodokotela wakho.
> Imithombo:
> I-American Cancer Society. (2017). I-Immunotherapy ye-Can-Small Cell Lung Cancer.
> Gettinger S. (June 2017). I-Immunotherapy yomdlavuza omncane ongasona omncane wamaphaphu nesifo sokuvivinya umzimba somzimba. Ku: UpToDate, Jett JR, Lilenbaum RC, iSchild SE (Eds), UpToDate, Waltham, MA.
> Reck M et al. I-Pembrolizumab ngokumelene ne-chemotherapy ye-PD-L1 I-Positive Non-Small-Cell Cell Lung Cancer. N Engl J Med . 2016 Nov 10; 375 (19): 1823-33.
> Rittmeyer A et al. I-Atezolizumab ngokumelene ne-docetaxel kuziguli ezinomdlavuza wamaphaphu wesifo samangqamuzana ongaphenduliwe ngaphambilini (OAK): isigaba sesi-3, ibulabula evulekile, isivivinyo esilawulwa ngokungahleliwe. I-Lancet . 2017 Jan 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. I-Nivolumab ku-NSCLC: ubufakazi bamuva kanye namakhono angokomtholampilo. UTher Adv Med Oncol . 2015 uMar; 7 (2): 85-96.