Yiziphi Izindlela Eziphuthumayo Ezisezingeni Eliphakeme 4 I-HER2-Positve Cancer Breast?
Uma uthola ukuthi unomdlavuza wesifuba we-HER2 wemetastatic, kungenzeka ukuthi ulwazi oluningi olutholayo lubhekisela kumdlavuza wesifo sokuqala noma isigaba somdlavuza webele wesine ngo-jikelele. Yini okudingeka ukwazi mayelana nokwelashwa kwesigaba se-4 somdlavuza webele esiwu-HER2 esihle?
I-Metastatic HER2 I-Cancer Positive Breast
Kungenzeka ukuthi ufunde ukuthi unesifo somdlavuza wesifuba se-4 (metastatic) sezinyosi lapho uthola ukuthi unesifo, kodwa ngokuvamile, izidakamizwa ezikude zenzeka njengendlela yokuphindaphindiwe kwesisu esasisuka ekuqaleni kwesisu esikuqaleni.
Ngakho-ke, ukuxilongwa ngokuvamile kuvame ukwethuka futhi kungazizwa kunzima kakhulu.
Akukhona nje ukuthi ukubikezelwa kwesifo akusizi kahle uma umdlavuza webele usakazeke, kodwa umcabango wokuthi uphinde ukwelashwa ungakusiza uzizwe udangele. Ngenkathi isigaba se-4 HER2 umdlavuza webele esifanele singelapheki, sitholwa, futhi ukwelashwa okuhloswe ukukhomba i-HER2 kuqhubeka nokwandisa nokuthuthukisa. Lezi zokwelapha ngokuvamile ziba nemiphumela emibi kakhulu kunezidakamizwa zamakhemikhali.
Cishe eyodwa kwezinhlanu zamabele zomuthi yi- HER2-positive umdlavuza webele . Lokho kusho ukuthi ezinye izifo zomdlavuza webele zinamaGERI angu-HER2 anemiprotheni engaphezu kwe-HER2. Lezi zinhlayiya zibophezela emangqamuzanini omdlavuza wesifuba, okubangela ukukhula kwezici zalezi zinhlayiya. Ngokuvamile, izicubu zebele ze-HER2 zihlukumeza futhi zikhula ngokushesha.
Kuze kube ngo-1998, lapho uHerceptin evunyiwe, izifo eziphefumulayo ezingu-HER2 zinesifo esibi kakhulu, ikakhulukazi kulabo ababenesifo se-estrogen ne-progesterone receptor negative.
Kusukela ngaleso sikhathi ezinye izidakamizwa ezihlosiwe zakhiwe ezikhomba i-HER2, zishiya izinketho ngisho nalapho umuthi owodwa, noma kabili, uhluleka.
Izinguquko Zesimo Semvume
Abantu abaningi bayamangala lapho bezwa ukuthi isimo sokuthola umdlavuza wabo sashintsha ngemuva kokuba siphinde siphenduke. Uma ngabe unesifo se- estrogen se-receptor esihle uma uthola ukuthi unesifo somdlavuza webele wesisu ekuqaleni, ukuphindaphinda kungase kube nesitholi se-estrogen (noma ngokuphambene nalokho).
Ngokufanayo, uma unesifo se-HER2 / neu esingaphambi kwalokho, kungase kube nombi manje futhi ngokuphambene nalokho.
Yingakho isimo se-biopsy nesiphinde sibheke isimo se-receptor kubaluleke kakhulu uma unokuphindaphinda okude kwesifo sakho.
Ukuphathwa Okujwayelekile
Ukuphathwa ngokujwayelekile komdlavuza wesifuba we-metastatic ngokuvamile kubamangaza kulabo abaye baphinde baphindele emuva ngemuva kokuqala umdlavuza webele esikhathini esedlule. Njengoba isifo somdlavuza webele sesasencane, ukwelashwa ngokuvamile kuvutha. Inhloso yokwelashwa okunonya nokuhlinzwa, i-chemotherapy, ukwelashwa okuhlosiwe, kanye / noma imisebe ukuvimbela ukuphindaphinda uma kunokwenzeka.
Ngesiteji sesine umdlavuza webele, indlela yokwelapha ihluke kakhulu, futhi abantu abaningi bayazibuza ukuthi kungani le ndlela engeyona intukuthelo (futhi uzizwa ukhathazekile ngenxa yalokhu). Umgomo onomdlavuza webele we-metastatic ngokuvamile usebenzise imithi encane yokwelashwa okudingekayo ukulawula lesi sifo. Ngokuyinhloko, ukwelashwa okunonya kakhulu kwesigaba 4 somdlavuza webele akusizi ngcono ukusinda kodwa kwandisa imiphumela emibi. Lokho kusho ukuthi uhlobo olulodwa olulodwa lwezokwelapha ngesikhathi esisetshenzisiwe (uma linciphisa ukukhula komdlavuza) kunezindlela eziningana ezihlanganisiwe njengezifo zesifo sokuqala.
Izinketho zokwelapha
Ukwelashwa kokuqala komdlavuza womdlavuza we-metastatic kuxhomeke kakhulu esimweni se-receptor, futhi uma sekuphindaphindiwe, isimo sakho se-estrogen nesiphakamiso se-progesterone nesimo se-HER2 / neu kufanele sihlolwe (njengoba kushiwo ngenhla, lokhu kungashintsha.)
Uma uketshezi kwakho kokubili isrogen receptor positive futhi HER2 ukwelashwa okuqala, kungase kuhlanganise ukwelashwa hormone , a therapy HER2 okuhlosiwe, noma kokubili. Lesi sinqumo sizoxhomeka emithini oye waphathwa ngaphambi kokuphindaphinda kwakho (uma umdlavuza wakho ukuphindaphinda kude kunesifo esiyisiteji 4 ngesikhathi sokuxilongwa.) I- Chemotherapy ingasetshenziswa futhi izinyanga ezine kuya kweziyisithupha .
Uma ungazange uphathwe ngaphambilini ngesidakamizwa esihlosiwe se-HER2, ukwelashwa kuvame ukuqala nge- Herceptin (trastuzumab) noma i-Perjeta (pertuzumab). Kulabo abaye baphathwa nge-Herceptin ngaphambili, omunye umuthi ohlosiwe we-HER2 ungasetshenziswa, njengePerjeta (pertuzumab). Ngisho nabantu abaye baphuthuka kwezidakamizwa ezimbili ezidlule ze-HER2, ukwelashwa nge-trastuzumab emtansine (TDM1) kwathuthukisa ukusinda okungaphezu kokukhethwa kwe-oncologist kwezinye izimo ezikhona (kufaka phakathi izidakamizwa eziningana zamakhemikhali) esifundweni esisodwa.
Uma umdlavuza uye waqhubeka ku-Herceptin noma ezinyangeni ezingu-12 zokumisa lesi sidakamizwa, i-T-DM1 (i-trastuzumab emtansine) iyindlela ekhethwa ngayo emgqeni wesibili.
Izinketho zomugqa wesithathu zizohlukahluka kuye ngokuthi ukwelashwa kwangaphambi. Kulabo abangazange baphathwe nge-T-DM1, lokhu kuyindlela. I-Perjeta ingase isetshenziselwe nalabo abangazange bayithole ngokuhambisana no-Herceptin. Kulabo abaye baphathwa nge-Perjeta no-T-DM1 kanti namanje baqhubekela phambili, izinketho zihlanganisa inhlanganisela ye-Xeloda (capecitabine) no-Tykerb (lapatinib), ukwelashwa kwama-hormonal kulabo abane-tumoror positive tumor, nezinye izinhlobo ze-chemotherapy ezihambisana ne-HER2 izidakamizwa ezihlosiwe.
Ukwelashwa okuqondile kwe-Metastasis
Ukwelapha okujwayelekile ngamathambo (isakazwa) somdlavuza webele kunoma yisiphi isayithi kuvame ukuphathwa ngezidakamizwa ze-hormonal, ama-HER2 ama-targeted therapy, noma i-chemotherapy. Lokhu kungadideka kwabanye abantu. Kungani amangqamuzana omdlavuza emaphashini, isibonelo, angaphathwa ngemithi yokwelapha?
Kubalulekile ukuqaphela ukuthi uma umdlavuza webele usakazeka kwezinye izitho, ezifana namathambo, ubuchopho, isibindi, namaphaphu, amangqamuzana omdlavuza wesifuba webelevuza asakazeka kulawo malungu.
Ukwelashwa okungukuthi "okuphathelene nesifo se-metastasis" kungasetshenziswa futhi. Lezi zindlela zokwelashwa eziqondisa ngokuqondile indawo ye-metastases, njenge-metastases yamathambo. I-liver and brain metastases zivame kakhulu kubantu besifazane abanomdlavuza webele we-HER2 / neu omuhle kunalabo abangenayo i-HER2 negative.
I-Bone Metastases
I-metastases ye-Bone nomdlavuza wesifuba ivame kakhulu, etholakala emazweni angaba ngu-70 amaphesenti abantu abanezifo ze-metastatic. Ngaphezu kokukhethwa kwendlela yokwelapha ekubhekaneni nomdlavuza wesifu ngokwayo, ukwelashwa okuqondene nemetastasis for bone metastases kunganciphisa ubuhlungu futhi kuthuthukise nokuphila, futhi metastases amathambo abe ukubikezela kangcono kunamanye amasayithi izifo metastatic. Okuqaphele ukuthi ukucindezeleka kwamathambo ayisifo samathambo, njengama-fractures, okubaluleke kakhulu njengoba kuningi lwezokwelapha umdlavuza webele kungaholela ekulahlekelweni kwethambo.
Izinketho zihlanganisa:
- Ama-agent modifying bone kuhlanganise nama-bisphosphonates, njenge-Zometa (zoledronic acid) anganciphisa izinkinga ezifana nokuhlukana futhi abe nomthelela oqinile we-anti-tumor. I-Xgeva (denosumab) yinye inketho ebonakala sengathi inezindawo zokulwa nomdlavuza.
- Ukwelashwa kwezidakamizwa kunganciphisa ubuhlungu futhi kunganciphisa ingozi
- Ama-Radiopharmaceuticals angasiza kulabo abanamathemitha amaningi amathambo, njengoba izinhlayiya zemisebe zithinteka kwenye ikhemikhali zijojelwa egazini bese zithathwa amathambo kuwo wonke umzimba.
Ama-Metastase we-Liver
Izifo zesifo se-fover ezivela emdlalweni webele wesikhumba iyisayithi yesibili ejwayelekile kakhulu ye-metastases futhi ivele kaningi kaningi phakathi kwabantu abane-HER2 emihle kakhulu. Ukwelashwa kwezidakamizwa kuvame ukusetshenziswa ngaphezu kwezinye izifo zomdlavuza. Ezinye izindlela zokwelapha ezifana nezindlela zokwenza izinto zingasetshenziswa.
Uma kunamasayithi ambalwa kuphela we-metastasis (i-oligometastases) ukususwa okuhlinzekwayo noma i- radiotherapy yomzimba wesimo somzimba kungenza ngcono ukusinda. Izidakamizwa zesibindi zivame ukubangela ascites (ukuvuvukala kwesisu) ne- paracentesis (ukususa umthamo esiswini ngesidingo eside eside) kuyadingeka ukunciphisa ukungakhululeki. Ukunambitheka kubuye kuvame kakhulu ne-metastase yesibindi kanye nokuphathwa kokwazisa kungathuthukisa izinga lokuphila.
I-Brain Metastases
Ngenkathi izidakamizwa ezivela emdlalweni webele webele zivame ukuphathwa njengengxenye yokwelashwa komdlavuza webele we-metastatic, ama-metastase ebuchosheni angenza inselele eyingqayizivele. Isivinini segazi-ingqondo iqoqo lama-capillari aqinile anamandla avimbela imithi eminingi, kuhlanganise nemithi eminingi ye-chemotherapy, ekufinyeleleni ebuchosheni. Ngokujabulisayo, ezinye izidakamizwa ziyakwazi ukuwela i-barr
Ukubuyekezwa kuka-2017 kwezincwadi ezitholakala ukuthi uHerceptin (trastuzumab) ngokucacile kuthuthukisa ukusinda kulabo abanomdlavuza webele we-HER2 abane-metastases yobuchopho. I-Trastuzumab emtansine (T-DM1) ne-Perjeta (pertuzumab) nayo iyathembisa. Ngokuphambene nalokho, i-Tykerb (lapatinib) ibonakala ingenalutho oluncane emasethini asebuchopho (njengezifundo zango-2017) futhi inephrofayli ephezulu yobuthi. Uma i-lapatinib ihlanganiswe ne-chemotherapy, noma kunjalo, izinga lokuphendula lihle.
Ama-Metastases e-Lung
Ama-metastases angamafutha emdlavuza webele abhekwe ngokuyinhloko ngezinyathelo ezijwayelekile zokwelapha umdlavuza webele, njengezokwelapha ze-hormonal, izidakamizwa ezihlosiwe ze-HER2, kanye ne-chemotherapy, kunanoma iyiphi imithi ethile. Uma kutholakala ama-metastase ambalwa nje kuphela, ukuphatha lokhu ngokuhlinzwa noma i-SBRT kungacatshangwa, kodwa izifundo azikakabonakali izinga lokusinda kulokhu kusetshenzwa.
Amanye ama-metastase asekude
Umdlavuza wesibeletho ungasakazeka kwezinye izindawo eziningi ezikude zomzimba, kufaka phakathi isikhumba, umsila, izicubu ezinamafutha, umnkantsha wesifuba nezinye izindawo. Esikhathini esiningi isikhathi lezi zimiso ezikude ziphathwa ngokuphathwa kokwelapha komdlavuza we-HER2 omuhle, kodwa uma kutholakala imithi ehlukanisiwe, izinketho ezifana nokuhlinzwa noma imithi yokwelashwa zingacatshangelwa.
Ukubhekana
Ukubhekana nomdlavuza webele we-metastatic kuyinselele kungakhathaliseki uhlobo noma iphrofayela ye-molecule. Uma uye waqala ukwelashwa izifo zesandulela ngculaza futhi umdlavuza wakho uphindaphindiwe, indlela ejwayelekile yomdlavuza we-metastatic ingase idideke ekuqaleni, njengoba umgomo uvame ukusebenzisa ukwelashwa okuncane ngangokunokwenzeka ukulawula lesi sifo, kunokuba ukwelashwa okufutheka wena cishe wayenomdlavuza webele wekusasa ekuqaleni.
Izwi elithi "kuthatha idolobhana" alizange lifanele nakakhulu kunesimo somdlavuza ophakeme. Kunamaqembu amaningi okusekela kanye nemiphakathi yomdlavuza webele e-intanethi etholakalayo, kodwa iningi labantu abanomdlavuza webele we-metastatic ikhetha amaqembu afaka phakathi ikakhulukazi labo abanesifo somdlavuza wesifuba sesigaba 4 kunabo ababandakanya abantu abanesifo somdlavuza webele.
Uma ngabe othandekayo wakho ohlala nomdlavuza webele wesine 4, thatha isikhashana ukuzijwayeza ngezinto ongazisho kumuntu onomdlavuza webele we-metastatic .
Izwi elivela
Umdlavuza webele we-Metastatic HER2 omuhle ungaphathwa ngezokwelapha ze-hormonal (kulabo abane-estrogen receptor positive) kanye ne-chemotherapy, kodwa ukhetho lokusebenzisa imithi yokwelapha e-HER2 lanezela esinye isimo esimweni salokhu kulungiselelwa.
I-HER2 i-tumors emihle ingase isakaze ebuchosheni nasebindi kunama-tumor a-HER2 angalungile. Uma lezi zithintekayo zenzeka, kokubili ukwelashwa okujwayelekile kanye nokwelapha okuqondile kungacatshangwa. Ngenhlanhla, futhi ngokungafani nemithi eminingi, i-Herceptin futhi mhlawumbe i-pertuzumab ibonakala sengathi iwela ukuvinjelwa kwengqondo yegazi ukuze ilawule ngokuphumelelayo lezi zidakamizwa.
> Imithombo:
> Dieras, V., Miles, D., Verma, S. et al. I-Trastuzumab Emtansine Versus Capecitabine Plus Lapatinib Ezilwelweni Eziphethwe Ngaphambi Kokubelethwa I-HER2-Positive Cancer Advanced Breast Cancer (EMILIA): Ukuhlaziya Okuchazayo Kwezinguquko Zokugcina Eziqhubekayo Ukusuka Kwimiqulu Engahleliwe, Evuliwe, Isigaba Sesi-3. I-Lancet Oncology . 2017. 18 (6): 732-742.
> Krop, I., Kim, S., Martin, A. et al. I-Trastuzumab Emtansine Ne-Treatment of Choice Weziguli Ezigulini Eziphethwe Ngaphambi Kokuthi Zithathwe I-HER2-Positive Canast Metastatic Breast Cancer (TH3RESA): Imiphumela Yokugcina YokuPhepha Okuvela Emkhakheni Wokungena Obala Ongajwayelekile. I-Lancet Oncology . 2017. 18 (6): 743-754.
> Laakmann, E., Muller, V., Schmidt, M. et al. Izinketho zokwelashwa zesistimu ze-HER2-Positive Cancer Breast Patients abane-Brain Metastase Beyond Trastuzumab: Ukubuyekezwa Kwezincwadi. Ukunakekelwa kwebele . 2017. 12 (3): 168-171.