Yini Okufanele Uyazi Nge-Immuotherapy Drug Opdivo?
Uma wena noma othandekayo uye waqokwa umuthi we-immunotherapy Opdivo (nivolumab), yini okudingeka ukwazi? Lo muthi usebenza kanjani? Yini i-cancers engasabela kulo muthi? Ngabe u-Opdivo usebenza kaningi kangakanani nokuthi yiziphi izimpendulo abantu ababenakho? Okokugcina, yiziphi imiphumela emibi ezivamile?
I-Opdivo (i-Nivolumab) -Ukucacisa
I-Opdivo (nivolumab) ibhekwa njengehlobo le-immunotherapy, umuthi wokuqala kulezi zigaba ezivunyelwe umdlavuza wamaphaphu (ngo-2015) futhi manje uvunyelwe ezinye izinhlobo zamanyevuza.
I-Immunotherapy iyindlela entsha yokwelashwa komdlavuza osebenzisa amasosha omzimba noma izimiso zokuphendula kwamagciwane omzimba ukulwa nomdlavuza.
Kunezinhlobo eziningi ezahlukene ze-immunotherapy. I-Opdivo ibhekwa njenge "checkpoint inhibitor" (esizoxoxa ngayo ngezansi ngezansi).
I-Opdivo (nivolumab) ibe yinto ejabulisayo yokuphatha umdlavuza eminyakeni embalwa eyedlule, futhi injabulo enkulu akuyona nje i-hype. Abanye abantu baye baba nezimpendulo kumuthi okwakungacabangi ngisho neminyaka emihlanu eyedlule. Ngeshwa, i-Opdivo ayisebenzi kuwo wonke umuntu, kodwa uma iphumelela ingabangela impendulo ehlala njalo (echazwe ngezansi). Imiphumela emibi iyavame, kepha ngokujwayelekile inamandla kunemiphumela emibi etholakalayo nemikhakha eminingi ye-chemotherapy.
Ingabe i-Opdivo (i-Nivolumab) uhlobo lwe-Chemotherapy?
Abantu abaningi badidekile mayelana nokuthi i-chemotherapy ne-immunotherapy zihlobene kanjani. Ingabe i-immunotherapy, kanye ne-nivolumab ngokuqondile, uhlobo lwe-chemotherapy?
Ngezinye izikhathi, i-chemotherapy isetshenziselwa ukuchaza noma yiluphi uhlobo lwezidakamizwa ezinikezwe ukulwa nomdlavuza. Kulokhu, izidakamizwa ze-immunotherapy ngezinye izikhathi zingabizwa ngokuthi yi-chemotherapy. Kodwa kukhona ukungezwani okubalulekile kanye. Igama elithi "chemotherapy" ngokuvamile libhekisela ekusetshenzisweni kwezidakamizwa ezithinta ukuhlukaniswa kwamaseli azo zonke amaseli akhula ngokushesha.
Imiphumela emibi eyaziwayo ye-chemotherapy ivela ngenxa yokuthi, ngaphezu kokulwa namangqamuzana omdlavuza, lezi zidakamizwa nazo zithinta amaseli avamile ahlukanisa ngokushesha. Lesi yisenzo se-chemotherapy emangqamuzaneni aphilile, afana nalawo asemnothweni wamathambo (okubangela inani eliphansi elimhlophe nokuningi), izinwele zezinwele (okuholela ekulahlekelweni kwezinwele), kanye ne-digestive tract (okuholela ekusikeni kwesisindo) okuholela esivumelwaneni okuqhamuka uma udla imishanguzo.
Ngokuphambene nalokho, izidakamizwa ze-immunotherapy zenzelwe ngokuqondile ukushintsha amasosha omzimba noma ukusebenzisa izinto ezenziwe yisistimu yomzimba wokulwa nomdlavuza. Ngenxa yalesi sizathu, izidakamizwa ze-immunotherapy ziba nemiphumela emibi kakhulu kunezidakamizwa zamakhemikhali.
I-Opdivo (i-Nivolumab) isebenza kanjani?
I-Opdivo (nivolumab) i-immunotherapy izidakamizwa ezibhekwa njenge-inhibitor yokuhlola.
I-inhibitors yokuhlola ilula ukuyiqonda uma ucabanga ngesimiso sakho somzimba sokuzivikela njengemoto, nge-checkpoint inhibitors kuba yi-brakes emotweni. Amasosha ethu omzimba aklanyelwe ukuhlasela amabhaktheriya, amagciwane, ngisho namangqamuzana omdlavuza emzimbeni wethu. Amasosha omzimba wethu kakade ayazi ukuthi angalwa kanjani nomdlavuza. Njengoba nje umzimba wethu ulwa nama-bacterium kanye nama-virus endaweni yethu, yenzelwe ukulwa namaseli angaphandle njengama-cell cell.
Nokho, isimiso somzimba sokuzivikela sisuke sibheke futhi silinganisa. Lezi zindawo zokuhlola zisebenza ukulawula isimiso somzimba sokuvikela omzimba ngakho-ke asikho ngaphansi kwesimo noma ngaphezulu. Isivikelo somzimba sokuzivikela ngokweqile, empeleni, inkinga ngezifo ezizimele njenge-arthritis ye-rheumatoid ne-lupus.
"Amabhuleki" emoto ayinciphisa le nqubo amaprotheni abizwa ngokuthi i-checkpoint inhibitors. Lezi ziprotheyini zokuhlola ziyanciphisa ukuphendula kwamagciwane ukuze kungasebenzi. Elinye lala maprotheni yi-PD-L1. I-PD-L1 ibopha kuma-receptors e-PD-1 emaT cell (amangqamuzana omzimba omzimba asebenza kakhulu ekuhlaseleni umdlavuza), etshela ukuba athule.
Amangqamuzana omdlavuza anengqondo. Amanye amangqamuzana omdlavuza athole indlela yokukhiqiza eziningi ze-PD-L1. Uma lokhu kubophezela kuma-receptor we-PD-1 kumaT cell , ivumela amangqamuzana omdlavuza ukuba akhule angahlosiwe, cishe afane nokubeka imaski kumaseli omdlavuza ukuze isimiso somzimba sokuzivikela singaboni futhi siwahlasele.
I-Opdivo isebenza ngokubophezela nokuvimbela ukusebenza kwe-PD-1 nge-PD-L1, ngokuyisisekelo ukukhulula ama-brake emotweni (isimiso somzimba) ukuze ikwazi ukulwa nomdlavuza. Konke, i-Opdivo isebenza ngokuthatha isisindo samaseli omdlavuza ukuze bangakwazi ukufihla esimisweni somzimba sokuzivikela, futhi bagcine bebhujiswa yimpendulo yomzimba wethu.
Ngabe futhi kanjani i-Opdivo (i-Nivolumab isebenzise)?
Ngokuvamile i-Opdivo isetshenziselwa isifo se-IV (esingasebenzi), amakhemikhali angakwazi ukuphathwa ngokuhlinzwa futhi avame ukusabalalisa kwezinye izingxenye zomzimba (okubizwa ngokuthi imetastatic).
I-Opdivo inikezwa umjovo wokugcoba phezu kwesikhathi sokungeniswa cishe cishe ihora. Kuvame ukunikezwa njalo emavikini amabili.
Kusho ukuthini "Ukuphendula Okuhlalayo"?
Ngaphambi kokuxoxa ngezifundo ze-nivolumab, kuyasiza ukuchaza igama elisetshenziselwa njalo lapho kuchaza impendulo kwimithi ye-immunotherapy: igama elithi "impendulo ehlala njalo."
"Impendulo ehlala njalo" ibhekisela ekuphenduleni okuhlala njalo kwesiguli kumuthi. Asikho isikhathi esithile, kodwa "ukuhlala isikhathi eside" ngokuvamile kusho okungenani okungenani unyaka owodwa futhi ngezinye izikhathi isikhathi eside.
Uma ubona izifundo zikhuluma ngokuthi "impendulo ehlala njalo," lokhu kuvame ukuhlukana nohlobo oluthile lwempendulo olulindeleke kusuka kumakhemikhali. Ngesisu se-IV esiqinile, i-chemotherapy ingaba ngempumelelo kepha isisu sikhombisa ukuhlala singamelana ne-chemotherapy ngemuva kwesikhathi esifushane (ngokuvamile esichazwe ezinyangeni). Ngamayeza ahlosiwe, isikhathi sokuphendula sivame ukuhlala isikhathi eside, kodwa ukuvama ngokuvamile kuvame esikhathini sonyaka ngokuya ngesidakamizwa esithile, uhlobo lomdlavuza, nokunye okuningi.
Ukusabela okuqinile akusho "ukwelashwa" kodwa kuchaza impendulo ukuthi ngezindlela eziningi yiyona nto esiseduze kakhulu esinayo ngalesi sikhathi-uma isebenza.
Ngokungafani ne-chemotherapy kanye nokwelapha okuhlosiwe-okusebenza kuphela uma nje umuntu ethatha izidakamizwa-kubantu abathile abathathe i-Opdivo, kubonakala sengathi ingaqhubeka isebenza kahle. Ngomdlavuza wamangqamuzana ongewona omncane, abanye abantu baye baba nezimpendulo eziqinile ngisho nangemva kokuyeka ukwelapha.
Yiziphi Izidakamizwa Ongaqondiswa Ngama-Opdivo?
I-Opdivo (nivolumab) ivunyelwe ukwelashwa kwabantu abane-lung adenocarcinoma (uhlobo lwe-non-small cell cell lung cancer), squamous cell carcinoma yamaphaphu (olunye uhlobo lomdlavuza wesifo samangqamuzana omncane), i-melanoma yemetastoma, isifo se-Hodgkin , umdlavuza wekhanda nentamo, i-Merkel cell carcinoma, ne-renal cell carcinoma (umdlavuza wezinso).
Yiziphi Izifundo Nezivivinyo Zomtholampilo Ezikusitshela Nge-Opdivo?
Ucwaningo luye lwabheka umphumela ka-Opdivo kuma-khansa ethize kunokuba ukhethe kansela:
- Umdlavuza we-cell wamaphaphu ongewona omncane - Ukubuyekezwa kuka-2017 kwezifundo eziyisishiyagalolunye ezibandakanya abantu abanezigaba ze-III nesigaba se-IV ezingekho emincane umdlavuza wamaphaphu wamaphaphu wathola ukuthi i-nivolumab (ne-atezolitumab ne-pembrolizumab) ithuthukise ukusinda okungaphezu kwe-chemotherapy uma kusetshenziswe umugqa wesibili (kanye ne-pembrolizumab umugqa wokuqala ku-PDL-1 izicubu ezinhle). Ukwengeza, abantu babhekana nemiphumela emincane emibikweni ye-check inhibitors kunokwamakhemikhali. I-Opdivo ingasetshenziselwa i- lung adenocarcinoma noma i- squamous cell carcinoma yamaphaphu . I-Opdivo kufanele isetshenziswe kuphela kulabo bantu abangenalo ukuguqulwa kwezakhi zofuzo noma abangazange baphendule ekwelashweni okuhlosiwe.
- I-melanoma ye-Metastatic - I-Opdivo manje isinconywa umugqa wokuqala (njengokwelashwa kokuqala) kwe- melanoma yemetastra .
- I-Classical Hodgkin lymphoma - I-Opdivo ingasetshenziselwa abantu abane- classic Hodgkin lymphoma abangathuthuki emva kokufakelwa kwe-stem cell kanye nokusetshenziswa kokwelashwa okuhlosiwe.
- Isikhwama sekhanda lesisindo nesifo somdlavuza (imetastatic noma ephindaphindiwe).
- I-Renal cell carcinoma - I-Opdivo ivunyelwe umugqa wesibili (emva kokulashwa kwe-anti-angiogenesis inhibitor) ye- renal cell carcinoma ehamba phambili, uhlobo oluvame kakhulu lomdlavuza wezinso.
- I-urothelial carcinoma - I-Opdivo ivunyelwe abantu abanalo hlobo lomdlavuza wesinyevu abangathuthuki ekhemotherapy.
- I-Merkel cell carcinoma
Ngabe I-Immunotherapy Isebenza Kanjani Kakhulu?
Ucwaningo olwenziwe nge-Opdivo kanye nezinye izidakamizwa ze-immunotherapy usemncane, kodwa ngomdlavuza wamaphaphu okungenani, kubonakala sengathi abantu abaye baphuza esikhathini esidlule banamathuba okuphendula izidakamizwa kunelabo abangazange baphuze. Lokhu kunengqondo uma ucabanga ngalendlela. Izicubu ezinamafutha kubantu ababhemayo banomthwalo "wokulayisha okuphezulu okuguquguqukayo." Ngamanye amazwi, amangqamuzana omdlavuza anomningi wezinguquko ezitholakala kumangqamuzana omdlavuza okwenzeka ngenqubo yeseli eba umdlavuza. (Lokhu akuhlobene nokuzalwa futhi lezi zinguquko azidluliswanga emndenini). Amaseli anezakhi eziningi ezishintshayo cishe avela engavamile (ezingaphansi kwamaseli avamile) esimisweni somzimba sokuzivikela, okwenza ukwelashwa okusebenzisa isimiso somzimba sokuzivikela noma izimiso zawo cishe ukuthi ziphumelele.
Imiphumela engase ibe khona ye-Opdivo (Nivolumab)
Njenganoma imuphi ukwelashwa komdlavuza, kukhona imiphumela ejwayelekile futhi engase ibe nemiphumela yokwelapha nge-Opdivo.
Imiphumela emibi evamile (leyo eyenzeka ngamaphesenti angu-10 noma ngaphezulu kwabantu) ihlanganisa:
- Ukukhwabanisa isikhumba
- I-itching (pruritis)
- Izinga eliphezulu le-potassium (i- hyperkalemia ) nezinga eliphansi le-sodium (hyponatremia)
- Izivivinyo zokusebenza zesibindi ezingavamile ezifana ne-ALT ne-alkaline phosphatase
- Isikhukhula
- Ukuphelelwa umoya
- Ukukhathala
- Ukubalwa kwesibalo segazi eliphansi
- Ubuhlungu be-muscle ikakhulukazi ngomdlavuza wamaphaphu
Imiphumela engavamile engavamile kepha engathà sina ingabandakanya:
- Cishe noma yini ephela ngesixhumi "itis" - okusho ukuvuvukala; ezifana ne-colitis, i-pneumonitis, i-hepatitis, i-nephritis, i-pancreatitis, nokuningi
- Izimo zamehlo ezifana ne- uveitis namahlo owomile
- Izinkinga ze-endocrine ezibandakanya igulane le-thyroid, izigulane eziyingozi, ne-pituitary gland
Izixwayiso Ngesikhathi ku-Opdivo (Nivolumab)
Abantu abasebenzisa i-Opdivo kufanele bahlolwe ngezibonakaliso zokuvuvukala, futhi uma bekhona, lesi sidakamizwa kungadingeka ukuba sibanjwe noma simiswe. Lezi zihlanganisa izimo ezifana ne-pneumonitis, i-encephalitis, i-nephritis, ne-colitis. Isidakamizwa singabangela uhlobo lwesifo sikashukela sohlobo, futhi ushukela wegazi kufanele lihlolwe.
Ukungakwazi ukukwazi ukungena ngokweqile noma ukukhathala okukhulu kungenzeka, futhi abantu kufanele baqaphele ukuthi kungenzeka yini lesi simo kanye nezimpawu ezingenzeka.
Ukuhlukunyezwa okuhlobene nomzimba okunjengeStevens -Johnson syndrome kungase kwenzeke, futhi kufanele ukhulume nodokotela wakho nganoma yisiphi isinqamuleli osikhulayo.
Kodwa-ke, ukuphendula okubi kakhulu okudinga ukuvimbela lesi sidakamizwa kungavamile, okwenzeka ngaphansi kwamaphesenti angu-1 esikhathi. Qiniseka ukuthi ukhuluma ne-oncologist yakho ngezinye izimpawu ezingase zibe khona kanye nalapho kufanele ubize.
Izwi elivela
I-Opdivo (nivolumab) iyisidakamizwa esisha kakhulu esibhekwa njengohlobo lwe-immunotherapy. Kulabo abasebenzisa lezi zidakamizwa ngempumelelo, ngezinye izikhathi siye sabona izimpendulo zezinambuzane ezithuthukile eziphezulu ezingacabangi eminyakeni embalwa edlule. Lokho kusho ukuthi akusebenzi kuwo wonke umuntu, futhi asinayo indlela enhle yokwazi ukuthi ngubani ozophendula kahle ukwelashwa.
Imiphumela emibi iyavame, ikakhulukazi izimpawu ezifana nokushona, ukuchwabanisa nokusebenza komzimba we-thyroid. Ukuphendula okubi kakhulu kungase kwenzeke ngezinye izikhathi. Kodwa-ke, ngokuvamile, i-Opdivo ibekezeleleke kangcono kunekhambi lezokwelapha.
Kuye kwaba nenjabulo enkulu emphakathini wezokwelapha ngezizathu ezimbalwa. I-Opdivo ingasetshenziselwa ukwelapha izicubu eziqinile kakhulu. Ngaphezu kwalokho, ingaba ngempumelelo ezinhlobonhlobo ezahlukene zomdlavuza. Kungenzeka ukuthi ukusetshenziswa okusha kwezidakamizwa kuzovunywa esikhathini esizayo esiseduze, futhi izinhlolo eziningi zemitholampilo ziyaqhubeka nokuhlola umphumela we-Opdivo ezinhlobonhlobo zemikhaza yomdlavuza, kokubili yedwa, futhi kuhlangene nezinye izidakamizwa ze-immunotherapy.
> Imithombo:
> Abdel-Rahman, O., > Oweira >, H., Petrausch, U. et al. Izidakamizwa ezinama-Ocular ezihlobene nomzimba ezikhungethwe iziguli ezinomzimba oqinile ezibhekene nezifo ezivimbela ukuzivikela nge-Immune Checkpoint Inhibitors: Ukubuyekeza Okuhlelekile. Ukubuyekezwa kobuchwepheshe be-Antiticancer Therapy . 2017. 17 (4): 387-394.
> Ellis, P., Vella, E., no-Y. Ung. I-Immune Checkpoint Inhibitors yeziguli ezine-Advanced NonSmall-Cell Cell Lung Cancer: Ukubuyekeza Okuhlelekile. Cancer Cancer Clinic . 2017 Feb 16. (Epub ngaphambi kokuphrinta).
> Iposi>> , M., noJ. J. Wolchok. I-Toxicities Ehambisana Ne-Checkpoint Inhibitor Immunotherapy. UpToDate . Kubuyekezwe 05/31/17.
> Wang, X., Bao, Z., Zhang, X. et al. Ukusebenza nokuphepha kwe-PD-1 / PD-L1 Inhibitors ekwelapheni kwezingqimba eziqinile: Ukubuyekezwa okuhlelekile kanye nokuhlaziywa kwe-Meta-Analysis. I-Oncotarget . 2017 Meyi 31. (i-Epub ngaphambi kokuphrinta).