Imithi yokwelapha i-hormonal ngokuvamile iyisinyathelo sokuqala sokuphatha umdlavuza webele we-metastatic, okungenani kulabo abanezinambuzane ezitholakala nge- estrogen receptor . Ukuzikhethela kwemithi kuzoxhomekeka ukuthi ngabe ungumama we-premenopausal noma i-postmenopausal, kanye nokuthi umdlavuza wakho uphindaphindeka ngenkathi usebenzisa enye yale mithi. (Uma umdlavuza wakho uphindaphinde ngenkathi uthatha enye yalezi zidakamizwa ucatshangwa ukuthi umdlavuza wakho ungamelana nomuthi.)
Umsebenzi we-Estrogen
I-estrogen isebenza njengamafutha, ibopha ama-estrogen receptors phezu kwamangqamuzana omdlavuza futhi ikhuthaza ukukhula nokwanda komdlavuza. Lesi senzo se-estrogen kumaseli omdlavuza singanciphisa ngezindlela ezimbalwa ezahlukene; ngokunciphisa inani le-estrogen emzimbeni, noma ngokuvimbela ama-estrogen receptors ngakho-ke isrogen ayikwazi ukukhuthaza ukukhula kwamaseli. Ngokungafani nezidakamizwa ze-chemotherapy ezibulala ngokuqondile amangqamuzana omdlavuza ngokuqondile (ngokulula), ukwelashwa kwama-hormonal kusebenza "ngokusobala" kwamangqamuzana omdlavuza we-estrogen.
Ngaphambi kokumisa esikhathini, ama-ovari akho angabakhiqizi abakhulu be-estrogen. Ngemuva kokumisa esikhathini, umthombo omkhulu we-estrogen emzimbeni uvela ekuguqulweni kwe-androgens kuya ku-estrogen. Lokhu kuguqulwa kuhloswe yi-enzyme aromatase etholakalayo kumafutha ne-muscle. I-Aromatase inhibitors imithi evimbela i-aromatase ukuze lokhu kuguqulwa kwe-androgens ku-estrogens kungeke kwenzeke, ukwehlisa ngokuphumelelayo amazinga e-estrogen.
Imithi yokwelashwa yama-hormonal ayiphumelelanga kulabo abane-receptor receptor kanye ne-progesterone receptor izifo ezimbi.
Kubuye kubalulekile ukuqaphela ukuthi ezinye izicubu zesisu se-receroor receptor nazo zingu- HER 2 positive . Emathunjini afanelekayo kokubili lawa ma-receptors, ukwelapha okulwa ne-estrogen kungasetshenziswa noma ngaphandle kwezidakamizwa ezenza ku-HER 2.
I-Premenopausal Therapy
Uma ngabe u-premenopausal, ama-ovaries akho asekhona umthombo omkhulu kakhulu we-estrogen, ngakho-ke uphethiloli, umdlavuza webele. Umgomo wokwelashwa kwabesifazane besandulela-ndlela kunganciphisa ikhono le-estrogen ukukhuthaza ukwanda komdlavuza wakho ngokunciphisa inani le-estrogen (ukwelapha ukucindezelwa kwe-ovarian) nokuphazamisa ikhono lika-estrogen ukubopha izidakamizwa ze-estrogen emdlalweni webele amaseli.
Imithi efana ne- tamoxifen ibizwa ngokuthi yi-SERMS-ekhetha i-esrogen receptor agents, futhi isebenza ngokubopha amangqamuzana omdlavuza ukuze i-estrogen ikhona emzimbeni ayikwazi ukubopha esitokisini futhi isho ukuthi iseli likhule.
Kucatshangwa ukuthi i-aromatase inhibitors ingase iphumelele kakhulu kune-tamoxifen, kodwa lezi azikwazi ukusetshenziselwa abesifazane base-premenopausal ngenxa yomsebenzi wama-ovari. Ukuze unciphise i-estrogen ekhiqizwa ama-ovarie, futhi ikuvumele ukuthi usebenzise i-inhibitor ye-aromatase, i-oncologist yakho ingancoma ukwelashwa kokukhipha i-ovarian.
Ukunciphisa i-ovari kungenziwa yi:
- Ukusebenzisa imithi ye-Zoladex (i-goserelin) - Lena imithi enikezwe ngaphansi komzimba futhi igxilise ukukhiqizwa kwe-estrogen ngomzimba, futhi iyaziwa ngokuthi i-gonadotropic ekhulula umphikisi we-hormone. Ama-ovari akhiqiza i-estrogen ekuphenduleni i-hormone eyaziwa ngokuthi i-gonadotropin evuselela i-hormone eyimfihlo ye-pituitary gland. I-Zoladex inqanda ikhono le-gonadotropin evuselela i-hormone ukukhuthaza ama-ovaries.
- I-Oophorectomy - Ngaphansi kokuvamile , abanye besifazane bakhetha ukuba basuswe ama-ovari (ngokusebenzisa inqubo ebizwa ngokuthi i-oophorectomy) kunokusebenzisa i-Zoladex. Lokhu kuhlinzwa kwenziwa kaningi kakhulu ngenxa yezingozi ezinkulu eziphathelene nokuhlinzwa, kodwa abanye besifazane bangase bakhethe le ndlela, ikakhulukazi labo abanesifo somdlavuza we-ovarian kanye nomdlavuza webele.
I-oophorectomy ingenziwa kaningi njengendlela ye-laparoscopic futhi ivame ukuhlinzwa okufanayo ngosuku. Ku-oophorectomy ye-laparoscopic, kwenziwa ukumbalwa okuncane okusesiswini esiswini kanti ama-ovari asuswa ngosizo lwezinsimbi ezikhethekile.
Ukulandela ukwelashwa kwe-ovarian ukwelashwa, abesifazane base-premenopausal bangabe beselashwa ngemithi njengabesifazane be-postmenopausal abakhulunywe ngezansi noma nge-tamoxifen.
I-Postmenopausal Therapy
Ngemuva kokumisa esikhathini, umthombo omkhulu we-estrogen emzimbeni uvela ekuguqulweni komzimba we-androgen kuya ku-estrogen. Umdlavuza wesifuba we-Postmenopausal ungaphathwa nge-tamoxifen (ukuvimbela le-estrogen engaguquguqukiyo ngokubopha ngamangqamuzana omdlavuza) kodwa isigaba semithi ebizwa ngokuthi i-aromatase inhibitors ibonakala iphumelela kakhulu ngemiphumela emibi embalwa.
I-aromatase inhibitors etholakalayo ihlanganisa:
- I-Arimidex (i-anastrozole)
- I-Femara (letrozole)
- I-Aromasin (i-exemestane)
I-Aromatase inhibitors ingasetshenziswa yedwa, noma ihlanganiswe nemithi yokwelapha i- chemotherapy . Isibonelo, inhlanganisela ye-Femara (letrozole) ne-Ibrance (palbociclib) ne-Aromasin (i-exemestane) ne-Afinitor (everolimus). Kukhona njalo ukulinganisela lapho ungeza omunye umuthi. Ngenkathi inhlanganisela ingase iphumelele ngokwengeziwe, kukhona nokwanda kwemiphumela emibi lapho kuhlanganiswa imithi engaphezu kweyodwa.
Kuwusizo ukuphawula futhi ukuthi umgomo wokwelapha uvame ukuhlukana nomdlavuza webele we-metastatic kunomdlavuza webele wesifuba. Njengoba isifo somdlavuza webele sesisencane, umgomo ukwelapha, futhi ifilosofi "ukukhipha izibhamu ezinkulu" ukuze uphulukise lesi sifo. Ifilosofi enomdlavuza wesifuba we-metastatic, ngokuphambene, ngokuvamile ukulawula ukukhula komdlavuza ngemithi encane yokwelashwa okungenzeka, ukugcina ezinye imithi isikhathi lapho imithi yokuqala ingasasebenzi.
Amanye amaHormonal Treatments
Ngaphezu kwe-tamoxifen ne-aromatase inhibitors, kuneminye imithi eminye ehlobene ne-hormone engase isetshenziselwe umdlavuza webele we-metastatic. Uma umdlavuza wesifuba uqhubeka ukwanda noma usakazeka emithini engenhla ngokuvamile kubhekwa ukuthi unamathele kule mithi. Umdlavuza wesifuba we-metastatic cishe uhlale unamathela kule mithi ngokuhamba kwesikhathi. Uma lokhu kwenzeka, izinketho zifaka:
- I-Faslodex (fulvestrant) -Ngokwebesifazane abakwa- postmenopausal abaqhubeka nomdlavuza wabo ku-tamoxifen noma i-aromatase inhibitor, ukhetho lusebenzisa imithi ye-Faslodex. I-Faslodex njengamanje imithi kuphela evunyelwe umdlavuza webele esifundeni esibizwa ngokuthi abahluleli be-estrogen receptor-selective selective.
Le mithi ibizwa ngokuthi "i-antiestrogen ehlanzekile" futhi ivimbela umphumela we-estrogen kumaseli omdlavuza wesifuba we-estrogen we-receptor-positive kodwa ngendlela ehlukile kune-tamoxifen (ingumphikisi we-estrogen.) I-Faslodex ingasetshenziswa yedwa noma ihlanganiswe Ibrance (palbociclib), imithi yokwelapha i-chemotherapy, futhi inikezwe njengesijova.
Imithi Eyasetshenziswa Ngaso sonke isikhathi
Kukhona nezinye izindlela zokwelashwa ezibizwa nge-hormone ezisetshenziswa njalo kepha ngezinye izikhathi zibhekwa njengezigaba ezintathu noma ukwelashwa kwe-4th line. Lokhu kufaka:
- I-Fareston (toremifene) - I-Fareston imithi efana ne-tamoxifen futhi ibuye ibhekwe njenge-agent yesimo se-receroor receptor ngezinye izikhathi ingabhekwa njengabesifazane be-postmenopausal abane-cancer e-receptor-positive yamabele, ikakhulukazi kwabesifazane abangenayo i-enzyme eguqula i-tamoxifen kwifomu layo esebenzayo umzimba.
- I-progestins - i-Megace (megestrol) iyindlela yokwenza i-progesterone eyesinye isikhathi isetshenziselwa abantu abanomdlavuza webele we-estrogen we-receptor-positive okuye kwaba ukumelana ne-tamoxifen. Yasetshenziswa kaningi esikhathini esidlule ngaphambi kokuba izidakamizwa ezintsha zitholakale.
- Ama-hormone e-sex steroid - Ama-hormone afana ne-estrogen ne-androgens awavamile ukusetshenziswa ngomdlavuza wesifuba we-metastatic, kodwa ngezinye izikhathi angasetshenziswa uma amanye ama-hormone zokwelashwa ehlulekile.
Imithi Yamadoda
Amadoda anomdlavuza webele we-metastatic okuyinto i-hormone receptor positive ngokuvamile iphathwa nge-tamoxifen.
Okuqhamuka uma udla imishanguzo
I-Tamoxifen
I-Tamoxifen inemisebenzi ehlukene, kokubili ukulingisa umphumela we-estrogen kwezinye izingxenye zomzimba nokuphikisana nabanye. Izimpawu ezivame kakhulu zihlanganisa ukushisa okushisayo nama-aches omzimba okuye kwahlanganiswa "i-lady lady syndrome" nakuba lezi zitho zomzimba zivame kakhulu kunama-aromatase inhibitors.
Imiphumela emibi kakhulu ihlanganisa ingozi eyengeziwe yokwehlukanisa igazi emilenzeni (i-thromboembolism ene-venous), uma ingalashwa, ingakwazi ukukhululeka futhi ibheke emaphashini (i-pulmonary emboli.) Ngokuhamba kwesikhathi, i-tamoxifen ingabangela ukuphuma kwegazi futhi ihlobene ngokunyuka okuncane ekuthuthukiseni umdlavuza wesibeletho.
Abanye besifazane (nabesilisa) abathatha i-tamoxifen bangase bahlakulele izimpawu zabo (isibonelo, ukwanda komzimba we-metastase noma ukwanda kwethambo kumathambo ayisithupha) ezinsukwini ezimbalwa zokuqala imithi.
Uma uthuthukisa lezi zimpawu, ngokuvamile zizoxazulula phakathi kwamasonto amane kuya kwamasonto, kanti ngezinye izikhathi imithi idinga ukuvalwa. Ukuqoqa isiliva uma kwenzeka lokhu kwenzeka ukuthi ukubhekwa komzimba kubhekwa njengesibonakaliso sokuthi imithi isebenza futhi iyosebenza kahle. I-Zoladex ingase ibangele ukusabela okungafani okufanayo.
Qaphela ukuthi i-Tamoxifen ingabangela ukuhlolwa kokusebenza okungavamile kwesibindi, i-anemia, namaplatelet aphansi futhi ihlotshaniswa nenengozi yokwanda komdlavuza we-endometrial. Xoxa nodokotela wakho uma le ndlela ingcono kuwe.
I-Aromatase inhibitors (i-AI)
I-AI ingabangela futhi ama-aches omzimba, anezingxenye ezingamaphesenti angama-40 abantu abaqaphela ukulingana kwamanye ama-muscle nokukhala ngokuhlanganyela. Ukulahlekelwa kwe-Bone kuyisici esiyingozi, futhi i-oncologist yakho ingase ihlele ukuthambo kwamathambo ukuze ikuhlolele ukuguqulwa kwamathambo, kokubili kokuqala kokwelapha futhi ngezikhathi ezithile emva kwalokho. Ama-fractures angenzeka ngenxa yokulahlekelwa kwethambo, ngisho nangaphandle kwamathambo ayisisindo. I-AI ingabuye yandisa ingozi yesifo senhliziyo.
Faslodex
I-Faslodex ivame ukubekezelelana kahle, nemiphumela emibi kakhulu efana nokushisa okushisayo nokuphakama kokuhlolwa kwesibindi.
I-Zoladex (i-goserelin)
Omunye wemiphumela emibi kakhulu yale mithi empeleni umphumela oyifunayo. Umgomo wokwelashwa ukuvimbela ama-ovari, ngamanye amazwi, ayeke ama-ovari ukukhipha i-estrogen. Ukwenza lokhu kubangelwa ukugudluka kokunqamuka kwemithi ngakho-ke, izibonakaliso ezijwayelekile zokuqeda ukuphuma komzimba ezifana nokushisa okushisayo nokumelela kwesisu kuvamile.
Njenge-tamoxifen, abanye abantu bangase babe nesisindo sokuqala lapho beqala ukuqala imithi, ngokwesibonelo, ukwanda kwezinhlungu zethambo kulabo abanezibalo zamathambo.
I-Oophorectomy
Imiphumela emibi kakhulu ehlobene nokukhipha ama-ovari, njengalapho yokwelashwa kwe-hormone yokwelapha, izibonakaliso ezijwayelekile ezivamile ngokuya esikhathini sokuqala njengokufana nokushisa okushisayo nokumelela kwesisu. Kukhona nemiphumela emibi kanye nengozi ehlobene nokuhlinzwa. I-oophorectomy manje ingenziwa ngokuhlinzwa okuncane okungavamile (i-laparcopysi) ngokusebenzisa ukusikeka okuncane esikhumbeni futhi ngokuvamile kwenziwa njengenqubo efanayo yokuhlinzwa ngosuku.
I-Faslodex (fulvestrant)
Njengoba lokhu kungumuthi we-anti-estrogen, iningi lezimpawu zifana nalabo abathola ukukhipha isisu, njenge-tamoxifen ne-aromatase inhibitors. Cishe ingxenye yesithathu yabantu izwa ubuhlungu obufayo, kepha ngenye indlela, le mithi ivame ukubekezelela kahle.
> Imithombo:
> Society of American of Clinical Oncology. I-Cancer.Net. Imithi yokwelapha ye-hormonal ye-Metastatic Breast Cancer. Kubuyekezwe 05/2016. https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/hormonal-therapy-metastatic-breast-cancer
> Martin, M., Lopez-Tarruella, S., noJ. Gilarranz. I-Endocrine Therapy ye-Hormone Treatment-Naïve Advanced Breast Cancer. Isisu . 2016. (i-Epub ngaphambi kokuphrinta).