Izinzuzo kanye nemiphumela emibi yeTamoxifen e-Premenopausal Breast Cancer
I-Tamoxifen, eyaziwa negama legama elithi Nolvadex, ingenye yemithi ejwayelekile kakhulu evikela ukuphindaphinda umdlavuza webele. Iyini inzuzo yokusebenzisa lesi sidakamizwa ngemuva kokwelashwa okuyinhloko ngomdlavuza webele , yiziphi imiphumela emibi, futhi yiziphi izingozi?
Sibutsetelo
I-Tamoxifen imithi ephikisana nemilenze ephikisana ne-estrogen ne-estrogen, kuye ngokuthi uhlobo oluthile lwesisindo emzimbeni lapho lisebenza khona.
Ihlukaniswa njengesimiso se-estrogen receptor receptor (SERM) kanye nomuthi u- Evista (raloxifene).
Kunezinhlobo ezintathu ezisetshenzisiwe ezisemqoka ku-tamoxifen:
- Abesilisa nabesilisa abaxilongwa nge- estrogen receptor-positive , umdlavuza webele wesandulela ngaphambi kokuhlinzwa, i- chemotherapy noma imisebe ukuze kuncishiswe ingozi yokuphindaphindiwe.
- Abesifazane namadoda abhekwe ngesiteji esiphambili noma umdlavuza webele we-metastatic okuyinto i-hormone receptor-positive
- Ukuvimbela umdlavuza wesibeletho samabele kulabo abasengozini enkulu yokuthuthukisa lesi sifo.
I-Tamoxifen ivame ukubhekwa njengenzuzo kulabo abane-estrogen noma i-progesterone yomdlavuza wesifuba omubi.
I-Tamoxifen iza kokubili amaphilisi angu-10 noma ama-20 mg ane-dose evamile kakhulu engu-20 mg kanye ngosuku. Kunezinhlobo ezimbalwa ezibalulekile zokusebenzisana kwezidakamizwa ezinganciphisa ukusebenza komuthi. Ngokuvamile kuthathwa nsuku zonke iminyaka emihlanu kuya kwengu-10 noma kuze kube yilapho umuntu eguqulela ku-inhibitor ye-aromatase.
Izinzuzo
I-Tamoxifen yamukelwa ngo-1998 futhi isesitholakale iphumelele ekwelapheni umdlavuza webele izigidi zabantu. Kusabhekwa njengendlela enhle kakhulu uma u-premenopausal noma u-postmenopausal futhi awukwazi ukuthatha inhibitor ye-aromatase.
Uma isetshenziselwa ukwelashwa okuyisisekelo kunganciphisa ingozi yakho yokuphindaphinda umdlavuza webele ngesigamu, uma isisu sakho singumamukela we-estrogen.
Kunganciphisa ingozi yokuthuthukisa omunye umdlavuza esifubeni esifanayo noma umdlavuza omusha kwesinye isifuba ngamaphesenti angama-50. Lokhu kubungozi okunciphise kubambelela kokubili kulabo abanengozi ephezulu ye-70-gene.
Kungasiza ukuqaphela ukuthi i-tamoxifen iyaqhubeka inenzuzo ekunciphiseni ingozi yokuphindaphinda ngisho nangemva kokuyeka ukuthatha izidakamizwa.
Ngaphezu kwemiphumela yayo ekunciphiseni ingozi yomdlavuza wesifu noma ukuphindaphindiwe, i-tamoxifen inezinye izinzuzo futhi. Ngokuphambene nemiphumela yayo yokulwa ne-estrogen ezincukeni zesifuba, i-tamoxifen inemiphumela efana ne-estrogen emathanjeni. Ngakho-ke i-tamoxifen (kanye ne-Evista) ingasiza ukuphuza noma ukuyeka ukulahleka kwethambo. (Ngokuphambene, i-aromatase inhibitors ivame ukuholela ekulahlekelweni kwethambo). I-Tamoxifen inganciphisa amazinga e-cholesterol, ikakhulukazi i-LDL cholesterol.
Indlela Esebenza ngayo
Amaseli omdlavuza webele we-estrogen receptor positive aphethwe yi-estrogen. I-Estrogen emzimbeni ibophezela kuma-protein emaceleni lawa maseli (izidakamizwa ze-estrogen) ukukhombisa ukuthi iseli lihlukanise futhi likhule. I-Tamoxifen ibopha kule receptor ngakho-ke isrogen ayikwazi, ngokuyinhloko ilambile amangqamuzana omdlavuza.
Imiphumela emibi kanye nezingozi
Imiphumela emibi eminingi evamile ye-tamoxifen empeleni imiphumela emibi yokuba nesilinganiso esinciphile se-estrogen emzimbeni (ukuyeka esikhathini sokuya esikhathini).
Ngakho-ke ukushisa okushisayo, ukujula ebusuku, ukuphuma kwamagciwane kanye nokugeleza kwamanzi, nokunciphisa i-libido kuvamile. Njengombhalo osheshayo, uma lokhu kukukhathaza, ukukhanya okushisayo kuhlobene nokusinda okungcono komdlavuza webele. I-cataract ingase ivele futhi.
Izenzo zikaTamoxifen ezifweni ze-uterine (endometrial) zingabangela ingozi yomdlavuza wesibeletho . Le ngozi ixhomeke ebude besikhathi osesidakamizweni. Le ngozi ingaphezulu kwabesifazane abangaphezu kweminyaka engu-50 kodwa ingaphansi kwephesenti elilodwa.
I-Tamoxifen ingandisa ingozi yokuthuthukisa ama-blood clots noma emilenzeni yakho (imfucuza ye-vein thrombosis) noma amaphaphu (i- pulmonary embolism ). Asinaso isiqiniseko ngalesi sikhathi, kodwa i-tamoxifen ingabuye yandisa ingozi yokuhlaselwa yinhliziyo noma isifo sohlangothi.
Nini Ukubiza Udokotela Wakho
Kubalulekile ukubiza udokotela wakho uma unayo izimpawu ozikhathazayo, kodwa ikakhulukazi, kufanele ubize uma uthuthukisa noma yikuphi okulandelayo:
- Ukuphuma kwegazi okungavamile
- Ubuhlungu ku-pelvis yakho
- Ukuvuvukala komlenze
- Ubuhlungu besifuba
- Ukuphelelwa umoya
- Ubuthakathaka, ukuphazamiseka noma ukulinganisa
- Izinkinga zembono
Tamoxifen vs. Aromatase Inhibitors
I-Tamoxifen ne-aromatase inhibitors zihlukile uma kuziwa kokubili izinzuzo nezingozi. Kulabo besifazane abangama-postmenopausal noma labo abakwa-premenopausal futhi bathole ukwelapha okukhipha i-ovarian, i-aromatase inhibitor inganikeza izinzuzo ezinkulu ekunciphiseni ingozi yokuphindaphinda. Ama-inhibitors e-Aromatase adala izimpawu ze-menopausal kodwa angenza ukulahlekelwa kwe-bone okusheshayo kunokunciphisa njenge-tamoxifen. Ubuhlungu be-Bone kanye nobunye bungaba khona noma yikilasi lezidakamizwa kodwa luvame kakhulu nge-aromatase inhibitors.
Izixwayiso
Ukusebenzisana kwezidakamizwa
Ngenxa yendlela ehlanganiswa ngayo, i-tamoxifen ingase ihlanganyele kokubili imithi yesiguli kanye nemithi eminingi. Khuluma nodokotela wakho mayelana nanoma yimiphi imithi oyisebenzisayo futhi uqinisekise ukuthi umuthi wakho wemithi uyazi futhi. Ngokuyinhloko, izidakamizwa eziningana zokucindezeleka, kanye nemithi eminingi yokuphuza imithi, zinganciphisa ukusebenza kwe-tamoxifen.
Ukukhulelwa
Ngenxa yezinga eliphakeme kakhulu lokukhubazeka kokuzalwa, i- tamoxifen akufanele isetshenziswe ekukhulelwe , futhi isidakamizwa kufanele simiswe okungenani izinyanga ezimbili ngaphambi kokuzama ukukhulelwa.
Kude Kanjani Okufanele Uwuthathe
Ngokusekelwe ebufakazini obucacile obuvela ezifundweni ezimbili zokwelashwa ezinkulu zesigaba se-III (ATLAS kanye ne-ATTom), iminyaka eyishumi kunokuba ukwelashwa kwe-adjuvant iminyaka emihlanu ne-Tamoxifen kuhlotshaniswa nengozi encane yokuphindaphinda nokunciphisa ukubulawa komdlavuza webele.
Lokhu kuncipha kokuphindaphinda umdlavuza webele kufanele kulinganiswe nemiphumela emibi engaba khona kumuntu ngamunye njengomuntu ngamunye. Uma ngabe u-premenopausal, udokotela wakho angancoma i-tamoxifen iminyaka engu-3 kuya kwezingu-5 ngaphambi kokushintshela ku-inhibitor ye-aromatase eminye iminyaka engu-5.
Kubalulekile ukunamathela ngemithi yakho. Ngeshwa, abantu abaningi baphoqeleka ukulinganisa noma bayeke le mithi masinyane, okuholela engozini enkulu yokuphindaphindiwe.
Okubalulekile
I-Tamoxifen inganciphisa kakhulu ingozi yokuphindaphindiwe komdlavuza webele ngemva kokuphathwa okuyisisekelo ngokuhlinzwa, chemotherapy kanye / noma ukwelashwa kwemisebe. Njenganoma yimiphi imithi, i-tamoxifen inezingozi nemiphumela emibi futhi izinzuzo zokwelashwa kufanele zilinganiswe ngalezi zingozi. Qinisekisa ukuthi uxoxisana nodokotela wakho nezimpawu zakho bese ukhuluma naye uma ubhekana nemiphumela emibi. Gcina imigqa yokuxhumana evulekile ukuqinisekisa ukuthi i-tamoxifen isebenza kuwe ngaphandle kokushiyeka okuphawulekayo.
> Imithombo:
> National Cancer Institute. Ukwelashwa Kwemdlavuza Webele (PDQ) -Health Professional Version.
> Sahebkar, A., uSerban, M., Penson, uP. et al. Imiphumela ye-Tamoxifen kwi-Plasma Lipoprotein (a) Izingqinamba: Ukubuyekezwa okuhlelekile kanye nokuhlaziywa kwe-Meta-Analysis. Izidakamizwa . 2017. 77 (11): 1187-1197.
> Yu, Z., Guo, X., Jiang, Y. et al. I-Adjuvant Endocrine Monotherapy ye-Postmenineusal Early Breast Cancer Iziguli ezine-Hormone-Receptor Positive: Ukubukezwa Okuhlelekile kanye ne-Network Meta-Analysis. Umdlavuza webele . 2017 Jul 28.