Ngeke yini kube kuhle uma odokotela bebheka umdlavuza wakho, ubheke izindlela zokwelapha ezintsha ezivela phambili, futhi uzimisele ukuthi yiziphi izinketho ezingase ziphumelele?
Nakuba ama-oncologists, ngezikhathi eziningi, angaba namathuluzi amahle kanye nedatha ukuhlunga nokuqhathanisa ukwelashwa okuhlukile, ukwelashwa okusha okwakhiwa okusha ngezinye izikhathi kungase kunzima ukubikezela, ngaphandle kokuhlangenwe nakho komtholampilo.
Ukuthuthuka kolwazi kuvela ekuhlolweni kwemitholampilo, lapho iziguli zivuma ukufaka izifundo ngezidakamizwa zocwaningo eziye zabonisa isithembiso esithile; kodwa, njengoba igama elithi 'uvivinyo' lisho, kukhona njalo ukungaqiniseki mayelana nokuthi izidakamizwa zizokwenza kanjani nokuthi ubani ozozuza kakhulu-okungukuthi, yiziphi izinhlobo zesiguli nokuthi yiziphi izingxenye zomdlavuza.
Yini I-Cancer Immunotherapy?
I-Cancer immunotherapy yindlela yokwelapha ehilela izingxenye ezithile zesistimu yomzimba omzimba ukulwa nokulimala. Esinye isibonelo sokuzivikela nge-immunotherapy ukusetshenziswa kwamagciwane omzimba njenge-rituximab ne-obinutuzumab . Ama-antibodies angama-monoclonal angama-antibodies eyenziwe ngabantu, noma amaprotheni omzimba omzimba. Lezi zinselo zomzimba zingakwazi ukuhlasela ingxenye ethile yecala lomdlavuza kulokho okubizwa ngokuthi ukwelashwa okuhlosiwe .
Ezinye izinhlobo ze-cancer immunotherapy zihlanganisa ama- inhibitors omzimba wokuzivikela omzimba , okuthatha ama-brake 'amasistimu omzimba ukusiza ukubona nokuhlasela amangqamuzana omdlavuza.
Izwe lomdlavuza we-immunotherapy alikho nje kuphela lezibonelo ezingenhla, kodwa nemibono emisha yokusebenzisa isimiso somzimba wakho womzimba ukulwa namaseli omdlavuza uyaqhubeka nokuthuthukiswa.
Ingabe i-Immunotherapy isebenza Konke I-Cancer?
Umuntu ngamunye uhlukile, nomdlavuza womuntu ngamunye uhlukile; akuwona wonke umuntu ophendula ngendlela efanayo ekuziphatheni okufanayo kwe-immunotherapy.
Ukulinganisa ngokuphumelelayo, kusengaphambili, ukuthi yikuphi abantu abangase basabele ekuzivikelweni kwe-immunotherapy kuyoba inzuzo emazingeni amaningi. Ukuze isiguli, singasindisa isikhathi esibalulekile, esingasiguqula sibe yinzuzo yomtholampilo.
Ngamanye amazwi, ngeke uchithe isikhathi sakho noma umphumela wengozi yokuzama ukuzama into engase ibe nemiphumela encane lapho kungase kube 'isibhamu esikhulu' noma ukwelashwa okusebenzayo okukhona. Kodwa umuntu angazi kanjani lolu hlobo lwezinto kusengaphambili? Indaba eyodwa ephathelene nendlela abacwaningi be-oncologists kanye nabacwaningi bomdlavuza abahamba ngayo lokhu kuqala ngento ethiwa neoantigens.
I-Neoantigens: I-Achilles Heal yomdlavuza?
Amaseli e-Cancer angaba nesibindi. Bavame ukuba nezinguquko eziningana emajeni abo, okunye okungahambisana nokukwazi kwabo ukwenza izinto ezimbi ukuthi amangqamuzana ajwayelekile, aphilile akakwazi. Eminye yalezi zinguquko empeleni kubangelwa ukungafani ngokomzimba noma ngaphandle kwamangqamuzana omdlavuza angatholakala ngesistimu yomzimba. Lezi zingxenye zamangqamuzana omdlavuza ukuthi amasosha omzimba angawabona njengabanye amazwe abizwa ngokuthi "neoantigens."
I-Neo, esho entsha, ngoba ivela esanda kuvela kumangqamuzana ethu, isuke ingenwa umdlavuza , ngokungafani nama-antigens avamile ososayensi avame ukukhuluma ngezifo ezithathelwanayo, isibonelo.
Ama-antigens avamile angatholakala ngaphandle kwama-bacteria, noma amangqamuzana aphethwe yi-virus. Ngokuphambene nalokho, ama-neoantigens afana namafulege abomvu angakwazi ukukhombisa isimiso sokuzivikela omzimba ukuthi amangqamuzana ethu ahlukumeza.
I-Neoantigens iholela ekusetshenzisweni kwamaseli amhlophe egazi aziwa ngokuthi ama-T-amaseli -amasosha omzimba omzimba. Lezi zamasosha T-seli zihamba ngemisipha yegazi, njengemigwaqo yama-Ancient Rome, ukuze ifinyelele isayithi lamaseli angenalutho angenalutho, ingene ngaphakathi kwesisu futhi isize ekunciphiseni inani lendawo yamangqamuzana abulalayo.
Ngakho-ke, i-neoantigens ingenye yezihluthulelo zokwelashwa okulwa nomzimba omelene nomdlavuza.
Lokho kusho ukuthi ukunqoba impi kaningi kuhilela ukuzivikela nge-immunotherapy yedwa, futhi ngokuvamile kuyadingeka indlela yokushisa emhlabathini edingekayo; i-immunotherapy ivame ukusetshenziswa ngokuhlanganyela ne-cytotoxic chemotherapy kanye / noma nezinye izifo ze-immunotherpies, kuye ngokuthi i-malignancy nesiguli ngasinye .
Ingabe I-Immunotherapy Iyongisebenza Ngami?
Lo ngumbuzo obalulekile kumanje oncology, futhi lowo osebenza ngokusebenzayo. Kuze kube sekugcineni, izici ezimbili zamangqamuzana omdlavuza wakho zingasiza odokotela babikezele ukuthi izifo zokuzivikela ezitholakalayo zizosebenza kanjani: TMB kanye neMSI.
Ukunyakaza komzimba okudumalayo, noma i- TMB , kungacatshangwa njengenhlawulo yazo zonke lezo zinguquko ezakhiweni zegciwane kumaseli omdlavuza ayenayo ama-awry-genes, ngokwesibonelo, asetshenziswa ikhodi yazo zonke izinto ezijwayelekile iseli okungadingeka-kodwa lokho zinezinguquko noma izinguquko uma kwenzeka amangqamuzana anomdlavuza. Ngezinye izikhathi i-TMB ibizwa nangokuthi ingumthwalo ophelele wokuguquka komzimba noma ukunyakaza komzimba.
Ama-Tumor ane-TMB ephezulu akholelwa ukuthi anezi-neoantigens ezingaphezulu futhi ngakho-ke angaphendula kangcono ku-immunotherapy. Amaseli e-Cancer angaqeda nge-TMB ephakeme ngokusebenzisa ukuvezwa okuhlobene nomdlavuza, kuhlanganise nogwayi noma ukukhanya kwe-UV. Enye indlela ngukungahlali kahle kwe-microsatellite, noma i- MSI , igama elibizwa ngokuthi yi-technical, elibhekisela enkingeni yezinhlelo zemvelo yomzimba wakho wokulungiswa kwe-DNA-inkinga eholela ekuguquleni okukhulu nokungahambisani nokuphindaphindiwe kwe-DNA gene gene.
Enye inkampani ebizwa ngokuthi i-Foundation Medicine manje inikeza ukuhlolwa kokuqala okuhlanganisiwe ngokugcwele, okuqinisekisiwe kwe-TMB njengengxenye yesilingo sayo se-FoundationOne, esingasiza ukubikezela ukuthi umuntu angasabela kanjani empilweni ye-immunotherapy.
"I-genomes engalungile yiyona ejwayelekile yezo zonke ukwelapha," kuchaza uVincent Miller, MD, isikhulu sezokwelapha e-Foundation Medicine. "Izicubu ezinezinombolo eziphezulu kakhulu zokuguqulwa komzimba zivame ukukhiqiza amaprotheni amasha, angajwayelekile abizwa ngokuthi ama-neoantigens. Isivikelo somzimba sokuzivikela sigcina lezi zingu-neoantigens njengangaphandle futhi ziyaqhubeka ziqaphile, ziqala uchungechunge olunzima lwezinyathelo zokuhlasela lesi sifo. "
Ingabe I-Immune Checkpoint Inhibitor Izosebenza Ngami?
Isakhiwo siqinisa ukuthi ezinye izifo zomshukela ziye zasungula izindlela eziqine kakhulu zokuvimbela amasosha omzimba-ngokwenza amaprotheni empeleni angasebenzi izinhlobo ezithile zamasosha omzimba wakho. Idivayisi ye-biologic cloaking , uma uthanda.
Ukuvimbela umdlavuza ukuba ungazigqoki ngalendlela ngaleyo ndlela, ezinye izivikeli ze-immunotherapi zenzelwe ukuvimbela la maprotheni anqanda ukumelana nomzimba. Lezi zingculazi, ezibizwa ngokuthi i- immune checkpoint inhibitors , zihlanganisa lezo ezibizwa ngokuthi anti-PD1 kanye nama-anti-PDL1 antibodies . Futhi, njengezinye izinhlobo ze-immunotherapy, kukhona ubufakazi obukhomba ukuthi amazinga aphakeme ama-neoantigens kumaseli omdlavuza ahlotshaniswa nezimpendulo ezingcono kuma-inhibitors wokuhlola omzimba.
Impendulo yokuhlola i-point inhibitors ihlukahluka cishe ngamaphesenti angu-20 emdlavuza wamaphaphu kuya kuma-80 amaphesenti eHodgkin lymphoma. Isizathu sokuthi izimbala ezithile ziphendule kanjani ekuhloliseni i-inhibitors iphuzu nabanye abanye akucaci.
Okubalulekile Ukubikezela Ukuphendula Kwemitholampilo
Lawa mathuluzi okubikezela kanye nempumelelo yawo yayiyisihloko sengxoxo emhlanganweni wonyaka we-American Society of Clinical Oncology, noma i-ASCO.
I-TMB iboniswe ukuthi ibikezela amathuba amaningi okuphendula kanye nesikhathi eside sempendulo kumdlavuza we-immunotherapies kwiziguli ezine nomdlavuza wesisu, umdlavuza wamaphaphu, i-melanoma nezinye izifo zomdlavuza. Ngaphandle kwe-TMB, i-FoundationOne iphinde ibeke ukungalingani kwe-microsatellite, emele ukuhlolwa okulodwa ukuqondisa izinqumo zokwelapha ezithintekayo zokwelashwa, izivivinyo zemitholampilo kanye nomdlavuza we-FDA ovunyelwe ukuzivikela usebenzisa i-biopsy eyodwa.
"I-Cancer immunotherapies ihamba phambili ekunakekelweni komdlavuza, futhi izindlela ezintsha, ezilinganiselwe ziyadingeka ukubikezela izimpendulo eziphathelene nezifo ezitholakala kulezi zindlela ezibalulekile, kodwa futhi zabiza," kusho uDkt. Miller.
"Ikhono lokulinganisa ngokunembile ama-biomarker amaningi ngesikhathi esisodwa, kufaka phakathi i-TMB ne-MSI, kuyisandulela esibalulekile emkhakheni we-cancer immunotherapy, futhi okuhlukile kwi-Foundation Medicine," kusho umqondisi wohlelo lwe-oncology, u-University of Florida, uThomas George, MD. . "Inhlanganisela ye-Foundation Medicine yamapulatifomu wokulandelana okuthuthukisiwe kanye neziqalo ezicacile kakhulu zinikeza ukungena kuzo zonke izici eziphilayo ezifanele iziguli zami ngesikhathi esisodwa, ngisize ukusindisa kokubili isikhathi nesikhumba."
"Sikhuthazwa yizinto ezitholakale e-ASCO, okufaka phakathi ukuthi kungenzeka ukuthi iziguli zizokwazi ukuthola inzuzo ye-checkpoint inhibitor immunotherapy," kusho uDkt. Miller. "Inhloso yethu ukunikeza odokotela neziguli ithuba lokugcwele ulwazi olufanele, olusebenzayo, futhi sijabule ukunikeza isisombululo sethu esihlukile sokulinganisa i-TMB kanye ne-MSI ngesikhathi esisodwa futhi ngokunemba okungafani, okusekelwa ukulungiswa kwemibono eyinkimbinkimbi futhi isuselwe ekuqondeni kwangokomqondo kusuka esisekelo sethu solwazi FoundationCORE. Lokhu akusikho okunye okunikezwayo kwesikhulumi sokulandelana kwesikhulumi esilandelayo. "
I-Independent ye-FoundationOne ne-FoundationOne-Heme, i-Foundation Medicine inikeza nokuhlolwa kwe-PD-1 ne-PD-L1 iphrotheni inkulumo, inikezela, ngokuhambisana nama-FoundationOne e-testay, i-suite egcwele ye-cancer immunotherapy yokuhlolwa kwama-oncologists.
Izwi elivela
Nakuba lokhu ngokuqinisekile kuyindawo ethembisayo, isayensi isathuthuka futhi ukuhlolwa okuhlukahlukene kusacwaningwa futhi kuqinisekiswe. Wonke ama-biomarkers wamanje wokubikezela kwempendulo yemitholampilo ukuhlola i-point inhibitors ayiphenyo kuphela futhi okwamanje ayikho ukuhlolwa okuvunyelwe kwe-FDA okungakwazi ukubikezela ngokunembile impendulo ukuhlola inhibitors iphuzu.
> Imithombo:
> Foundation Medicine inikeza idatha emisha e-ASCO 2016 ebonisa ukuthi i-FoundationOne ingasiza ukubikezela ukusabela komdlavuza we-immunotherapy kuwo wonke ama-cancer aphezulu.
Ansell SM, Lesokhin AM, Borrello I, et al. I-PD-1 Ukuvinjelwa ne-Nivolumab kuLymphoma eLahliswayo noma e-Refractory's Lymphoma. N Engl J Med. 2015; 372 (4): 311-319.
I-Pardoll DM. Ukuvimbela ukuhlolwa kwamagciwane okulwa nomdlavuza we-immunotherapy. I-Can Rev Cancer. 2012; 12 (4): 252-64.