I-Immunotherapy ikhula ngokushesha njengethuluzi elinamandla lokulwa nezifo, ikakhulukazi izifo ezinzima ukuzinakekela. Ngomdlavuza we-immunotherapy , isimiso somzimba sokuvikela omzimba sivinjelwe ukulwa nezicubu ngezindlela ezintsha. Ukungenelela kwe-Immunotherapy kungakhuthaza ngokuqondile isimiso somzimba sokuzivikela omzimba noma ukunikeza isimiso somzimba sokuvikela omzimba ngamaprotheni okufakelwa, noma ama- antigens , ukuze aqeqeshe amasosha omzimba emathunjini.
Imishanguzo yokwelapha i-cancer iyindlela ye-immunotherapy esetshenziselwa ukwelapha umdlavuza osuvele ukhona. Ngokuvamile, imishanguzo yokwelapha umdlavuza yizinto eziphilayo, noma i-biopharmaceuticals. Ezinye zezinto eziphilayo zihlanganisa izingxenye zegazi, ukwelashwa kwegciwane, i-allergenics, neminye imithi.
Njengamanje, ukuphela komuthi wokugoma owenziwe yi-FDA ubizwa ngokuthi Isibonelelo sokuphatha umdlavuza wesibeletho .
I-Vaccines Treatment Treatment
Ama-antigens yizinto ezibangela ukuphendula kwesimiso somzimba. Imithi eminingi yokwelashwa komdlavuza ekuthuthukiseni inikeza ama-antigens ahlobene nomdlavuza kumaseli adendritic. La maseli e-dendritic amangamasosha omzimba asebenza ngokuqondile endaweni yokujola (i-dermis) futhi asebenze i-antigen. Ngaphezu kwalokho, ama-molecule e-immunostimulatory avela emgodini wokugoma umdlavuza, noma ukwandisa ukukhiqizwa, kwama-molecule adingekayo ekugcineni axhumane namaseli T. Inothi, ama-antigens ahlobene nomdlavuza angachaza uhlobo olulodwa lomdlavuza noma iqembu lamanqamu amaningana.
La maseli e-dendritic asetshenziselwe athuthela ema-lymph nodes, amancane amathisiphiliki angaphansi komzimba. Uma la maseli e-dendritic esebenzayo enza kube lymph node, athula amangqamuzana e-antigen e-T-cell. Amaseli e-T asebenzayo ahambahamba kuwo wonke umzimba futhi ahlose amaseli omdlavuza avela nge-antigen ne-lyse, noma aphule, iseli somdlavuza.
(Ngokuvamile, amaseli e-CD4 + acushiwe akhiqiza ama-cytokines okusiza ukuvuthwa kwamaseli e-CD 8, ngemva kokuhamba komzimba kuwo wonke umzimba.)
Ngokusho kwe-FDA, imishanguzo eminingi yomdlavuza njengamanje ekuthuthukiseni isebenzisa amabhaktheriya, amagciwane, noma imvubelo njengezimoto, noma izidakamizwa , ukuhambisa ama-antigens. Ama-bacteria, amagciwane, imvubelo njalonjalo ngokwemvelo ngokwemvelo i-immunogenic futhi ibangela ukuphendula komzimba ngokwabo; Nokho, ziguqulwa ukuze zingabangeli izifo.
Ngaphandle kwalokho, imishanguzo yokwelashwa komdlavuza ingenziwa nge-DNA noma i-RNA leyo ikhodi yama-antigen. Lezi zinto eziphathekayo zifakwa emaseleni bese zikhiqiza ama-antigens. Ithemba ukuthi lezi amangqamuzana zomzimba eziguqulwayo zizokhiqiza ama-antigens anesifo somdlavuza okwanele ukuze zivuselele izimpendulo zamasosha omzimba ukuze zibulale amangqamuzana omzimba.
Ekugcineni, kufanele kulandelwe izindlela ezintathu ukuze amangqamuzana amathumba abhujiswe umgomo:
- inqwaba yamangqamuzana omzimba omzimba anesisindo esanele ngokwanele okumele ahlangane nawo amangqamuzana omdlavuza kufanele akhiqizwe
- la maseli e-T kufanele akwazi ukungena ngaphakathi kwe-tumor
- lawa maseli T kumele aqale ukusebenza endaweni yokulahla ukudala umonakalo oqondene nendawo
Imithi Ye-Cancer Isebenza Kanjani?
Phakathi neminyaka embalwa eyedlule, imigomo yomdlavuza (dendritic-cell) ihlolwe.
Nokho, izinga lokuphendula kule migomo liphansi kakhulu-cishe ngamaphesenti angu-2.6. Eqinisweni, ezinye izinhlobo ze-immunotherapy ziye zafakazela ukuthi ziphumelela kakhulu, ezithonya ochwepheshe abaningi ukuba baphawule imithi yethu yokwelashwa "yokuphuza".
Ngakho-ke uma imithi yokwelashwa yomdlavuza ingavamile ukusebenza kubantu, kungani siqhubeka nokutshala izimali kanye nesikhathi ekuthuthukiseni imigomo yomdlavuza? Kukhona okungenani izizathu ezintathu ezichaza intshisekelo yethu kulolu hlobo lokungenelela.
Okokuqala, imishanguzo iye yaphumelela ekuvimbeleni umdlavuza, futhi le mpumelelo yenze ukwelashwa komdlavuza ngemigomo.
Ngamanye amazwi, umsebenzi esiwenzile ukuthuthukisa imithi yokuvimbela umdlavuza uye wasifundisa okuningi mayelana nama-immunology wamangqamuzana omdlavuza futhi unikeze uhlaka lokuqondisa ukuthuthukiswa kwemishanguzo yokwelashwa komdlavuza. Kukhona okwamanje imithi emibili evimbela umdlavuza: Ukugoma kwesibindi se-hepatitis B kuvimbela umdlavuza wesibindi, futhi umgomo wokugoma we-papillomavirus (HPV) uvimbela umlomo, umlomo wesibeletho, umlomo wesibeletho nezinye izifo zomdlavuza
Okwesibili, imishanguzo yokwelashwa yomdlavuza ilula ukuphatha futhi ibangele imiphumela embalwa embi kakhulu.
Okwesibili, abacwaningi bavame ukugxila ekuchazeni kwabo imiphumela yezilingo ezibandakanya imishanguzo yokwelapha yomdlavuza, edlalwa yilolu hlobo lokungenelela. Ngokucacile, abacwaningi bavame ukugxila ezintweni ezingenalutho ezingenangqondo, noma amaselula, izinguquko kanye ne-lymphocyte (T cell) ukungena kwamathumba esikhundleni sokugxila ekuguqulweni kwangempela : kunciphise ubukhulu besisu noma ukuthuthukiswa ezimpawu zomtholampilo.
Ngaphezu kwalokho, abaphenyi abakhulu abahlola imishanguzo yomdlavuza bavame ukusebenzisa izincazelo ezilahlekisayo namagama ukuze baveze imiphumela, njengokuthi "izimpawu zanyamalala," "ukuphela kwesikhashana kwamanye ama-metastases," "i-tumor necrosis" nokulinda okungalindelekile isikhathi eside. Ngaphandle kweminye imininingwane, la magama asho kancane.
Encwadini ehlobene nalokhu, ucwaningo oluningi lomdlavuza luye lwasetshenziswa ezingeni lesayensi yezokwelapha esebenzisa izibonelo zezilwane. Amagundane, njengoba omunye angase avele ebukhulu bawo, ukuziphatha nokubukeka komlilo, ahluke kubantu. Ngakho-ke, noma yikuphi impumelelo esiyibona ekuphatheni lezi zilwane ngemishanguzo yokwelashwa yomdlavuza akusho ukuthi ihumushe kubantu.
Ngokuqondile, nakuba imishanguzo yomdlavuza iye yafakazelwa ukuthi isebenza kahle ezilwaneni, kunzima ukuthola noma yimuphi umphumela onjalo kubantu. Ngokukodwa, kunomuthi owodwa wokugonywa komdlavuza ovunyelwe yi-FDA yokwelashwa komdlavuza kubantu: Nikeza. Kodwa-ke, kunomuthi wokugoma womdlavuza we-prostate okwamanje ezivivinyweni zesigaba sesi-3 eziye zafakazela ukuthi ziyasebenza: Prostvac.
Ngaphambi kokubheka kokubili i-Provenge ne-Prostac, ake siqhube kancane kancane kolwazi lwethu ngomdlavuza wesicathulo .
I-prostate Cancer
Ngaphandle komdlavuza wesikhumba, umdlavuza wesifo sofuba ngumdlavuza ovame kakhulu owenzela amadoda aseMelika. Nakuba cishe umuntu oyedwa kwabayisikhombisa baseMelika eba nomdlavuza wesifo sofuba, kancane kakhulu ufe ngesifo (cishe ku-1 ngo-39). Esikhundleni salokho, amadoda avame ukufa ngesinye isifo kuqala, njengesifo senhliziyo. Noma kunjalo, ngo-2016, kwaba nokufa okungu-26,120 okubangelwa umdlavuza wesi-prostate.
Ngenxa yokuhlolwa okujwayelekile kwe-prostate-specific (PSA) antigen, i-biomarker yomdlavuza wesifo sofuba, sesikwazi ukuthola amacala omdlavuza wesifo sofuba ngaphambili, kuyilapho umdlavuza usalokhu uvinjelwe ku-prostate, Ngokungajwayelekile, amadoda anesifo somdlavuza we-prostate okuye kwasungulwa noma kwasakazeka emathanjeni futhi yafa.
Izinto ezandisa ingozi yomdlavuza we-prostate zihlanganisa iminyaka yobudala, umhlanga wase-Afrika nomlando womndeni.
Iningi labantu abanomdlavuza wesifo sofuba akudingi ukwelashwa kanti kunalokho kubonakala odokotela babo. Ukwelashwa komdlavuza we-prostate kungabandakanya ukulindela okulindelekile (ukubhekwa okusebenzayo), ukuhlinzwa (prostatectomy noma ukususwa kwe-prostate), i-radiotherapy kanye ne-androgen, noma i-hormone yesondo, ukunqotshwa.
Nika
Ukuhlinzeka noma ukuphuza isisindo-T yindlela yokugoma e-dendritic-cell evunyiwe yi-FDA ngo-2010. Ukunikezela yilokho okuyaziwa ngokuthi i- autologous cell immunotherapy futhi isetshenziselwa ukwelapha isifo samathambo esingasakazeli kude kakhulu okwamanje (singenasidingo esincane). Ngaphezu kwalokho, Yenza umdlavuza womzimba wesifo sofuba ongathandeki kuma-hormone (i-hormone refractory).
Encwadini ehlobene, ama-hormone refractory cancers aphendule ezithombeni zokwehla kwe-hormone, noma izidakamizwa ezilahla nge-androgens, noma ama-hormone ocansi (cabanga nge-medical castration).
Ukuhlinzekwa kulungiselelwe ngokusebenzisa amaseli egazi omhlophe wesiguli (cells peripheral blood mononuclear cells) ukuxoshwa ngeprotheyini ebizwa ngokuthi i-granulocyte-macrophage-colony-stimulating factor (GM-CSF) ne-prostatic acid phosphatase, noma i-PAP, i-antigen yomdlavuza we-prostate.
Isizathu sokuthi i-GM-CSF inikezwa nge-PAP ye-antigen yukuthi abacwaningi bakholelwa ukuthi GM-CSF insiza ukunikezwa kwe-antigen. Okuphawula, i-peripheral blood mononuclear cells isebenza njengamaseli e-dendritic lapho i-antigen ihanjiswa khona.
Ngeshwa, Isibonelelo sandisa ukuphila ngezinyanga ezingu-4 kuphela. Noma kunjalo, lesi sikhathi singavumela umuntu ukuba athole izindaba zakhe ngokuhlelekile futhi asebenzise isikhathi esincane nomndeni wakhe.
Imiphumela emibi yezinhlinzeko zifaka okulandelayo:
- umkhuhlane
- izikhukhula
- ukukhathala
- ukuhlungu obusemhlane
- ikhanda
Ngesikhathi kuhlolwa izivivinyo ze-Provenge, amadoda ambalwa abhekene nemiphumela emibi kakhulu ebandakanya ukuphefumula, ubuhlungu besifuba, ukushaya kwenhliziyo okungajwayelekile, ukwehluleka ukuzulazula nokushintshashintsha kwegazi. Ngakho-ke, abantu abanezinkinga zenhliziyo nephuphu kufanele baxoxisane nale mibandela nomhlinzeki wabo wezempilo.
I-Prostvac
Inqubo yeProstvac ihluke ekunikezelweni.
I-Prostvac iqukethe i-poxvirus (fowlpox) vector, i-prostate-specific antigen (i-PSA) neyinkimbinkimbi ye-costimulatory ebizwa nge-TRICOM. Lokhu kugonywa kwe-PSA-TRICOM kuhlasela amangqamuzana e-antigen-okwenza abonise ukuthi baveze amaprotheni-aqondene namaprotheni e-surface. Lawa maseli e-antigen avela emaT cell futhi aqeqesha ukuba ahlasele amangqamuzana omdlavuza we-prostate.
I-Prostvac Phase 2 yokuhlolwa kwemithi yayihlanganisa nabangu-82 abahlanganyeli abangu-42 abathola khona iProstvac. I-Prostvac yandise impilo eqenjini lokuhlola ngobukhulu obuphakathi kwamaphesenti angu-8.5. Njengamanje, i-Prostvac isesimweni sokuhlolwa kwemithi yesigaba sesi-3, futhi abacwaningi abazama nje ukuqinisekisa ukusizwa kokusebenza kwezidakamizwa kodwa futhi bazama ukuthola ukuthi i-GM-CSF kufanele ingezwe yini emtholampilo.
Phakathi nezivivinyo zokwelapha zesigaba sesi-2, imiphumela emibi yeProstvac yayifakwe lokhu okulandelayo:
- ukusabela kwesayithi (injini, ukuvuvukala, ukubomvu nokunye)
- ukukhathala
- umkhuhlane
- ukuvuvukala
- izikhukhula
- izinhlungu ezihlangene
- isiyezi
- isiyaluyalu
- ukuhlanza
- isifo sohudo
- ukuqotshwa
Imishanguzo yomdlavuza we-prostate ayihloselwe ukusetshenziselwa ukwelashwa kokuqala komdlavuza wesi-prostate. Esikhundleni salokho, zilawulwa ngaphezu kwe-chemotherapy.
Kuyini Imlygic?
Ngonyaka ka-2015, i-FDA ivume i-Imlygic, umuthi wokugoma oncolytic wokwelapha noma i-melanoma ebulalayo engasebenzi. Yize engekho umuthi wokugoma ngomdlavuza, i-Imlygic inemiphumela emibili efana nemigomo yokwelapha yomdlavuza.
Ama-viral oncolytic awuhlobo lwe-immunotherapy lapho igciwane lesakhi zofuzo lijova ngqo kwi-tumor tumor and lyses noma iphula amangqamuzana e-tumor. Ngaphezu kokuphula amangqamuzana, la ma-virus anomthelela ovamile wokusiza umphumela wokuphikisa ofana nemithi yokulwa ne-antiticancer.
I-Cancer Therapeutic Vaccines kanye nami
Njengamanje, ukusetshenziswa kwemigomo yomdlavuza kuzilungiselelo zokwelashwa kunqunyelwe. Ukwengeza, njengoba kushiwo ngaphambili, kunzima kakhulu ukuthola imishanguzo yomdlavuza onomthelela kubantu abahlanganyele. Akungabazeki ukuthi sizobona imigomo yomdlavuza esetshenziselwa ukwelapha izinhlobo ezihlukahlukene ze-khansela noma kunini.
Noma kunjalo, imishanguzo yomdlavuza ibonisa ukuthuthukiswa kwesimiso somzimba sokuzivikela kanye nensimu ye-immunotherapy. Kungcono ukuthi siqonde lokho okushiwo amasosha omzimba, kungcono ukuthi singabheka izindlela zokwelashwa ezingahle zigcine izimpilo.
Imithombo:
Goswami S, Allison JP, Sharma P. Immuno-Oncology. Ku: Hant Kantarjian, Wolff RA. ama-eds. I-MD Anderson Manual ye-Medical Oncology, 3e . ENew York, NY: McGraw-Hill; 2016. Kufinyelelwe kuMeyi 19, 2016.
I-Kantoff PW et al. Ukuhlaziywa Okuphelele Kwesigaba Sesibili Sesivivinyo Esilawulwe Ngokungahleliwe se-Poxviral Based Based PSA-Targeted Immunotherapy Emdlalweni We-Metastatic Castration-Resistant Cancer Prostate. J Clin Oncol. 2010 Mar 1; 28 (7): 1099-1105.
I-Pienta KJ. Isahluko 96. Umdlavuza we-Prostate. Ku: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. eds. I-Geriatric Medicine and Gerontology, 6e . ENew York, NY: McGraw-Hill; 2009. Kufinyelelwe ngomhla ka-22 Meyi, 2016.
I-Rosenberg SA, i-Yang JC Restifo NP. I-Cancer Immunotherapy: Ukuhamba Ngaphandle Kwamanje Amagciwane. Nat Med . 2004 September: 10 (9): 909-915.