Imithi ehlosiwe yindlela yokwelapha entsha yomdlavuza webele ongasetshenziswa yedwa noma ngokuhambisana nezinye izifo. Ngokungafani namakhemikhali ejwayelekile avimbela amangqamuzana akhula ngokushesha, izindlela zokwelapha ezibhekiswe ngqo ziqondisa ngqo amangqamuzana omdlavuza noma ukubonisa izindlela ezifaka ekukhuleni kwamangqamuzana omdlavuza. Ngenxa yalesi sizathu, izidakamizwa eziningi zingase zibe nemiphumela emibi kakhulu kune-chemotherapy.
Imithi yokwelashwa ehlosiwe iyatholakala kulabo abanesifo somdlavuza we-estrogen se-receptor-positive , amakhemikhali webele angu- 2 amahle , ngisho nomdlavuza webele wesithathu.
Lezi zidakamizwa zingasebenza kahle ngezinye izikhathi, kodwa njengeminye imithi esetshenziselwa ukwelapha umdlavuza webele we-metastatic, ukumelana ngokuvamile kuvame ngokuhamba kwesikhathi. Ezinye zalezi zidakamizwa zisetshenziselwa umdlavuza wesifuba we-metastatic, kanti ezinye zisetshenziselwa abantu abanomdlavuza webele we-metastatic.
I-HER2 Cancer Positive
Njengoba kuphawuliwe ngaphambili, cishe amaphesenti angama-25 ekhanda lamabele, isakhi esibizwa ngokuthi i-epidermal growth receptor 2 (noma i-HER 2 / neu) imiphumela ekucindezelweni okukhulu kweprojekthi ye-HER 2 (receptors) ebusweni bamaseli omdlavuza webele.
Ngokufanayo, ngendlela, indlela yokwamukela ngayo i-estrogen receptors enesibopho sokubonisa iseli lomdlavuza ukuba likhule futhi likhule, ama-receptors angu-2 angabangela ukukhula nokwanda kwama-Cancer emihle ka-HER 2.
Imithi ephazamisa lezi receptors ngaleyo ndlela iphazamise isignali kula maseli omdlavuza, inciphisa ukukhula kwabo.
Imithi ehlose i-HER 2 ihlanganisa:
- I-Herceptin (i-trastuzumab) - i- Herceptin inikwa i-IV ngokuvamile kanye ngesonto noma kanye njalo ngemva kwamasonto amathathu. Imiphumela emibi ifaka phakathi komkhuhlane kanye nezikhukhula zakuqala. Ukuhluleka kwenhliziyo kungathuthuka ngamaphesenti amathathu kuya kwayisihlanu abantu abaphathwa ngodokotela, kodwa ngokungafani nokuhluleka kwenhliziyo okuhlobene nezidakamizwa ze-chemotherapy ezifana ne-Adriamycin (doxorubicin), lokhu kuhluleka kwenhliziyo kungabuyekezwa lapho ukwelashwa sekuvinjelwe. Imiphumela emibi evela ku-Herceptin ivame ukuthuthukisa ngokuhamba kwesikhathi.
- I-Kadcyla (i-ado-trastuzumab) - uKaydcyla imithi ehlanganisa kokubili i-Herceptin kanye nomuthi omkhulu we-chemotherapy obizwa nge-emtansine. Ingxenye ye-Herceptin yesidakamizwa ibophezela ku-HER 2 amangqamuzana omdlavuza omuhle, kodwa esikhundleni sokuvimbela nje umtholampilo ukuvimbela ama-hormone okukhula ekuhlanganiseni, inikeza "ukukhokha" kwayo-imithi yokwelapha-ngqo kwamangqamuzana omdlavuza.
I-Herceptin ivumela i-chemotherapy ukuba ingene kumangqamuzana omdlavuza, lapho kukhishwa khona i-emtansine. Nakuba le-agent ye-chemotherapy ihanjiswe ngokugcwele kumangqamuzana omdlavuza, kukhona nokubambelela okujwayelekile kwesidakamizwa ku-circulation systemic.
Ngenxa yalesi sizathu, lesi sidakamizwa singase sibe nemiphumela emibi ejwayelekile emithini ye-chemotherapy efaka ukucindezelwa komnyoba we-bone kanye ne-peripheral neuropathy. U-Kaydycla angase asebenze ngisho nabantu abahlulele uHerceptin. - I-Perjeta (pertuzumab) - I-Perjeta yayiyi-FDA evunyelwe umdlavuza wesifuba we-metastatic ngo-2013 kanti izifundo zithole ukwanda kwesilinganiso sokusinda kwabafazi abanomdlavuza wesisu we-metastatic (HER 2 positive) abaphathwa ngezidakamizwa. Ingasetshenziswa yedwa noma ihlanganiswe no-Herceptin noma i-chemotherapy.
- U-Tykerb (lapatinib) - U-Tykerb uphinde ahlasele ama-HER 2 amangqamuzana omdlavuza wesifuba omuhle, kodwa ngendlela ehlukile kune-Herceptin. U-Tykerb, ongafani no-Herceptin akuyona i-antibody, angasetshenziswa yedwa, noma ehlangene no-Herceptin noma i-chemotherapy. Imiphumela emibi kakhulu yilezi ziphazamiso ezibonakala zifana ne-acne (kodwa ayiphathwa njenge-acne) ne-diarrhea.
Imiphumela emibi yale Mithi
U-Herceptin, uKaydcyla noPerjeta banezinyathelo ezifanayo zesenzo futhi ngenxa yalokho, imiphumela emibi efanayo. Enye yezinto eziphathelene nemiphumela emibi yalezi zidakamizwa kuyingozi yokulimala. I-oncologist yakho ingancoma ukuhlolwa kokuhlola kwenhliziyo yakho ngaphambi kokuba uqale le mithi futhi izokukwazisa izimpawu ezibonisa ukuthi kufanele ubize.
I-Estrogen Receptor I-Cancer Positive
Kulabo besifazane abanomdlavuza webele we-hormone-receptor-positive, izinkinga ezithintekayo ziyatholakala futhi. Lezi zidakamizwa zisetshenziselwa abesifazane abama-postmenopausal (noma abama-premenopausal futhi bathole ukwelashwa kokukhipha i-ovarian) ukwenza ukwelashwa kwama-hormonal kusebenze kakhudlwana.
Izidakamizwa zihlanganisa:
- Ibrance (palbociclib ) - Lesi sidakamizwa sivimbela ama-enzyme okuthiwa i-cyclin-dependent kinases (i-CDK4 ne-CDK6) futhi isetshenziselwa umdlavuza webele we-estrogen we-receptor-positive kumfazi wesimo se-postmenopausal uba umelana nemithi yokwelapha. Ingasetshenziswa kanye ne-aromatase inhibitor njenge-Femara (letrozole) noma nesidakamizwa esilwa ne-anti-estrogen i-Faslodex (fulvestrant.)
- Afinitor (everolimus) - Lesi sidakamizwa sivimbela amaprotheni emzimbeni owaziwa ngokuthi mTOR. I-Affinitor ivame ukusetshenziswa esithombeni se-estrogen esihle nesifo esibi se-HER 2 ngemuva kokuba singamelana ne-aromatase inhibitor njenge-Aromatase (exemastine).
I-Cancer Negative Negative Breast Cancer
Izidumbu ezingenayo i-estrogen receptor, i-progesterone receptor negative, futhi i-HER 2 negative (umdlavuza wesifuba we-triple negative) ingaba inselelo enkulu yokwelapha, njengoba ukwelashwa kwama-hormone nemithi yokwelapha ye-HER 2 ngokuvamile engasebenzi. Ngesikhathi isetshenzisiwe kakhulu ngalesi sikhathi, i-Avastin yokwelashwa okuhlosiwe ingacatshangwa kwabanye abantu.
- I-Avastin (bevacizumab) - Lokhu akusetshenziselwa ukuhlinzwa umdlavuza webele ngenxa ngezinye izikhathi imiphumela emibi yegazi. Ihlukaniswa njenge-inhibitor ye-angiogenesis. Igama elithi angiogenesis lisho "igazi elisha" futhi libhekisela emithonjeni entsha yegazi okudingeka ifake ukuze kuvumele ukwelashwa.
I-Angiogenesis inhibitors isebenza ngokuvimbela ukwelashwa ekukhuleni imikhumbi emisha yegazi, futhi "ngokusobala" umdlavuza.
> Imithombo:
> DeVita, Vincent., Et al. I-Cancer: Izimiso Nokusebenza Kwe-Oncology. Cancer of the Breast. I-Wolters Kluwer, ngo-2016.
> Liedtke, C., no H. Kolberg. Ukwelapha Okuhlelekile Kwe-Advanced / Metastatic Breast Cancer-Ubufakazi Besikhathi Esizayo kanye Nemicabango Yesikhathi Esizayo. Ukunakekelwa kwebele . 2016. 11 (4): 275-281.