Izidakamizwa ezivimbela izindlela zokukhohlisa zomdlavuza
Umdlavuza wesangqamuzana wamangqamuzana entanyeni nasentanyeni ngumdlavuza wesithupha ovamile kakhulu emhlabeni futhi ulandisa cishe ngamaphesenti ayisithupha kuya kokubili kwawo wonke ukufa komdlavuza. Enye inkinga enkulu ikhona ekunakekeleni abantu abanomdlavuza wekhanda noma wenhliziyo ophindaphindiwe noma ophindaphindiwe, njengokuba ithuba lokusinda ngokuvamile libi.
Izindaba ezinhle ukuthi ukucwaninga kuyaqhubeka, futhi odokotela baqala ukusebenzisa imithi yokuzivikela kulezi ziguli.
I-Immunotherapy iyindlela yokwelapha ebonakalayo ephephile futhi ithuthukisa izimpawu ngisho nesikhathi sokusindisa abanye abantu, ngokusekelwe ezincwadini zesayensi zakuqala.
Ukuqonda Okuyisisekelo Sekhanda Nekhanda Lomkhuhlane
Ngaphambi kokuba ukwazi ukuthi lezi zivikeli ze-immunotherapi zisebenza kanjani, kuhle ukuthola isibambo kulokho okushoyo "imithwalo nenhloko" ethize.
Kuyini Isigungu Esiyisigqila?
Amangqamuzana angama-squamous angama-skinny, amangqamuzana aphambene nesikhumba, ama-digestive kanye namapheshana okuphefumula, nezinhlaka ezithile emzimbeni.
Izibonelo zezindawo lapho i-squamous cell carcinoma (umdlavuza) ingahlakulela ifaka lezi zingosi:
- Inhloko nentamo
- Isikhumba
- I-Cervix
- I-Vagina
- Lung
- Anus
Kuyini Okusho Okubi?
Isisu esibi (ngokungafani nesifo esinomdlavuza, esingesiyo umdlavuza) esifundeni senhloko nentamo sibhekisela ekuqoqweni kwamangqamuzana omdlavuza okhula ngokungalawuleki futhi kungenzeka noma angakafiki izicubu ezinempilo ezivamile.
I-Immunotherapy nezinye izindlela zokwelapha ezifana ne- chemotherapy zisetshenziselwa ukwelapha izicubu ezimbi, ngoba lezi ziyingozi futhi zingase zibulale.
Uphi Ikhanda Nekhanda Lezinyosi Litholakala?
Igama elithi 'ikhanda nentamo' lingase liphazamise, njengoba lihlanganisa indawo enkulu. Ngamanye amazwi, ungase uzibuze ukuthi kusho ukuthini lapho umuntu ethola ukuthi unalo hlobo lomdlavuza.
Umdlavuza wekhanda nentamo ubhekisela emathunjini akhula kwenye yalezi zindawo eziningi:
- Lip / umlomo
- Emuva emlonyeni noma emphinjeni (obizwa nge-oropharynx)
- Ingxenye engezansi yomphimbo ongemva nangemva kwebhokisi lezwi (ebizwa ngokuthi i-hypopharynx)
- Ingxenye ephezulu yomphimbo ngemuva kwempumu (ebizwa nge-nasopharynx)
- Ibhokisi lezwi (elibizwa ngokuthi i-larynx)
Yini Eyabangela Inhloko Nekhanda Lomkhuhlane?
Esikhathini esidlule, ukuthuthukiswa komdlavuza wekhanda nentamo kwahlanganiswa nokusetshenziswa kotshwala nokusetshenziswa kotshwala. Kodwa kule minyaka eyishumi edlule noma ngaphezulu, ukuthuthukiswa kwamanye khansa emakhanda nasentanyeni kuye kwaxhunyaniswa nokutheleleka ngezinhlobo ezithile ze-papillomaviruses yabantu (i- HPV ). Ngokwesibonelo, idatha yesayensi iye yabonisa ukuthi uhlobo lwe-HPV olubizwa nge-HPV-16, olubangela umdlavuza wesibeletho nomdlavuza womuntu kumadoda nabesifazane, kuhlotshaniswa nomdlavuza we-oropharynx.
Ukutheleleka nge-HPV kuvame kakhulu, kodwa amaphesenti amancane abantu adala umdlavuza kuwo. Lokhu kungenxa yokuthi amasosha omzimba amaningi asula ukutheleleka.
Okuthakazelisayo nakakhulu kunokuthola isixhumanisi phakathi kwe-HPV nomdlavuza wekhanda nentamo, ukuthola ukuthi izifo zomdlavuza wekhanda nentamo ezenzelwe i-HPV zande. Ngakolunye uhlangothi, ukukhubazeka kwekhanda nentamo yegciwane elibhekene nokubhema nokusetshenziswa kotshwala kuye kwehla. Kungani lokhu kuguqulwa? Ochwepheshe basolisa ukuthi kungenxa yokushintsha komphakathi emisebenzini yezocansi-ikakhulukazi, ukuthi ucansi lomlomo seluvame kakhulu.
Okwamanje, kunesithakazelo esithile endleleni yokuphatha kangcono ikhanda lekhanda lekhanda le-HPV-positive, njengoba i-biology yabo ihluke ezikhumba ze-HPV-negative. Ngalokho, ochwepheshe bahlolisisa amasu amaningi e-immunotherapy ukuze aphathe amagciwane ahlobene ne-HPV.
Yini Yokuhlola I-Immune System?
Ama-checkpoints amasistimu omzimba ngamaprotheni avame ukutholakala kumaseli omzimba omzimba omuntu (okuthiwa ama-T cells). Amaseli e-T afana nephoyisa efuna inkinga (umdlavuza noma ukutheleleka) ngaphakathi komzimba. Lapho i-T ehlangana nesinye iseli, ihlola amangqamuzana asebenzisa amaprotheni aphezulu ukuze abone ukuthi iseli "livamile" noma "alivamile." Uma kungavamile, i-T cell izoqala ukuhlaselwa kweseli.
Kodwa phakathi nalokhu kuhlaselwa, amangqamuzana avamile, anempilo avikela kanjani? Yilapho amaprotheni wokuhlola aqala khona. Amaprotheni e-Checkpoint aphezu kwamangqamuzana e-T futhi aqinisekise ukuthi amangqamuzana anempilo asele yedwa.
Ikhansela likhohlisayo ngokuthi empeleni lenza lezi protheyini zokuhlola (i-copycat yangempela) ukugwema ukuhlaselwa kwesimiso somzimba somuntu. Enye iprotheni yokuhlola ekhonjiswe emangqamuzaneni omdlavuza ukuze ahlaselwe amasosha omzimba yi-PD-1.
Kodwa manje ososayensi bathole ukuthi bangavimbela i-PD-1 emangqamuzanini omdlavuza, ukuze umdlavuza utholakale ngempela ngomzimba womuntu. Lokhu yilapho i-immunotherapy iqala ukudlala khona, futhi lezi zidakamizwa ezivimbela i-PD-1 zibizwa ngokuthi izivikeli zokuzivikela zesimiso sokuzivikela.
Immunotherapy ukuphatha iNhloko neNeck Cancer
Kukhona ama-inhibitors amabili okuhlola amasosha omzimba okuyi-FDA avunyelwe ngo-2016 ukuze aphathe abantu abanekhanda le-metastatic kanye / noma eliphindaphindiwe le-squamous cell carcinoma.
Umdlavuza we-Metastatic ubhekisela emdlashini wekhanda nentamo osakazekele kwezinye izingxenye zomzimba, kanti umdlavuza okhanda njalo nentamo yomlomo usho umdlavuza oye waqhubeka naphezu kokwelashwa nge-platinum-based based chemotherapy regimen (isibonelo, cisplatin).
Lawa ma-immunotherapies amabili abizwa ngokuthi i-Keytruda (pembrolizumab) ne-Opdivo (nivolumab).
I-Pembrolizumab
Ucwaningo oluqala lubonisa ukuthi i-pembrolizumab inephrofayili enhle yokuphepha futhi ingaba ngempumelelo ekunciphiseni umdlavuza wabantu abathile.
Kwesifundo esisodwa se-II, abantu abangu-171 abanomdlavuza wekhanda nentamo owaqhubeka naphezu kokuphathwa ngaphambili nge-chemotherapy kanye nalolu (i- monoclonal antibody therapy ) bathola ukumnika kwe-pembrolizumab njalo ngemva kwamasonto amathathu.
Izinga lokuphendula jikelele lilingamaphesenti angu-16, kanti ubude besikhathi esiphendulayo bezinyanga ezingu-8. Izinga lokuphendula libhekisela emaphesenti abahlanganyeli abanomdlavuza wehla noma oyekeka ekuphenduleni ukwelashwa.
Ngokuphepha, amaphesenti angu-64 abahlanganyeli abhekana nomphumela omubi ohlobene nokwelashwa, kodwa amaphesenti angu-15 kuphela ahlangabezana nesenzakalo esibi noma esinezinhlekelele ezine (ebunzima noma esongela ukuphila).
Imiphumela emibi kakhulu evamile yilezi:
- Ukukhathala
- I-Hypothyroidism (isikhumba se-thyroid esingasebenzi)
- I-nausea
- Ukuphakama kwe-enzyme yesibindi
- Uhudo
Ngokuvamile, izimo ezimbi ezihlobene nezivikeli-mzimba ziyi-hypothyroidism, i-hyperthyroidism, ne-pneumonitis.
Ngombhalo ohlangothini, izivikeli zomzimba zomzimba ezimbi kakhulu zikhathazeka kakhulu ngama-immunotherapies, njengoba kunokukhathazeka ukuthi isimiso somzimba sokuzivikela somuntu ngeke sihlasele kuphela amangqamuzana omdlavuza kodwa nezicubu ezinempilo nazo. Endabeni ye-pneumonitis, amaphaphu omuntu ahloselwe, okungenza kube nzima ukuphefumula.
Isithombe esikhulu ukuthi ukwamukela i-immunotherapy kuyinkimbinkimbi, njengoba umzimba nomuthi basebenza ndawonye ukuze banqume okubi (umdlavuza) nokuthi yini evamile futhi enempilo.
Ucwaningo lweSigaba III lwe -pembrolizumab luqhubeka. Ucwaningo lwesigaba III lusho ukuthi i-pembrolizumab izoqhathaniswa nomgomo wemithi yokunakekelwa ukuze ubone ukuthi ihamba njani, njengokungathi iyasebenza yini noma cha.
I-Nivolumab
Esifundweni sesigaba III, abantu abangaphezu kuka-350 abane-squadous squamous cell carcinoma ekhanda nasentanyeni, isifo sabo esaphuthukile phakathi nezinyanga eziyisithupha sokwamukela i-platinum-based chemotherapy, kwakungakahleleki ukuthola i-nivolumab njalo ngemva kwamasonto amabili nge-vein) noma ukwelapha okujwayelekile (methotrexate, docetaxel, noma cetuximab ).
Imiphumela yembulwe ukusinda okuphelele kakhudlwana kubantu abathola i-nivolumab ngokumelene nalabo abathola ukwelashwa okujwayelekile (ukusinda okuphakathi kwaminyaka engu-7.5 kuya kwezi-5.1, ngokulandelana).
Ngaphezu kwalokho, izinga lokusinda konyaka owodwa kwaba ngamaphesenti angama-36 eqenjini le-nivolumab eliphakathi kwamaphesenti angu-16.6 eqenjini elivamile lelashwa. Ngamanye amazwi, isilinganiso seminyaka esisodwa sokusinda singaphezu kokuphindwe kabili.
Ngokuphathelene nokuphepha, imiphumela emibi yebanga 3 noma 4 yenzeke ngamaphesenti angu-13 eqembu le-nivolumab ngokumelene namaphesenti angu-35 eqembu le-therapy elijwayelekile. Eqembu le-nivolumab imiphumela emibi kakhulu evamile yilezi:
- Ukukhathala
- I-nausea
- Rash
- Ukunciphisa ukudla
- Itching
Ngokuvamile, imiphumela emibi ehlobene ne-thyroid yayivame kakhulu eqenjini le-nivolumab (amaphesenti angu-7.6 athuthukiswe i- hypothyroidism ngokumelene namaphesenti angu-0.9 eqenjini elijwayelekile lelashwa).
I-pneumonitis yenzeke ngamaphesenti angu-2.1 abantu abaphathwa nge-nivolumab, futhi kwafa abantu ababili (eyodwa kusuka ku-pneumonitis neyodwa kusuka emazingeni aphezulu e-calcium egazini). Umuntu oyedwa eqenjini elisezingeni elijwayelekile lafa ngenxa yokutheleleka kwamaphaphu ahlobene nokuphathwa okwenziwe.
Ngokuthakazelisayo, i-questionnaire ehlolisisa ikhwalithi yokuphila ekupheleni kocwaningo, ayitholanga ukwehla okuphawulekayo kwekhwalithi yokuphila ngemuva kokwelashwa nge-nivolumab. Ngakolunye uhlangothi, kwaba nokunciphisa okukhulu kwezinga lokuphila ezindaweni eziningana (isibonelo, ubuhlungu, ukusebenza ngokomzimba kanye nomphakathi, izinkinga ezithinta izinzwa) ngemuva kokwelashwa nge-chemotherapy.
Izwi elivela
I-Immunotherapy isivele ishintshe ubuso bomuthi wokwelashwa. Kusemthethweni, "kunengqondo," futhi uthembisa.
Khumbula ukuthi, ukuphatha umdlavuza wekhanda nentamo kuyinkimbinkimbi. Kunezici eziningi ezithatha isinqumo ngokucacile ukuthi udokotela wakho ufuna ukuphatha kanjani isisu sakho, njengomlando wakho wezokwelapha zangaphambili, ngabe unezinye izinkinga zezokwelapha, kanye nezidakamizwa ezihlobene nomuthi othile.
Hlala ungummeli womdlavuza wakho siqu ngokuthola ulwazi. Uhambo lude futhi lunzima, kodwa zama ukufuna ukunethezeka kanye nenjabulo endleleni.
> Imithombo:
> Bauml J et al. I-Pembrolizumab ye-platinum- kanye nomdlavuza wekhanda nentamo ye-refractory ye-ceuximab: Imiphumela evela engxenyeni eyodwa, isifundo sesibili. J Clin Oncol . 2017 Meyi 10; 35 (14): 1542-49.
> Brockstein BE, Vokes E. Ukwelashwa komdlavuza wekhanda nomthofu ophindaphindiwe futhi ophindaphindiwe. Ku: UpToDate, Posner MR (Ed), UpToDate, Waltham, MA.
> Economopoulou P, Perisanidis C, i-Giotakis EI, i-Psyrri A. Indima ekhulayo ye-immunotherapy ekhanda nasentanyeni i-squamous cell carcinoma (i-HNSCC): ukuvimbela ukulwa nesisu nesicelo semitholampilo. Ann Transl Med. I-2016 Meyi; 4 (9): 173.
> Ferris RL et al. I-Nivolumab ye-squamous-cell carcinoma ephindaphindiwe yekhanda nentamo. N Engl J Med . 2016 Nov 10; 375 (19): 1856-67.
> National Cancer Institute. (2017). Head and Cancer Cancer. I-Health Professional Version: Ucwaningo.