Izinzuzo kanye nemiphumela emibi ye-Aromatase Inhibitors ye-Cancer Breast
Yini okudingeka ukwazi mayelana nezinzuzo, izinkomba, nemiphumela emibi ka-Femara (letrozole) yomdlavuza wesifuba?
I-Femara (i-letrozole) (ngokuvamile engeke iphelelwe ngamagama njenge-fimara, i-femarra, ne-femera) yisidakamizwa esigaba esaziwa ngokuthi i-aromatase inhibitors. Lezi zidakamizwa zivimbela ukwakheka kwe-estrogen ezenziwe ezindaweni ngaphandle kwama-ovari. Njengoba i-estrogen ingaba yindlela yokukhula komdlavuza wesifuba, i-Femara isiza ukunciphisa ingozi yakho yokuphindaphinda umdlavuza webele futhi ithuthukise amathuba okuphila kwakho.
Uma ubhekene nemiphumela emibi kule mithi, qiniseka ukuthi ufunda mayelana nezinzuzo ze-Femara nezindlela lapho imiphumela emibi yalo muthi ingalawulwa khona.
Uhlobo Lwezidakamizwa
I-Femara iyi-antiestrogen, noma i-aromatase inhibitor. Ezinye i-aromatase inhibitors zihlanganisa i-Aromasin (i-exemestane) ne-Arimidex (i-anastrozole.) I-Femara akuyona i-steroid.
Ukwelashwa kwamaHormon for Cancer Breast
Ucwaningo lubonisa ukuthi ukusebenzisa i- hormone therapy yesifo somdlavuza we-estrogen se-receptor-positive kunciphisa ingozi yokuphindaphinda futhi kwandiswe ukusinda. Kunezinhlobo ezimbili eziyinhloko zokwelashwa kwe-hormone kubantu abanomdlavuza webele.
Ngaphambi kokuya esikhathini, ama-ovari enza inani elikhulu kakhulu le-estrogen. Uma ama-ovari akho esebenza, i- Tamoxifen isetshenziselwa ukuvimbela ikhono le-estrogen ukubopha ngamaseli omdlavuza.
Ngemva kokumisa esikhathini, kungakhathaliseki ukuthi ukuphuma esikhathini sokuzalwa komzimba , ukukhishwa kwesikhashana kokuhlinzwa, noma imithi yokucindezela i-ovarian , umthombo omkhulu we-estrogen emzimbeni yilowo okhiqizwa ekuqhekekeni kwe-androgens kwezinye izindawo zomzimba.
I-Aromatase inhibitors isebenza ukuvimbela lokhu okuphendulayo okuguqula i-estrogen futhi ivimbela ukwakheka kwe-estrogen.
Indlela i-Femara isebenza ngayo ekuvimbeleni ukwelashwa kwebelevuza
Njengoba kuphawuliwe, ngemuva kokunqamuka kwesikhashana, umthombo oyinhloko we-estrogen emzimbeni yilokho okukhiqizwa ngendlela ye-androgens emaqenjini amafutha emzimbeni.
Lezi zinhlobo ze-androgens ("ama-hormone" wesilisa) ziguqulwa zibe yi-estrogen ekuphenduleni okwenziwe yi-enzyme ebizwa ngokuthi i-aromatase. Ngokuvimbela isenzo se-aromatase, ukukhiqizwa kwe-estrogen kuvinjelwe. Lokhu kubangela ukuthi i-estrogen encane itholakale emzimbeni ukuvuselela noma yikuphi amaseli omdlavuza webele webele (ase-strogen receptor-positive cells).
Kubaluleke kangakanani ukwelashwa ukunciphisa ingozi yokuphindaphinda umdlavuza webele? Kubonakala sengathi sonke siyazi ngomuntu owayenomdlavuza webele owaphulukiswa kodwa wabuye wabuya iminyaka noma ngisho namashumi eminyaka kamuva. Asiqiniseki ukuthi lezi zingqamuzana zomdlavuza zingakwazi kanjani ukulala isikhathi eside kangaka, kodwa kunezinkolelo zokuthi kungani ukuphindaphindiwe kamuva kwenzeka njengokomdlavuza wesifo somdlavuza onamandla kakhulu kunamaseli avamile omdlavuza webele. Ukuphindaphinda esikhathini esidlule kufana kakhulu ne-canrogen receptor-positive cancer cancer, okwenza usesho lwezindlela ze-adjuvant ezifana ne-Femara kubaluleke kakhulu.
Manje kunconywa ukuthi i-Zometa iqale ngesikhathi esifanayo ne-Femara kulabo abanomdlavuza webele we-postmenopausal abaye baphothula ukuhlinzwa kanye ne-chemotherapy (bheka ngezansi).
Ucwaningo Lutjela Kanjani Ngo-Femara?
Kwabesifazane abanomdlavuza webele we-estrogen-receptor-positive, futhi bathola i-adjuvant chemotherapy, ukwelashwa nge-aromatase inhibitor kubonakala kunciphisa ingozi yokuphindaphinda ngamaphesenti angama-50.
Ucwaningo olubheke abesifazane abathole ukwelashwa kwe-Tamoxifen iminyaka emihlanu, bathola ukuthi ukusebenzisa i-Femara ngemuva kwalesi sikhathi, ngisho nokuqala eminyakeni embalwa kamuva, kwaholela ekusindeni okuqhubekayo.
Abesifazane ababa yisifo sengculaza eminyakeni engu-2 kuya kwengu-3 yokuqala ku-Tamoxifen therapy futhi base beshintshwa ku-Femara iminyaka engama-5 ubudala, babe nengozi ephansi yokuphindaphinda kunabesifazane abaqhubeka besebenzisa i-Tamoxifen yedwa iminyaka emihlanu.
Kulabo besifazane abane-menopausal ekuqaleni kokuphathwa kwe-hormone, kunezinzuzo eziningi ekusebenziseni i-aromatase inhibitors ekuqaleni kunokuqala nge-Tamoxifen.
Akukwazi kahle ukuthi ubude besikhathi obuhle uBuara abonisa ngayo inzuzo, ngamanye amazwi, ukuthi ngabe usebenzise i-Femara isikhathi esingaphezu kweminyaka emihlanu kungakhathaliseki ukuthi uyayisebenzisa yini (bheka ngezansi.) Khuluma ne-oncologist yakho njengoba le ndawo ishintsha ngokuphathelene izincomo zamanje.
Ubani Ongathatha I-Femara
Lesi sidakamizwa sabantu besifazane abaye bathola ukuthi banesifo somdlavuza wesifuba se-estrogen. Owesifazane kumele ukuba agcwalise ukwelashwa okuyisisekelo futhi abe esekupheleni kwesikhathi . Abesifazane besandulela ngculaza bangathatha i-Femara uma ama-ovari awo ekhishwa ngamakhemikhali. Abesifazane abaye banomdlavuza wesifuba we-estrogen we-receptor-negative ngeke bazuze kulo muthi.
Imiphumela Ejwayelekile Yezinsikazi ze-Femara nezinye ze-Aromatase Inhibitors
Njengeminye imithi, imiphumela emibi ijwayelekile ne-Femara. Imiphumela emibi kakhulu evame ukushisa okushisayo kanye nobuhlungu bomzimba nobuhlungu. Eqinisweni, ubuhlungu bomzimba nobuhlungu buyisinye sezizathu ezivame kakhulu lapho abantu beyeka ukuthatha imithi (bona ngezansi).
Ukushisa okushisayo nakho kuvame kakhulu, nakuba abantu abaguqula kusukela ku-tamoxifen kuya ku-Femara ngemuva kokuba i-postmenopousal (ngenxa yobudala, ukuhlinza, noma ukwelashwa kwe-ovarian suppression) ukuthi ukukhanya okushisayo kubonakala kunamandla kakhulu ku-Femara kune-tamoxifen. Nakuba le mphumela yecala ikhungathekisa, noma yini eyanciphisa i-estrogen emizimbeni yethu ingaholela ekukhanyeni okushisayo, nokunciphisa i-estrogen kuyindlela engcono kakhulu yokunciphisa ingozi yokuphindaphindiwe. Abanye abantu baye bakuthola kuwusizo ukuba "baphinde" futhi babheke ukukhanya okushisayo njengesibonakaliso sokuthi ukwelashwa kusebenza.
Eminye imiphumela emibi ejwayelekile ihlanganisa ikhanda, ukukhathala , ukujula okukhulu nokulala. Funda ngezingozi zokulala ukulala ngenxa yeziguli zomdlavuza ngoba zinganciphisa ukusinda komdlavuza webele, kepha ukhetho lwezokwelapha luyatholakala.
I-Aromatase inhibitors ingabangela nokulahleka kwamathambo okungaholela ekutheni i- osteoporosis , nakuba ukusetshenziswa okuhlanganyelwe kwe-Femara ne-Zometa (isincomo esenziwe ngo-2017) singase singanaki lokhu (bheka ngezansi).
Ama-inhibitors e-Aromatase awabonakali okwandisa ingozi yokuhlaselwa yinhliziyo nokushaywa komzimba okuhlobene nokusetshenziswa kwe-tamoxifen kodwa kuhlotshaniswa nezinkinga zenhliziyo ezingathí sina ezinjengezinhliziyo ezingavamile kanye ne-pericarditis (ukuvuvukala kwendwangu yenhliziyo)
Nini Ukucabangela Ukuyeka Ukwelapha
Ngeshwa, ama-aches e-muscle kanye nama-joint awumphumela ojwayelekile kakhulu wokwelashwa no-Femara. Kwesifundo esisodwa esikhulu, kutholakale ukuthi amaphesenti angu-32 weziguli ayeke ukusetshenziswa kwalo muthi ngenxa yemiphumela emibi. Abantu abangamaphesenti angama-24 bamisa lesi sidakamizwa ngenxa ye-aches ye-muscle neyodwa. Kubalulekile ukuthi uqaphele ukuthi phakathi kwalabo abaye bavimba i-aromatase inhibitor ngenxa yemiphumela emibi, okwesithathu bakwazi ukubekezelela omunye weminye imithi kuleli klasi yezidakamizwa.
Khuluma nodokotela wakho mayelana nokuthi ungenzani ukukusiza ukuthi ubhekane nezinhlungu ezihlangene nezomzimba. Ngesilingo esisodwa esilawulwayo sitholwe ukuthi ukukhishwa kwe-acupuncture kwakuwusizo kunokwakheka kwesikhumba ekunciphiseni ama-aches we-muscle ngenxa ye-aromatase inhibitors.
Ukukhanya okushisayo nakho kungacasula futhi kulindeleke ukuthi imithi iyancipha ukukhiqizwa kwe-estrogen emzimbeni wakho. Hlola lezi zindlela ngezindlela zokubhekana nokukhanya okushisayo.
Ukuvimbela I-Osteoporosis
Ukusetshenziswa kwe-aromatase inhibitors kwandisa ukulahleka kwethambo futhi kuye kwaphawulwa ukuthi akugcini nje ukwandisa ingozi ye- osteoporosis kodwa inani lamathambo laphuka phakathi kwabesifazane abasebenzisa lezi zidakamizwa. Xoxa nodokotela wakho mayelana nokuhlolwa kwe-osteoporosis. Qinisekisa ukuthi uthola i-vitamin D ne-calcium eyanele. Empeleni, amazinga aphezulu e-vitamin D egazini lakho noma ahambisana nomdlavuza wesifuba webele, ngakho-ke khuluma nodokotela wakho mayelana nokuhlolwa kwezinga lakho le-vitamin D, nokuthi yini ongayenza uma izinga liphansi.
Abaningi be-oncologists batusa ukuthola ukuhlolwa kwamathambo lapho i-aromatase inhibitors iqaliswa, futhi ngokulandelana kamuva.
Ukusetshenziswa Okubambisana Kwe-Femara ne-Zometa nokulahlekelwa kweThambo
Kulabo abatholakala benomdlavuza webele we-postmenopausal, ama-oncologists manje aqala ukuqala i-bisphosphonate Zometa (zoledronic acid) ngesikhathi esifanayo. I-Zometa ingagcini nje ukunciphisa ingozi yokulahleka kwethambo kanye ne-osteoporosis nge-aromatase inhibitors kodwa iyanciphisa ingozi yokuphindaphindiwe.
Tradeoffs
Imiphumela emibi yesikhashana ye-Femara ibekezelela kakhulu uma wazi ukuthi ingozi yakho yokuphindaphinda incishiswe kakhulu. Abesifazane abathatha u-Femara ngemuva kweminyaka emihlanu yaseTamoxifen babenengozini ephansi kakhulu yokuphindaphinda labo abaphethe iminyaka emihlanu yeTamoxifen. Ngaphezu kwalokho, nge-Femara, ingozi yakho yomdlavuza omusha esifubeni esingehlukile ingaphansi kukaTamoxifen yedwa.
Izincomo zokudinga
Thatha i-Femara kanye ngosuku ngamanzi. Lesi sidakamizwa akudingeki sithathwe ngokudla. Zama ukuyithatha ngesikhathi esifanayo usuku ngalunye, ukugcina ngisho nezinga lemithi ohlelweni lwakho. Uma ungaphuthelwa umthamo, ungaqhubeki kabili, ulinde kuze kube usuku olulandelayo uphinde uqale isimiso sakho semithi. Ungathathi lesi sidakamizwa uma usenesikhathi sokuya esikhathini noma ukhulelwe.
Itholakala njengephilisi ye-2.5 mg, igama lomshicileli (akukho nhlobo lomkhiqizo otholakala), kanye ne-odokotela kuphela.
Ingabe i-Femara kufanele isetshenziswe isikhathi eside kuneminyaka emihlanu?
Izincomo mayelana nobude obuhle be-Femara (nezinye i-aromatase inhibitors) okwamanje zixoxwa ngazo. Izincomo zangaphambilini zaziyiminyaka emihlanu elandela ukwelashwa okuyinhloko ngokuhlinzwa futhi mhlawumbe ukwelashwa ngamakhemikhali kanye / noma ukwelashwa kwemisebe kodwa lokhu kungashintsha.
Nini Ukubiza Udokotela Wakho
Imiphumela emibi kakhulu, njenge-heart disease, ngezinye izikhathi ingenzeka. Izimpawu okufanele zikushayele ukubiza udokotela wakho zihlanganisa ukuphefumula ubunzima, ubuhlungu besifuba, ubuhlungu bomlenze noma ukuvuvukala, ukuphuma kwegazi elingavamile, ukuqhuma kwesikhumba , isifo sohudo, noma isicanucanu nokuhlanza.
Okubalulekile
Uma isetshenziselwa ukulandela ukwelashwa okuyisisekelo komdlavuza wesifuba (ngokuhlinzwa, kanye nokwelashwa kwe-chemotherapy kanye / noma imishanguzo), i-Femara inganciphisa ingozi yokuphindaphinda. Kuyinto ephindaphindiwe kanye nesifo se-metastatic, ngokuvamile, yimbangela enkulu yokufa ekhanda lomabele.
U-Femara uboniswa ngabesifazane besimo se-postmenopausal noma labo abano-premenopausal kodwa baye banomuthi wokwelapha ovariy. Imiphumela emibi evamile ihlanganisa ukushisa okushisayo nama-acular aches nobuhlungu. Imiphumela emibi kakhulu efana nesifo esingenabulawa nesifo sofuba singase senzeke. Ngokungezwa kwe-bisphosphonate therapy, noma kunjalo, ubungozi bokulahlekelwa amathambo kubonakala buyancipha.
I-Femara isinconywa okungenani iminyaka engu-5 kulandela ukwelashwa okuyinhloko, kodwa izifundo zamuva ziphakamisa ukuthi ukusebenzisa isikhathi eside kunganconywa esikhathini esizayo.
> Imithombo
> Dhesy-Isimpungushe, S., Fletcher, C., Blanchette, P. et at. Ukusetshenziswa kwe-Adjuvant Bisphosphonates nezinye izifo ezithinta izifo ezitholakala emdlalweni we-Cancer: I-Cancer Care Ontario ne-American Society of Clinical Oncology Clinical Practice Guideline. I-Journal ye-Clinical Oncology . 2017. 35 (18): 2062-2081.
> Hague, R., Shi, J., Schottinger, J., et al. Izifo Zezinhliziyo Ngemva Kokusetshenziswa Kwe-Aromatase Inhibitor. I-JAMA Oncology . 2 (12): 1590.
> Halsey, E., Xing, M., no-R. Stockley. Ukwakheka kwegazi ukuze uthole izimpawu ezihlangene ezihlobene nokwelashwa kwe-aromatase inhibitor kuma-postmenopausal abesifazane abanomdlavuza wesifuba sokuqala: ukubuyekezwa okulandwayo. Ukukhishwa kwesikhashana kuMithi . 2015. 33: 188-195.
> Henry, N., Azzouz, F., Desta, A. et al. Izibikezelo ze-Aromatase Inhibitor Discontinuation njengengumphumela wezokwelapha-Izimpawu ezivame ukutholakala emdlalweni we-Cancer Stage Cancer. I-Journal ye-Clinical Oncology . 2012. 30 (9): 936-942.
> Senkus, E., Kyriakides, S., Ohno, S. et al. Umdlavuza webele oyinhloko: Imihlahlandlela yokuSebenza ngezifo ze-ESMO zokuxilongwa, ukwelashwa nokulandelwa. Amanothi we-Oncology . 2015. 26 (isibalo sesi-5): v8-v30.