Izindlela zokwelapha ezintsha ezinhlanu zokuphila-I- Provenge , iZytiga , Xtandi, i-Xofigo, ne- Jevtana- zizotholakala ekuphatheni umdlavuza wesi-prostate eminyakeni emihlanu edlule. Ngenhlanhla, izindlela zokwelapha ezindala ezifana ne-radiation, i-Lupron, ne-Taxotere zihlala zisebenza kahle. Ngokuvamile, umdlavuza we-prostate uqhubeka kancane kancane, okusho ukuthi ukufa kungahlehliswa isikhathi eside kakhulu.
Naphezu kwazo zonke lezi zici ezinethemba, amadoda angama-28,000 awela umdlavuza wesibeletho unyaka ngamunye. Ezimweni eziningi, ukushona kwenzeka ngenxa yokuthi umdlavuza ugcina unamathele kuzo zonke izifo ezijwayelekile ezibalulwe ngenhla. Uma lokhu kwenzeka, isinyathelo esilandelayo esilandelayo ukucabangela ukwelashwa kwelebuli ngaphandle kwemithi efana nemithi evezwe yi-FDA kwezinye izinhlobo zomdlavuza, kusho umdlavuza wezinso noma umdlavuza wamaphaphu, isibonelo. Inkinga ikhethwa phakathi kwezinketho eziningi. Uma uzothatha isibhamu ebumnyameni, yisiphi isibhamu okufanele ukhethe?
Ama-Label Agxishiwe: Indaba Yomguli
Ukufuna i-agent esebenzayo ye-off-label ingaba nenkokhelo enkulu uma uthola lucky. Kusukela kumbono we-FDA, izidakamizwa ezivunyelwe zingasetshenziselwa ukusetshenziswa okungavunyelwe uma umhlinzeki wezempilo ezwa ukuthi kufaneleka isiguli sakhe ngokwemithi, kungakhathaliseki ukuthi asikho isidakamizwa esivunyelwe ukuphatha isimo esinikeziwe noma ngoba isiguli sizame konke okuvunyiwe ukwelashwa ngaphandle kokubona imiphumela.
Ake ngilandise indaba kaBill. Utholwe ukuthi uqale ngasekupheleni kuka-2010 nge-PSA ye-4.2 ne- Gleason score of 3 + 4 futhi waphathwa nge ukuhlinzwa ukususa prostate. Isibonakaliso sokuqala senkathazo eyengeziwe ukuthi umbiko wakhe wezinkinga wabonisa umdlavuza ngaphandle komngcele we-prostate. Isaphulelo sakhe seGleason sabuye savuselelwa ku-4 + 5 = 9, futhi i-PSA yakhe ayizange ihlaselwe ku-zero ngemva kokuthi isisindo sasuswa.
Ngo-Mashi 2011, waba nomswakama oqondiswe endaweni yomzimba lapho i-prostate yayikhona khona, kodwa i-PSA yahlala iphansi isikhathi esifushane. Wabe eseqala uLupron, kodwa isisu sakhe saba umelana phakathi nonyaka. Eminyakeni emithathu eyalandela, waphathwa ngemithi echazwe ngenhla, i-Provenge, i-Zytiga, i-Xtandi ne-Taxotere. Ngohlobo lwe-2014, umdlavuza wakhe wasakazeka kakhulu kuwo wonke umthambo wakhe. Ukwelashwa nge-Xofigo kwaqalwa ngoFebhuwari 2014. Ngeshwa, wahlakulela ukuhluleka komnyofu we-bone, ukuthuthukiswa okuvamile emadodeni anomdlavuza ongasalawuleki wesifo sofuba. Ukukhiqizwa kwakhe kwamangqamuzana egazi abomvu kwakungabonakali kakhulu, kodwa wayezogcinwa ephila ngokumpompela igazi njalo ngenyanga. Lapho i-Xofigo ivaliwe ngo-Agasti 2014, i-PSA ikhuphukile ibe ngaphezu kuka-120. Ithuba likaBill lokuhlala ezinye izinyanga eziyisithupha lingaphansi kweyodwa kwabayishumi.
Kuze kube manje, omunye udokotela wayephethe icala lakhe. Ngaphambi kokuba ashintshe ukuqondiswa kokunakekelwa kwakhe kwezempilo ehhovisi lami udokotela wakhe odlule waqala uBill ngemithi e-off-label ebizwa ngokuthi i-Mekinist. I-Mekinist iphilisi e-FDA-evunyelwe i-melanoma yemetrase. Njengoba ukusetshenziswa komdlavuza we-prostate (ukusetshenziswa kwelebuli engekho) akuhlanganiswa nomshuwalense, uBill wathenga iphilisi ngokwakhe ngezindleko zamaRandi ayizigidi ezingu-10 ngenyanga.
Nokho, utshalomali lwakhe lukhokhwe. Ngenyanga kaDisemba 2014 i-PSA yawela ku-18.96, umongo wakhe waqala ukusebenza futhi wayengekho isidingo sokumpontshelwa igazi.
Impilo kaBill yathuthuka kakhulu kangangokuthi wabuyela emsebenzini wakhe ogcwele futhi wahamba nohambo lwakhe njalo eYurophu nasezindaweni ezihlukahlukene e-US eminyakeni emibili elandelayo. I-Mekinist yayinakekelwa kahle ngaphandle kwemiphumela emibi ephawulekayo. Ngeshwa, umdlavuza wakhe we-prostate wagcina umelana noMekinist futhi umdlavuza waqala ukuqhubeka. Imizamo yethu eyengeziwe yokuthola enye i-off-label magic bullet ayiphumelelanga futhi yahlukana nesifo ekuqaleni kuka-2016.
I-Mekinist kaBill yayiyikhetho elimangalisayo lucky. Ngemuva kokubonisa impendulo enkulu yomdlavuza, wayesekwazi ngisho nokwenza inkampani yakhe yomshuwalense ukuba ihlanganise izindleko. Ukuphumelela komsulwa womdlavuza esikhathini esesiphezulu sesifo kuyamangalisa ngempela, isithembiso semikhiqizo ye-groundbreaking esakhiwe embonini yezokwelapha. Njengoba kunikezwe ama-agent amaningi amasha, izinkinga zokuthola inzuzo enhle, njengokwesimo sikaBill, ukuphinda ziphindwe ziyathuthuka.
Ukuhlolwa Kwemvelo: Indlela Yokukhetha Okuhlakaniphile
Inkinga manje ukuthi kukhona inqwaba enkulu yezinxusa ezintsha ezivunyelwe kuzo zonke izinhlobo ezahlukene zomdlavuza. Uyazi kanjani ukuthi iyiphi i-ejenti okufanele uyikhethe? Sizame ukunikeza ama-Mekinist kwezinye iziguli ezimbalwa, kodwa ngaphandle kokuthola usizo oluphikisana nomdlavuza. Lokhu akumangalisi uma ucabanga ukuthi umdlavuza wesifo sofuba awuyona isifo esisodwa. Sekuyisikhathi eside sibheke ukuhluka okubanzi endleleni iziguli ezithinta ngayo ama agent ahlukene. Kodwa-ke, kukhona enye indawo yentuthuko yezobuchwepheshe esheshayo engasisiza ukuba sihlele iziguli zelashwa ezithile. Ukufika kokuhlolwa kofuzo kwamangqamuzana omzimba kungaqeda ukuphela kwesikhathi sokukhetha ukwelashwa ngezikhathi ezithile.
Umqondo uwukukhetha ukwelashwa ngokukhomba i-genetic profile yamangqamuzana omdlavuza ngokulandelana kwezakhi zofuzo. Ukukhula kwamaselula okungalawulwa, "umdlavuza," kubangelwa ukungaziphathi kahle kwezakhi zofuzo. Izakhi zofuzo eziguqulwe ngokuqondile ezihlobene nokukhula kwamangqamuzana zingangena endaweni "ku-". Lezi zinguquko zingabonakala ngokulandelana kwezakhi zofuzo. Kuye kwaqaphela ukuthi ama-geni angaphezu kwama-50 ayengasebenzi emdlalweni wesibeletho. Ukuhlaziywa kwezakhi zofuzo kubonisa ukuthi kulesisindo samangqamuzana omdlavuza mayelana nezakhi zofuzo ezine atholakala ukuthi ashintshwe. Kodwa-ke, inani lezakhi zofuzo ezimbi ezitholakalayo lingabalwa ukusuka kumbalwa kunye kuya kwezingu-10.
Ngokuthakazelisayo njengoba isithembiso saloluhlobo lwe "smart" luzwakala, kusekhona izinselele eziningana okumelwe zinqobe. I-gene yokulandelana ingakwazi ukukhomba ngokuzenzakalelayo izakhi zofuzo ezingasebenzi, kodwa hhayi njalo umsebenzi wangempela wofuzo. Uma sisazi umsebenzi, kaningi asinayo imithi ethile yokulwa nenkinga igesi idala. Ngisho noma imithi esebenzayo ikhona ukuze aphathe isakhi esithile esingasebenzi kahle komunye uhlobo lomdlavuza, akukho isiqinisekiso sokuthi ukuphathwa kwayo kuzophinde kuphumelele emdlalweni we-prostate. Isibonelo, i-Mekinist icatshangwa ukuthi iphumelela ekumelaneni nokungaziphathi kahle kwegesi ebizwa nge- GNAS kuziguli ezine-melanoma. Kodwa-ke, njengamanje, asinayo imininingwane ebonisa ukuthi i-Mekinist izosebenza kahle iziguli zomdlavuza we-prostate nge- GNAS .
Izindlela Zokuvivinya I-Genetic
Ngempela sazama ukuthola amangqamuzana omdlavuza wezokuhlolwa kofuzo kuBill nge-bone-oriented bone biopsy. Ngeshwa, i-biopsy ayiphumelelanga ngoba akukho namaseli we-tumor asebenzayo atholakala. Okuhlangenwe nakho kwethu nge-biopsy ukuthola amangqamuzana e-tumor avela emthanjeni wokuhlolwa kwezakhi zofuzo ezigulini zomdlavuza we-prostate uye waphumelela cishe cishe kwesigamu seziguli esazame ukuzenza nge-biopsy. Kuze kube yamuva nje, i-bone biopsy yindlela kuphela yokufinyelela izinto eziphathekayo ezakhiweni zamangqamuzana. I-Bone biopsy, noma kunjalo, iyinkimbinkimbi futhi ingenakulungele idinga inaliti enkulu. Ngenhlanhla, ubuchwepheshe buqhubeka nokuqhubeka ngesivinini esisheshayo. Ukuphumelela kwamuva ukutholakala ukuthi i-DNA ye-tumor ekhishwe egazini kumaseli omdlavuza wokufa ingatholakala futhi ihlolwe ngokuhlolwa kwegazi.
Ukuhlola i-DNA yegazi kulula kakhulu kunokukwenza i-bone biopsy. Ngaphandle kwento elula, i-DNA egazini ihlanganiswe ne-DNA ekhishwe kuzo zonke izicubu kuwo wonke umzimba. Izakhi zofuzo ezitholakala kwi-biopsy yesifo esisodwa ngokuvamile ngeke zilandise yonke indaba ngoba umdlavuza usuke ungenakulinganiswa ukuthi izakhi zomdlavuza ezivela kwesiguli esifanayo zingase zihluke ngokwezakhi zofuzo.
I-blood test ye-DNA ye-tumor manje itholakale ngokuthengisa. Inkampani eyenza i-assay ibizwa ngokuthi i-Guardant Health. Babiza i-assay yabo yegazi ehlola umdlavuza wezakhi zomzimba i-Guardant360. Izivivinyo zama-testay ezingu-70 zinguquko ezivame kakhulu ezibonakala emdlalweni. Ucwaningo selwenziwe ukuhlola uma izakhi zofuzo ezingavamile ezitholakala egazini zifanelana nezakhi zofuzo ezingavamile ezitholakale ngesifo sofuba se-biopsy esifundeni esifanayo. I-assay yegazi ibonakala yenza kahle kakhulu.
Ngemuva kweGene engavamile kutholakala
Ngakho-ke ake sibuyele esihlokweni sethu esiyinhloko sokusebenzisa ulwazi olusuka ku-genetically-otholwe ukukhetha ukwelapha umdlavuza welebula kumadoda ane-prostate umdlavuza oye waphelela ukhetho lwabo lwe-FDA oluvunyiwe. Uma igesi elingavamile litholakala kukhona imiphumela emine engenzeka:
- Ayikho yokwelapha eyaziwayo ehlotshaniswa nalesi sifo esingavamile somdlavuza.
- Kukhona ukwelashwa okugunyaziwe yi-FDA yomdlavuza we-prostate etholakalayo kule ge gene ethize
- Kukhona ukwelashwa okuvunyiwe kwe-FDA etholakalayo okwenza olunye uhlobo lomdlavuza (lung, izinso, i-melanoma, njll) okungenzeka kube nomsebenzi we-antiticancer kumdlavuza wesi-prostate nalesi sifo esingavamile.
- Kukhona ama-ejenti amasha ahlolwe ngalolu hlobo olungajwayelekile lwezakhi zofuzo ezivivinyweni zomtholampilo noma emdlalweni wesifo somzimba noma olunye uhlobo lomdlavuza. Iziguli ezinalolu hlobo lokuguqulwa komzimba zingase zenzeke kangcono ukuphendula le-ejenti ethile ngokucubungula indlela yokusebenza eyaziwa yile ejenti.
Ukubhekisisa ngenhla ngezindlela ezisebenzayo, imiphumela emibili yokuqala ngeke ibe usizo olukhulu kuziguli. Ngokuqondile, ngokuqondene nomphumela wesibili, iziguli eziningi ezithola ukuhlolwa kofuzo lomdlavuza we-prostate sezikhathele kakade ukhetho lwezokwelapha lwe -FDA-oluvunyelwe ukwelashwa okwamanje. Imiphumela yesithathu neyesine yilawo engase ikhombe uhlobo lokwelapha okungase lulahleke ngemuva kwesixuku sezinketho ze-off-label okufanele zicatshangelwe.
Kuyadabukisa ukuthi iphrofayli kaGill ye-gene ayitholakali naphezu kwemizamo yethu emihle. Umthelela weMekinist empilweni yakhe kanye nempilo yakhe yayinempilo enkulu. Kuleli qophelo, asazi ukuthi impendulo yakhe enhle kakhulu yenzeke ngenxa yokuthi abe nokusebenza kabi kwe-GNAS, esinye isakhi noma inhlanganisela ethize yezakhi zofuzo. Kodwa-ke, manje ngokufinyelela okulula kokuthola ulwazi lwezofuzo ngokuhlolwa kwegazi nge-Guardant360, sizokwazi ukufunda ukuthi yiziphi izindlela zokwelashwa ezingase zenze impendulo yomdlavuza isekelwe kuphrofayli yesiguli ngasinye somuthi.