Kunezinketho eziningi zokwelashwa ezihlosiwe ezikhona
Emashumini ambalwa edlule, sifunde ukuthi akuzona zonke izinhlobo zomdlavuza webele. Ngaphandle kokuhluka okubonakalayo ngaphansi kwe-microscope, kukhona umehluko phakathi kwalezi zomshukela ezingeni lemangqamuzana. Ngemuva kokuthi ube ne-biopsy noma ukuhlinzwa uzofunda ukuthi ngabe umdlavuza wakho webele ungumamukeli we-estrogen noma i-progesterone receptor emihle, kanye nesimo sakho se-HER2.
Uma utshelwe ukuthi umdlavuza wakho webele usu-HER2 omuhle, kusho ukuthini lokho? Yiziphi izindlela zokwelapha ezisebenza ngokukhethekile kulolu hlobo lomdlavuza webele nokuthi yiziphi ezinye izifo ezingasetshenziswa?
Uhlolojikelele lwezinketho zokwelapha
Abantu abane- cancer yebele ye-HER2 bangase baphathwe ngendlela efanayo nabantu abanezinkinga ezimbi ze-HER2 ngezindlela ezithile. Isibonelo, ukuhlinzekwa (noma i-lumpectomy noma i-mastectomy,) i-adjuvant chemotherapy, kanye / noma ukwelashwa kwama-hormone (uma isisu kuyinto isrogen receptor positive) ingasetshenziswa.
Izindlela zokwelashwa ezihlosiwe eziqondene nezicubu ezihle ze-HER2 nazo zisetshenzisiwe futhi ziye zathuthukisa izinga lokusinda kwama-HER2-positive tumors. Okukhethwa kukho ukwelashwa kokubili kwesigaba sokuqala kanye nezifo ze-metastatic kuxoxwa ngezansi.
Yeka ukuthi zithinteka kanjani izindlela zokwelashwa
Abantu abangabahlanu noma abayisithupha abanomdlavuza wesifuba bazoba nezicubu eziyi-HER2 / neu ezihle. Lokhu kusho ukuthi amangqamuzana omdlavuza webele womdlavuza anomsebenzi owengeziwe kumaGER2 we-HER2, okuholela ekukhiqizeni ngokweqile kwama-HER2 amaprotheni.
La maprotheni asebenza ukushayela ukukhula komdlavuza wesifo somdlavuza.
I-HER2 imithi yesifo esihle sebele ijwayele ukuhlukumezeka, futhi eminyakeni eyedlule yayinezinkinga ezimbi. Ngo-1998 imithi yokuqala yokukhomba ngqo i-HER2 ivunyiwe. Le mithi i-Herceptin (trastuzumab).
Kusukela ngaleso sikhathi ezinye ze-HER2 ezithintekile zokwelapha zitholakale.
I-Perjeta (pertuzumab) ne-T-DM1 (trastuzumab emtansine) nayo ivunyiwe.
Ngo-2017, imithi uNerlynx (neratinib) nayo yavunywa kubantu abanezinkinga zebele ze-HER2-positive ngemuva kokulandela ukwelashwa no-Herceptin. Lapho i-neratinib (i-tyrosine kinase inhibitor) ingezwe ekwelashweni okujwayelekile yomdlavuza webele esifundweni se-2016, amanani okuphendula okuphelele ayephakeme kunabantu abaphathwa nge-Herceptin kanye nokwelapha okujwayelekile.
I-Tykerb (i-lapatinib) ingenye inhibitor ye-tyrosine kinase engase isetshenziswe ngemuva kokwelashwa ne-Herceptin noma ezinye izindlela ze-HER2.
Ukwelashwa Kwezinyathelo Zokuqala
Ukwelashwa kwesifo somdlavuza webele we-HER2 esifundazweni sekuqala kufana nesifo somdlavuza webele we-HER2, kodwa ngokuvamile kuhlanganisa nokusetshenziswa kwesidakamizwa esihlosiwe se-HER2 njenge-Herceptin.
Izinketho zihlanganisa:
- Ukuhlinzwa: Kungakhathaliseki ukuthi i- lumpectomy noma i- mastectomy ivame ukunconywa ukususa isisu. Uma i-tumor i- DCIS (isiteji esingu-0) noma uma ine-genetic profile (ukuvivinya kofuzo ukuthola ingozi yokuphindaphinda), ezinye izindlela zokwelapha zingadingeka. Ukuze izidumbu ezinkulu, futhi ikakhulukazi lezo ezinama- lymph nodes amahle , ukwelashwa kwe-adjuvant kuvame ukuphakanyiswa.
- Imithi yokwelashwa: Uma isisu sinesifo se- estrogen , ama- hormonal aphethwe njalo (ngokulandela i-chemotherapy kulabo abazophinde babe namakhemikhali e-adjuvant). Kwabesifazane be-premenopausal, ukhetho lokuqala luvame ukuthi i-tamoxifen, ne-aromatase inhibitors inconywa kwabesifazane abase-postmenopausal. Ngaphandle kwalokho, ukwelashwa kwe-ovarian ukucindezela, ukuphuza ama-ovarian, noma okungajwayelekile, i-ovariectomy inganconywa abesifazane besandulela ngculazi ukunciphisa amazinga e-estrogen nokuvumela ukusetshenziswa kwe-aromatase inhibitors.
- I-Chemotherapy: Ngokuya ngesiteji somdlavuza webele, ubukhulu, noma ukubandakanyeka kwe-lymph node kukhona, nokuhlolwa kofuzo, i-adjuvant chemotherapy inganconywa. Lokhu kuvame ukuqala cishe inyanga emva kwe-lumpectomy noma i-mastectomy futhi kwenziwa esikhathini esingangezinyanga ezine kuya kweziyisithupha.
- Imithi yokwelapha ye-HER2: Njengoba kuphawuliwe ngenhla, manje kukhona izinketho eziningana zokwelashwa okuhlosiwe kwezicubu zebele ze-HER2, ezihlanganisa i-Herceptin (trastuzumab), i-Perjeta (pertuzumab), ne-T-DM1 (i-trastuzumab emtansine), nezinye izidakamizwa ezihlolwa emtholampilo izilingo. Ngokuvamile, i-Herceptin isetshenziswa kuqala. I-Tykerb (i-lapatinib) iyinhibitha ye-tyrosine kinase esebenza kahle nge-HER2 izicubu ezinhle. I-Nelynx (neratinib), enye i-kinase inhibitor, nayo isanda kuvunyelwa ukwelashwa kwesifo se-HER2-positive umdlavuza webele esilandelayo ngemuva kokwelashwa no-Herceptin.
- Ukwelashwa kwezidakamizwa: Kubantu abakhetha i-lumpectomy, ukwelashwa kwemisebe ngokuvamile kuvunyelwe ukuhlinzwa okulandelayo. Ngama-tumor ane-lymph nodes amane noma ngaphezulu, ukwelashwa kwe-radiation ngemuva kwe-mastectomy ngokuvamile kubhekwa. Izikhwama ezine-lymph nodes ezintathu ezihle zisezindaweni ezimpunga, futhi kubalulekile ukukhuluma nombili oncologist yakho yezokwelapha kanye ne-oncologist yemisebe mayelana nezinzuzo zalokhu ukwelashwa.
- Izivivinyo zemitholampilo: Kunezinhlobo eziningi zokuvivinya kwemitholampilo eziqhubekayo ezibhekene nezinketho ezahlukene zokwelashwa, amakhemikhali, kanye nokwelashwa kwemishanguzo, kanye nokuqhathanisa izindlela ezahlukene zokwelapha eziphathelene ne-hormonal kanye ne-HER2. Kunezinkolelo eziningi mayelana nokuhlolwa kwemitholampilo , kodwa ngezinye izikhathi ukuhlolwa komtholampilo kunika ithuba lokuthola ukwelashwa. Kubalulekile ukukhuluma ne-oncologist yakho nganoma yikuphi ukuvivinywa kokwelashwa okungenzeka kube kuhle kuwe.
- I-Bone yokwenza izidakamizwa: Muva nje, ukungezwa kwe-bisphosphonate therapy kuye kwacatshangwa ekuqaleni komdlavuza wesifuba webele ngoba kunganciphisa ingozi ye-metastases yamathambo esikhathini esizayo. Khuluma ne-oncologist yakho ngalokhu kungenzeka.
Ukwelashwa Kwezinyathelo Eziphakeme
Ngomdlavuza wesifuba we-metastatic (isigaba 4), izindlela zokwelapha zokulawula lesi sifo ngokuvamile ziwumgomo wokwelashwa. Ukwelapha nokwelapha imisebe kubhekwa njengokwelashwa kwendawo futhi akuvame ukusetshenziselwa ngaphandle kwezinhloso zokwehliswa (ukunciphisa ubuhlungu kanye / noma ukuvimbela ama-fractures).
Uma umdlavuza webele we-HER2 we-metastatic isifo somdlavuza esikude esifundazweni somdlavuza webele, kubalulekile ukuqaphela ukuthi isimo se-HER2 (nesimo se-receptor yestergen) singashintsha. I-biopsy yesayithi ye-metastasis nokuphindaphinda izifundo ze-receptor kuvame ukuphakanyiswa. I-tumor eyayiqale i-HER2 enhle ingaba yi-HER2 engalungile kokuphindaphindiwe futhi ngokuphambene nalokho.
Ukwelapha kokuqala komdlavuza webele we-HER2 ophuthumayo kuzoxhomeka kulezi zifundo zokuthola. Kulabo abano-HER2 positive, enye ye-HER2 ethintekayo yokwelapha ivame ukusetshenziswa. Uma isisu sinesifo se-estrogen esihle, noma ukwelashwa kwe-hormonal, ukwelashwa kwe-HER2, noma kokubili kungacatshangwa. I-Chemotherapy ingasetshenziswa futhi izinyanga ezimbalwa.
Kubalulekile ukuqaphela ukuthi umgomo wokwelashwa komdlavuza wesifuba we-metastatic uvame ukuhluka kunokuba isifo somdlavuza webele sesisencane, ngakho lapho ukwelashwa kancane ngangokunokwenzeka ukuze ulawule lesi sifo kuvame ukuphakanyiswa.
Uma isisu sesiphathwe kakade no-Herceptin (trastuzumab) esimweni esinqunyiwe, ngemuva kwesikhathi esingenayo ukwelashwa (kulinganiswa kusukela ekupheleni kwe-adjuvant trastuzumab) ezinyangeni ezingaphansi kwezinyanga eziyisithupha ukwelashwa kwemigqa yesibili okukhethwa yi-T-DM1 (i-ado -trastuzumab emtansine). Ngaphandle kwalokho, uma isisu sesivele sesiphathwe i-Herceptin esimweni esinqunyiwe, ngemuva kwesikhathi esingenasipiliyoni esingaphezu kwezinyanga eziyisithupha I-Perjeta (pertuzumab) ehlangene ne-trastuzumab kanye ne-taxane ingasetshenziswa.
Kulezi ziguli ezithuthuka ngemuva kwe-trastuzumab ne-taxane esimisweni sesimiso, i-T-DM1 iyona khetho olukhethiwe. Ngeziguli ezingazange ziphathwe no-Herceptin ngaphambili, inhlanganisela yeHerceptin kanye nePerjeta kanye ne-taxane kufanele isetshenziswe.
Uma umdlavuza uye waqhubeka naphezu kwalezi zelashwa, inhlanganisela yeTykerb (lapatinib) ne-Xeloda (capecitabine) ingahlolwa. Amanye amakhemikhali e-chemotherapy noma ama-hormonal therapies nawo angahlolwa.
I-HER2 umdlavuza wesifuba omuhle cishe uyasakazeka ebuchosheni nasebindi kunama-tumor aHER2 angalungile. Ngenhlanhla, u-Herceptin, futhi mhlawumbe iPerjeta ibonakala idlula emkhakheni wezinkinga zegazi futhi unciphisa ubukhulu be-metastases yobuchopho. Kubantu abanamathambo asetsheni, amathambo okwenza izidakamizwa ezinjenge-bisphosphonates angeke anciphise kuphela ingozi yezinhlanzi kodwa angase athuthukise nokuphila.
Ukwelapha Okudidiyelwe
Abantu abaningi babuza ukuthi kungenzeka ukuthi kunezinye izindlela zokwelapha lapho bebona ukuthi banekhansisi yesifuba. Ngesikhathi samanje, azikho "ezinye izindlela" zokwelashwa ezitholakale ziphumelele ekwelapheni umdlavuza webele. Esikhundleni salokho, abanye abantu abaye bakhethe lezi zindlela zokwelashwa ngaphandle kokuphathwa okwejwayelekile baye balahlekelwa ukwelashwa okuye kwaboniswa ukuthi kusebenza kahle.
Kodwa kubalulekile ukuthi ungaphonsa umntwana ngaphandle kwamanzi okugeza. Kunezindlela eziningi zokwelapha zomdlavuza ezitholakale ukusiza abantu ukuba babhekane nezibonakaliso zesifo kanye nemithi yokwelashwa, kusukela ekukhathala nokukhathazeka kuya kwesisulu sokudla, isifo sezinzwa ze-peripheral neuropathy , nokuningi. Ezinye zezokwelapha eziye zahlolwa ikakhulukazi kwabesifazane abanomdlavuza webele zihlanganisa i- yoga , ukuzindla , ukwelapha ukusikhipha umzimba , kanye nokukhwabanisa .
Isibikezelo
Ngaphambi kokuba i-HER2 ihlolwe ngemithi yokwelashwa, kwakungekho ukwelashwa okuqondile okutholakala ku-HER2 izicubu ezinhle, futhi lezi zibhekwa njengezifo zomdlavuza. Njengoba kufika ukwelashwa okuhlosiwe, lokhu, lokhu kushintshile.
Ucwaningo lwango-2017 lwathola ukuthi abesifazane abanomdlavuza webele we-HER2 we-metastatic positive babenezinga eliphezulu lokusinda kunabesifazane ababengaba yi-HER2 negative lapho ukwelashwa ku-Herceptin kusetshenzisiwe. Izindleko zokusinda eziphansi kunawo wonke zivame ukuba ngabesifazane abanomdlavuza webele wesithathu.
Ukuthola Ukusekela
Ngenhlanhla, ukuqwashisa nokwesekwa kwemali yomdlavuza webele kunikeze inqwaba yemithombo yokusiza abantu ukuba babhekane nalesi sifo. Amaqembu asekela kanye nemiphakathi yokusekela iyatholakala kulabo besifazane abanomdlavuza wesifuba ngokujwayelekile, kanye nalabo ababhekana ngqo nomdlavuza we-metastatic. Imiphakathi e-inthanethi ngisho namaqembu e-Facebook abantu abane-HER2-positive umdlavuza webele abuthana ndawonye njengoba bebhekana nezinselelo zabo eziyingqayizivele.
Ukubamba iqhaza emithonjeni yezenhlalakahle bekuwumthombo kokubili ukusekela nokufundisa kubantu abaningi abanesifo. Uma ukhetha ukuhileleka ngale ndlela, nokho, thatha isikhashana ukufunda ukuthi ungaba kanjani uhambo lwakho lomdlavuza online ngokuphepha.
I-intanethi yindawo enkulu futhi ngezinye izikhathi kungase kube nzima ukuthola abantu ababhekene nohambo olufanayo kuya kweyakho. Ukuze uxhumane nabanye abahlala nabo, noma ukwelapha, umdlavuza webele, ukusebenzisa i-hashtag #BCSM iyasiza kakhulu. I-BCSM imele abezindaba zomdlavuza webele webele.
Izwi elivela
Esikhathini esidlule, umdlavuza webele we-HER2 wayebhekwa njengesisu esinonya ngaphandle kokuthola ukwelashwa okuqondile. Konke kwashintsha ngo-1998 ngokuvunywa kwe-HER2 yokuqala yokwelashwa okuhlosiwe, i-Herceptin. Kusukela ngaleso sikhathi, ezinye izidakamizwa zitholakale zihlanganisa i-Perjeta, i-T-DM1, i-lapatinib, kanye ne-neratinib yakamuva, nezinye izidakamizwa ezihlolwe ekuvivinyweni kwemitholampilo. Imithi yokwelashwa ye-HER2 inganciphisa ingozi yokuphindaphindiwe ekuqaleni kwesigaba se-HER2-positive umdlavuza wesifuba futhi ithuthukise izinga lokusinda emdlalweni webele we-HER2-breast metastatic.
Ngaphezu kwemithi yokwelapha ye-HER2, ukwelashwa kwama-cancer webele we-HER2 kuhlanganisa nokuphathwa kwezifo ezimbi ze-HER2 ezifana nokuhlinzwa, ukwelashwa kwe-hormone (uma kusebenza), ukwelashwa kwe-chemotherapy, ukwelashwa kweminye imithi, ukwelashwa okuqondile kwamathambo, kanye nokutholakala kokuhlolwa kwamakhambi .
> Imithombo:
> Chan, A., Delaloge, S., Holmes, F. et al. I-Neratinib Emva kwe-Trastuzumab-based Based Adjuvant Therapy kwiziguli ezine-HER2-Positive Cancer Breast (ExteNET): A Multiticentre, Randomized, Double-Blind, I-Placebo-Controlled Phase 3 Trial. I-Lancet Oncology . 17 (3): 367-77.
> Kast, K., Schoffer, O., Isixhumanisi, T. et al. I-Trastuzumab nokuPhepha kweziguli ezine-Metastatic Breast Cancer. I-Archives ye-Gynecology ne-Obstetrics . 2017. 296 (2): 303-312.
> Park, J., Liu, M., Yee, D. et al. Randomzation Adaptive of Neratinib in Cancer Early Breast. I-New England Journal of Medicine . 2016. 375 (1): 11-22.