Ukwelashwa komdlavuza wesifo se-prostate omelana nesifo se-prostate
Izinto eziningi ziye zashintsha ekwelapheni umdlavuza wesibeletho eminyakeni eminingi edlule. Lokhu kuyiqiniso ikakhulukazi ekwelapheni umdlavuza we-metastatic castration-resistant prostate (mCRPC). Lona umdlavuza wesibeletho ohlulekile ukwelashwa okuyisisekelo (ukuhlinzwa, ukushiswa kwemisebe njll.) Futhi uye wahluleka ukwelashwa kwama-hormone (androgen blockade noma castration).
Lokhu kusebenza nasezigulini ezethula ngesifo se-metastatic futhi ziye zahluleka ukwelashwa kwama-hormonal. Ngaphambi kokuqala kokusetshenziswa kwe-chemotherapy kulaba baguli isikhathi sokuphila esiphakathi sasinezinyanga ezingaba ngu-8. I-Chemotherapy ithuthukisiwe ngalokhu kodwa ayikhambi kahle.
Kusukela ngo-2010 imithi emisha eminingi isitholiwe iziguli ezine-mCRPC. Okulandelayo incazelo emfushane yezokwelapha ezintsha.
- I-Abiraterone Acetate (i-Zytiga) - i-Zytiga ivimbela ukukhiqizwa kwababikezeli be-testosterone futhi inciphisa amazinga e-testosterone. Kuvame ukunikezwa nge-prednisone. I-Zytiga ekuqaleni yaboniswa ezigulini ezihlulekile i- docetaxel (i-chemotherapy) kodwa izifundo zakamuva zakubonisa inzuzo kumguli we-pre-chemo. Ucwaningo olulodwa lubonise ukuthi ukusinda kwamahhala okuqhubekayo kwe-radiographic (rPFS) kwakunezinyanga ezingaphezu kwengu-16 ku-Abiraterone ne-prednisone eqenjini lezinyanga ezingu-8 eqenjini lokulawula.
- I-Enzalutamide (i-Xtandi) - Eyaziwa ngokugcwele njenge-MDV3100 le mithi yesibili i-androgen-receptor blocker yesizukulwane. Isebenza kokubili naphakathi kweseli. Ekuqaleni kuboniswe iziguli zokuthunyelwa kwe-chemotherapy ye-mCRPC kodwa izifundo zibonise inzuzo kumguli we-pre-chemo futhi. Ucwaningo olulandelayo lubonisile ukuthi ngokwesilinganiso, i-enzalutamide ilibale isidingo sokwelapha ngamakhemikhali ngezinyanga ezingu-17 (28 vs 11). Kubuye kubonise ukuthi ukusetshenziswa kwalokhu kuthuthukiswa kwe-radiographic okuphuthumayo ngo-81%.
- I-Radium 223 Dichloride (Xofigo) - Nakuba lokhu kungumjovo empeleni uhlobo lwama-radiation okuthiwa i-alpha rayation. Le ukwelashwa kuhloswe ukubhekisela amangqamuzana omdlavuza we-prostate emathanjeni. Amathoni anomdlavuza we-prostate ayethanda kakhulu i-Xofigo. I-Radium iphinda ikhiphe imisebe ye-alpha, elula kakhulu. Umqondo ukubulala amangqamuzana omdlavuza osebenzayo onomonakalo omncane amathambo avamile. Lokhu kufanele kuhloswe kakhulu kune-strontium-89, esetshenziswe esikhathini esidlule. Ucwaningo lubonise ukusinda okwandayo kwiziguli ezine-mCRPC kanye ne-metastasis yethambo.
- I-Sipuleucel-T (Nikeza) - I-Sipuleucel-T iyinomdlavuza womdlavuza we-prostate umdlavuza. Lenzelwe iziguli ezingenakulinganiswa noma ezincane ezibonakaliswa nge-mCRPC. Ihlukile kumuntu ngamunye isiguli futhi idinga ukunikela ngegazi. Igazi lenziwe kusebenze ebhodini bese liphinde lifakwa kamuva ngesonto. Ukwelashwa kunikezwa izikhathi ezintathu ngaphezu kwenyanga. Kuyinto yokuqala yokugoma yomdlavuza we-FDA (okungafani nomgomo wokuvimbela). Ukusinda jikelele kwanda ngokusetshenziswa kweziNxephezelo ngezigulane ze-mCRPC eziphawulekayo noma ezincane.
Imibuzo ekumele iqinisekiswe esikhathini esizayo ukuthi ingcono kanjani ukulandelana lezi zindlela ezintsha zokwelapha? Uma isiguli sihluleka ama-hormone, yimiphi imithi okufanele isetshenziswe kuqala noma kufanele i-chemo iqale? Imiphi imithi inikeza inzuzo engcono kakhulu? Ingabe le mithi kufanele isetshenziswe yedwa noma ihlanganiswe? Ngenkathi kunemibuzo eminingi evelele lezi zengezo zamuva kumdlavuza we-prostate yemithi izosiza ngempela iziguli eziningi.
Imithombo
URathkopf DE, Smith MR, De Bono JS, et al. Kubuyekezwe ukuhlaziywa kwesikhashana (IA) kwe-COU-AA-302, isifundo se-Phair III se-abiraterone acetate (AA) esihleliwe ngeziguli (pts) esinomdlavuza we-prostate-resistant-resistant (mCRPC) we-metastatic ngaphandle kwe-chemotherapy ngaphambi. J Clin Oncol. 2013; 31 (isidlo sesithupha, sigqamile 5).
Ubhiya TM et. al. I-Enzalutamide emadodeni anomdlavuza we-chemotherapy-naive metastatic prostate (mCRPC): Imiphumela yesigaba III UKUFUNDA OKUPHAKATHI. J Clin Oncol 32, 2014 (isibalo esingu-4; sichitha i-LBA1 ^).
I-Parker C et al. I-Alpha Emitter Radium-223 kanye Nokusinda Emdlalweni We-Metastatic Cancer. N Engl J Med. 2013; 369: 213.
Longo DL (Julayi 2010). "Izindlela ezintsha zokwelapha umdlavuza we-prostate-resistant". N. Engl. J. Med. 363 (5): 479-81.