EML4-ALK muLung Cancer uye Basa reCrizotinib
Kana chiremba wako akakuudza kuti une rearrangement ye ALK kana kenza yemapapu emuAlk-positive, unganzwa sokuti iwe uri munyika inotaura mutauro wekunze usina muturikiri. Ndezvipi zvakaitwa ALK, zvakakosha sei rearrangement ye ALK, uye vanhu vane kenza yemapapu emuAlk vanobata sei?
Tsanangudzo yeA ALK Mutation
Chirongwa cheAARK chisingaenzaniswi mujeni rinogona kuitika mumasero emukenza semakenza emukenza emapapu.
Sokudzokorora kwakakurumidza, mazamu ndiwo zvikamu zvekromosomes muDNA yedu iyo inoratidzira zvinhu zvakadai semuvara weziso redu uye mvere dzemvere. Izvowo zvirongwa zvinoratidzira mapuroteni anokonzera nzira dzinochengetedza miviri yedu inoshanda zvakanaka-kana kuti kuita kuti masero aparadzanise nekukura.
Kanzera masero masero akave akawana mamiriyoni akawanda echishanduko-kuchinja mumagenjini-mukutora masero ekenza. Kufanana nevanhu, kenza yese yakasiyana uye inotakura kuchinja kwakasiyana-siyana uye kuchinja kwemajini. Izvozvo zvakashandura majee emakemikari epo mapuroteni asina kukwana uye anoita mabasa asina kukodzera-akadai sokufambisa kukura kwekenza.
Zakawanikwa muna 2007, mutauro we ALK unoshanduka mumutumbi unonzi ALK (anaplastic lymphoma kinase.) Kuti zvive zvakanyatsojeka, kuchinja uku ndiko chaizvoizvo kugadziriswa kwegene-kusanganiswa kwemajini maviri anozivikanwa seAl uye EML4 (echinoderm microtubule-yakabatana neprotein sai 4.) Iri jeni risingawanzoiti (gene fusion) mumitemo yepuroteni isina kufanana inonzi tyrosine kinase (kune marudzi mazhinji eudrosine kinases.)
Tyrosine kinases ma enzyme (mapuroteni) anoshanda semakemikari nhume, kutumira zviratidzo kumasero ekukura kukura anotaura kuti sero kugovana uye kuwedzera. Zviri nyore, tyrosine kinase "inotya" kana kuti inotaurira kukura kwekenza (kuchinja kwakafanana neEEML4-ALK fusion gene inozivikanwa se "kuchinja kwekutyaira.")
Chikamu chinonakidza chekuwanikwa uku ndechekuti iye zvino mamwe kanzira inogona kurapwa ne tyrosine kinase inhibitors, zvinodhaka zvinodzivisa tyrosine kinase (munyaya iyi fusion protein EML4-ALK) uye inodzivisa kukura kwekenza nekudzivirira zviratidzo zvinoudza sero kugovana. Nokunyanya kudzora kenza ye "on-off" kushandura, mishonga iyi yakavandudza hupenyu hwevamwe vanhu vanorarama nekenza avo vane mutano we ALK.
Vamwe vanhu vanoziva kune imwe shanduko inowanikwa kune vamwe vanhu vane kenza isiri duku yemapapu, inonzi EGFR mutation . Izvi zvinoguma nekugadzirwa kwechirwere che tyrosine kinase mapuroteni, uye EGFR tyrosine kinase inhibitor Tarceva (erlotinib) yakawedzera hupenyu hwevanhu vazhinji vane kenza yemapapu vane chiremera chakanaka chekuchinja uku.
Nyaya dzinotevera dzinotaurazve pamusoro pebasa rekuchinja kwemukenza masero:
Chii chinonzi ALK-Positive Lung Cancer?
ALK mukana wemukenza wemapapu unoreva vanhu vane chirwere chemapapu chinotarisa zvakanaka kune mutambo we ALK (iyo EML4-ALK fusion gene.) Kuchinja uku kuripo kune vatatu kusvika ku5 kubva muzana yevanhu vasina kamudiki kenza yemapapu emapapu . Izvozvo zvingaita sezvinoitwa nhamba shoma pakutarisa kwekutanga, asi tichifunga nhamba yakawanda yevanhu vanorwara nekenza yemapapu gore negore muU.S. (inofungidzirwa kuti inopfuura 200 000 muna 2017), nhamba iyoyo ihuru chaizvo.
IA ALK Rearrangements Inowanikwa MuLung Cancer Here?
Iyi EML4-ALK fusion gene inowanikwa mune vamwe vanhu vane neuroblastoma uye amaplastic huru cell lymphoma .
Kujekesa Kuchinja Kwevanhu Muvanhu vane Kanzera
Chimwe chinhu chinokanganisa uye chinonyanya kukosha ndechekuti EML4-ALK fusion gene haisi yekutendeuka kwechizvarwa semhando ye BRCA1 uye BRCA2 mune vamwe vanhu vane kenza yemazamu (nezvimwewo zvirwere.) Vanhu vane kenza yemapapu inobatsira EML4 -KANA kufungidzirwa kwemajini hakuna kuberekwa nemasero akave nekuchinja uku uye haana kugamuchira chimiro chekuchinja uku kubva kuvabereki vavo. Pane kudaro, uku ndiko kuchinjwa kunowanikwa mune mamwe masero emukenza sechikamu chekugadzirwa kwekenza.
Kuziva
An ALK mutation inoratidzwa nemapurisa kufungidzira kwemuenzaniso wechiremera. Zvakakosha pakuita izvi kuedza kuti kuwanika kwakakwana kwezviviri kubva kumapapu emapapu kana chirwere chemapapu kunowanikwa. Vatsvakurudzi vari kutarisa nzira dzekuona kana kuchinja kwe ALK kune ikozvino kusati kwaitwa maitiro ekugadzira muviri, kana kuti kunogona kutora nzvimbo yekuongorora mazita. Zvinhu zvishomanana zvinoratidzira mutsauko we ALK ungave uripo unosanganisira:
- Basa reRopa - Muedzo unonzi CEA (carcinoembryonic antigen) unowanzove usina kunaka kune vanhu vane mutsauko we ALK.
- Radiology - Mukudzidza kumwe, matumire akanaka kune ALK yakaratidzwa yakasimba uye yakanga isina chimwe chinhu chinonzi pasi girazi kuonekwa. Kusiyana neizvi, makumi mashanu kubva kune makumi mashanu evaya vasina kushanduka kwemairairasi vakaidzidza negirazi yegirasi yakaoneka.
Panguva ino, zvisinei, kufungidzirwa kwema molecular (kuongorora maitiro) inoramba iri muedzo wakanakisisa uye ndiyo yekutarisira.
Ndiani Anogona Kuva neAlk Mutation?
Mhando dzekuchinja-chinja zviripo mumapapu emapapu zvinowirirana zvichienderana nemhando yemukenza wemapapu . EML4-ALK fusion genes inowanikwa zvikuru kune vanhu vane rudzi rwusingaiti duku rwekenza yemapapu emapapu inonzi lung adenocarcinoma . Izvozvo zvakati, muzviitiko zvisingawanzoitiki, ALK yakawanikwa mune vanhu vane squamous cell carcinoma yemapapu (imwe mhando yekasi-duku duku yemukenza yemapapu) nekenza duku yemukenza yemapapu .
Kunewo vamwe vanhu vanove vachida kuva neFK fusion gene. Izvi zvinosanganisira varwere vaduku, vanhu vasina kumboputa (kana kusvuta zvishoma), vakadzi, uye avo vane East Asian ethnicity . Mune kumwe kuongorora kwechangobva kuitika, zvakawanikwa kuti varwere vaduku vanopfuura makore makumi mana vakaedzwa zvakanaka kune EML4-ALK fusion geni anenge 50 muzana yenguva (kusiyana ne 3 kusvika ku5 muzana yevanhu vemakore ose ane kenza yemapapu.)
Ndiani Anofanira Kuedzwa kweAlk Mutation (Rearrangement)?
Misangano yakawanda yakashanda pamwe chete kukura mazano pamusoro peani anofanira kuongororwa kwekuchinja kwe ALK. Chibvumirano chaiva chokuti vese varwere vane chekuita-stene adenocarcinoma vanofanira kuongororwa kweAlk neEGFR mutations, pasinei nehutano, hupfumi hwehupfumi, zvimwe zvipingamupinyi, uye rudzi.
Chimwe chidimbu ndechokuti mamwe matumire ane nzvimbo dzinoita sezvirudzi zvakasiyana dzemukenza wemapapu. Semuenzaniso, mavara ari mune imwe chikamu chebiopsy angaratidzika seadenocarcinoma uye mhuka mune imwe chikamu chemuenzaniso webiopsy inogona kutarisa semukenza mutsvuku wemapapu.
Kune zvimwe zvisiri izvo vanachiremba vangaita kune aya mazano. Somuenzaniso, kuedza kunogona kukurudzirwa kune mumwe munhu asina kumbobvira aputa, kunyange zvazvo chirwere chemupapu chemapapu hachiratiki seine adenocarcinoma. Aya mazano anogona kuchinja sezvinodzidza zvakawanda pamusoro pekugadzirisa uku, uye zvimwe zvinogadziriswa zvakawanikwa uye zvirwere zvinotevera zvakagadzirwa.
Ndeapi ALK Positive Lung Cancer Inotariswa?
Kunyange zvazvo rearrangements muAlk mukenza yemapapu yakangowanikwa muna 2007, kurapwa (ikozvino kwaine) kwevanhu vane mutsauko uyu (uyewo vane kenza yemapapu yemapapu) yakatove yakagamuchirwa neDFA. Izvi zvinogamuchirwa neDDA - makore mana chete mushure mekuwanikwa kwekugadzirisazve - kunofadza pakati pemamiriro ekurapa kwemapapu emapapu asina kuwedzera kukurarama zvakanyanya mumakumi emakore akapfuura.
Ngatitange nokutaura pamusoro pemishonga inotenderwa kutanga, uye taura nezvemishonga inowanikwa ikozvino yakagamuchirwa kune avo vane rearrangements dzeAlk
Rinoshanda sei ? Mishonga - Xalkori (crizotinib) inhibitor ye tyrosine kinase. Muchiitiko ichi, Xalkori inonamatira kune tyrosine kinase receptor pamusoro pemasero emukenza emapapu uye inodzivisa ALK mapuroteni asina kukwana. Nzira iri nyore yokunzwisisa iyi ndeyekufunga nezvehurosine kinase receptor sekivha, uye tyrosine kinase protein (yakagadzirwa nejasi risingawanzo) seyiyi. Vanhu vane mutano we ALK vane chitubu chisingawanzoitiki. Apo kiyi "inowanikwa," zviratidzo zvinotumirwa kunzvimbo yekukura kuti masero aparadzanise pasina kumira. Mishonga yakadai seHalkalkori kuburikidza nekuvhara chinangwa-yakangofanana kana ukazadza chiphole pamusuo wako wekutanga nekrete. Sezvo kiyi (iyo puroteni isina kukwana) isingakwanisi kupinda mucheki (kusunga neyakagadziriswa,) chiratidzo chesero chekuparadzanisa uye kukura hachisati chasvika panzvimbo yekudzivirira uye kupatsana kwemasero (kukura kwemuviri) kunogadziriswa.
Inoshanda zvakadini? Zvidzidzo zvakawana kuti kurapwa neXalkori kunoguma nekuenderera mberi kwemuviri-kusununguka kusina kwemwedzi 7 kusvika kune gumi. Pano pane inenge 50 kusvika ku 60% mhinduro yekupindura mushonga. Izvi zvingasaratidzika sezvinoshamisa, kunyanya kana zvichienzaniswa nemishonga kune dzimwe mimwe mishonga, asi zvinonakidza kuti vanhu vari mune zvidzidzo izvi vakanga vatowana kare uye vakakundikana kare chemotherapy uye tarisiro yekutaridzirwa yakatarwa yekuenderera mberi kwechikwereti chemotherapy ingangova yega yega 10% nevhareji kufambira mberi-kusununguka-kusununguka kwemwedzi mitatu.
Kunyange zvazvo mukana wekutarisana neXalkori uri nani kudarika nemaitiro emakemikrasi akazara, zvidzidzo hazvina kuwana kuti Xalkori inowedzera hupenyu hwehupenyu hwose . Asi apo kupona kwakakosha, hupenyu hwehupenyu hunokosha zvakare. Kurambidza kufambira mberi kwekenza kunogona kuderedza zviratidzo zvine chokuita nekenza, uye chaizvoizvo, varwere vanobatwa neXalkori vane zviratidzo zvishomanana zvine chokuita nekenza yemapapu (kushoma kwepfufu, kufema kwepfuva, uye kuneta.) Hazvinyatsozivikanwi kana chidzidzo ichi chakanyatsoongororwa kupona kwevanhu kubva muchidzidzo ichi vakabvumirwa "kuyambuka" uye kushandisa imwe kurapa kana zvirwere zvavo zvichifambira mberi. Vanhu vakawanda vakamira chemotherapy uye vakashandura crizotinib kupfuura imwe nzira yakapoteredza.
Sezvo Xalkori yakabvumirwa, mamwe mishonga yakagamuchirwa kuitira kurapwa kwekenza yemapapu eAA-positive. Izvi zvinosanganisira:
- Zykadia (ceritinib)
- Alectinib (alencensa)
Mukuwedzera, mushonga mutsva unotarisana nemukenza wemapapu weAlk-positive, Alunbrig (brigatnib) yakagamuchirwa musi waApril 28, 2017.
Panguva ino yazvino inofungidzirwa kuti alectinib inopa nguva yakareba kupona kusununguka kupfuura crizotinib (25.7 mwedzi vs 10,4 mwedzi) uye ine zvishoma zvinoguma. Izvozvo zvakati, zvakakosha kutaura nemumwe wako oncologist pamusoro peipi yemishonga iyi inogona kushanda zvakakunakira iwe.
Zvakakosha kuchengeta mupfungwa kuti tyrosine kinase inhibitors haisi mushonga wekenza yemapapu , asi pane chimwe chinhu chinobvumira tumarara kuti "ichengetedzwe" sekurapa kwechirwere cheshuga kunogona kudzora chirwere asi hachirape. Zvinotarisirwa kuti mune ramangwana, kenza yemapapu, zvishoma nezvimwe mhando nezvimwe zviitiko, zvinogona kurapwa sezvimwe zvirwere zvisingaperi sezvinonzi chirwere cheshuga.
Kurwisana
Zvinosuruvarisa, kunyange zvazvo hafu yevanhu inopindura zvakanaka pakurapwa, kushorwa kunowanzotanga nguva uye mishonga inorasikirwa nekubudirira. Kune vanhu vanokura kushorwa, pane zvimwe zvingasarudzwa zviripo. Alectinib yakabvumirwa kuparidzirwa muna 2013 kuti vanhu vane ALK-positive yemapapu emapapu vasagadzikane ne crizotinib. MunaMarch ya2014 imwe mishonga - Zykadia (ceritinib) - yakagamuchirwa nehuwandu hweDAA. Pakutanga mhinduro dzeZykadia dzakange dzakafanana neavo vane Xalkori. Mukuwedzera - vanhu vazhinji vakange vashandura kuXalkori vakapindura Zykada. Mishonga mitsva iri kuongororwa mumakiriniki ekuedzwa kwevanhu vanokura kushorwa, uye vamwe vatsvakurudzi vanotarisira kuti mune ramangwana varwere vanogona kurapwa nenzira yakasiyana nemishonga iyi sezvo kushorwa kuchikura.
Mukuwedzera, zvipembenene zvinowanzochinja (kuvandudza kuchinja mutsva) nekufamba kwenguva. Dzimwe nguva mishonga inoshandisa imwe shanduko inogadziriswa (yakadai seEGFR) inogona kushanda kunyange zvazvo chirwere chisina kutanga chakanaka chekuchinja kwe EGFR. Zvinotarisirwa kuti mune ramangwana rava pedyo tichakwanisa kurapa kenza yemapapu - zvichida iyi subtype - nenzira yakafanana nenzira yatinobata nayo dzimwe zvirwere zvisingaperi.
Ndeipi Mishonga Inonyanya Kupfuura?
Zvirwere zvemakiriniki zviripo zvino zvichienderera mberi kuedza kudzidza zvakawanda nezvepi yemishonga mina ikozvino iripo inoshanda zvakanaka. Pane humwe humwe uchapupu hwokuti mishonga mitsva (zvose pamwe neAARK rearrangements uye nedzimwe shanduko) inokwanisa kukwanisa kurapa mastasisita kuuropi. Pamusana pekuvapo kweropa-uropi huripo, ruzhinji rwemapapirore akaomeswa akavharidzirwa anovhara tsvina dzakawanda (kusanganisira chemotherapy uye zvakarongwa nemishonga) kupinda muuropi, mishonga yakawanda yatinayo ikozvino yekurapa kenza yemapapu haisi yakagadzikana nehupfungwa metastases. Kune avo vane maitiro mashomanana emakemikari ehope, stereotactic urodie radiotherapy (SBRT) kana cyber thipa yakapa sarudzo yekubata idzi, asi zvakanaka, mune ramangwana, tichava nemishonga inokwanisa kutarisa izvi zviri nani zvakare.
Chenjerera Pamusoro pe Vitamini E Zvimwewo
Tinogara tichiraira vanhu nezvekutora chero zvigadzirwa zvinenge zvichisarudzwa nekenza pasina kutanga kutaura neo oncologist yavo, uye izvi zvinokosha ne crizotinib (pamwe pamwe nezvimwe zvinotarisirwa kurapwa). Muna 2018 zvakawanikwa kuti chikamu che vitamini E chinonzi a-tocopherol chinogona kukanganisa zvikuru chirwere che crizotinib. Vitamin E (kana kuti zvimwe chikamu ichi) zvose vakanyora basa re cri cribinib, uye vakadzivisawo kenza yesero rufu nekuda kwe crizotinib. Izvo zvakaratidzwa zvinongova zvechokwadi kune-tocopherol, uye kwete mamwe mavitamini E chikamu chakadai se y-tocopherol. Izvozvo zvakati, mavitamini E akawanda akawanda uye mamwe mavitamini anowedzera ane vitamin E anowanzove ne-tocopherol sechinhu chinotungamirira.
Migumisiro Yechirwere yeMutano
Sezvo nemishonga yakawanda yekenza, mishonga yakadai seXalkori ine madhara. Zvinotenderera kuti zvizhinji zveizvi zvakanyanya kukura kupfuura izvo vanhu vanowanzoona panguva yemakemikrasi. Zviratidzo zvinowanzoonekwa nevanhu paXalkori zvinosanganisira matambudziko anooneka, kuora, kusuruvara, kupererwa kwemhepo, uye zvisingaiti zvechiropa chekuita. Chinhu chisingawanzwi asi chakanyanya kusimba icho chave chakaonekwa ndekukudziridzwa kwepakati pemapapu chirwere chinogona kuuraya.
Ramangwana
Iyo ALK fusion gene ndiyo imwe chete yezvinhu zvakasiyana-siyana zvinochinja mumasero emukenza emapapu. Zvinotarisirwa kuti sezvo izvi zvinonzwisiswa zviri nani, zvirongwa zvitsva zvinenge zvichange zvichange zviripo izvo zvisingagone kurwisa kupikisa asi zvinotarisa zvimwe zvisingaiti (kufambisa mutambi) mumasero ekenza. Nezve crizotinib, inofungidzirwa kuti mishonga inogona kubatsirawo vamwe vanhu vasina vanaAFK fusion gene asi vane mamwe maitiro asina kufanira ejrosine kinase (akadai seROS1 rearrangement .)
Mashoko ekupedzisira
Kuti mishonga inoshandiswa iyo inoshandurudzwa kuchinja-shanduka kwakafanana neAAA, vanhu vane chirwere chemapapu vanofanira kuongororwa kuchinja. Kunyange zvazvo mirayiridzo inokurudzira kuedza munhu wose ane adenocarcinoma uye kushandiswa kwekombiyuta iri kuri kuwedzera, kune vanhu vakawanda vasina kumbobvunzwa.
Pane zvikonzero zvishoma zveizvi. Chimwe ndechokuti iyi ndiyo nzvimbo inokurumidza kuchinja yemishonga, uye hapana chiremba anogona kunge ari pamusoro pezvinhu zvose zvitsva. Bvunza mibvunzo. Ita zvishoma kutsvakurudza (kana kuva neshamwari kana kuda iwe kutsvakurudza tsvina yako.) Funga kuwana pfungwa yechipiri pamusana wekenza unoona boka guru revarwere vemapapu emapapu.
- Nzira Yokusarudza Mungozi yeKenza Cancer Treatment Center
- Matanho Okutanga Paunenge Uchangobva Kuzivikanwa neLung Cancer
- Nzira Yokuzvidzivirira nayo neKenza
Chimwe chinetseka ndeye mari. Mishonga mitsva inotarisa kusagadzikana kwemasero emukenza kazhinji inouya nemutengo wepamusoro. Asi pane zvingasarudzwa zviripo. Kune avo vasina inshuwarisi, kune hurumende pamwe nemapurogiramu ega ega anobatsira. Kune avo vane inshuwarisi, mapurogiramu anobatsira ekubhadharwa mari anogona kubatsira kubhadhara mari. Mune zvimwe zviitiko, mugadziri wezvinodhaka anogona kukwanisa kupa mishonga pakaderedzwa mari. Uye zvakakosha, sechikamu chekuongororwa kwekliniki , mishonga, uyewo kushanya kwehofisi, inowanzopiwa pasina mari.
Sezvinyorwa zvekupedzisira, zvisinei kuti unodzidza zvakadini kubva muboka rako rezvechiremba, hakuna chinhu chakafanana nekunzwa kubva kune vanhu vakambove varipo uye vakagamuchira marapirwo aunogona kugamuchira. Tarisai maboka ekutsigira vanhu vane kenza yemapapu uye mubvunze kana mumwe munhu ane mutauro we ALK. Mamwe masangano akaita seLUNGevity ane sangano rinofananidza (iro LUNGevity LifeLine) iro ravanogona kukufananidza naro nemumwe munhu ane kenza yemapapu ane chimiro chakafanana nechikamu chemuviri.
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