Arimidex, Femara, uye Aromasin Kuenzanisa uye Migumisiro Yechechi
Kana iwe wapedza kunyanya kurapwa kwekutanga-gadziriro, chirwere chetestro-receptor-positive, chiremba wako angangokurudzira hormonal therapy kwemakore mashanu kusvika kune gumi. Kusarudzwa kwezvinodhaka kunotarisana nemamiriro ako evanhu vane menopausal, ne aromatase inhibitors kazhinji chisarudzo chekutanga chemadzimai anonzi menopausal pamwe chete nevamwe vakadzi vechimenopaopausal pamwe nehutano hwekuvhara maawa.
Ndeupi musiyano pakati pe Femara, Arimidex, uye Aromasin, ndeipi migumisiro yaunogona kutarisira, uye mishonga iyi yakasiyana sei ne tamoxifen? Inobatsira zvakadini pakudzivirira kudzokorora kwekenza yebonde?
Aromatase Inhibitors: Tsanangudzo
Aromatase inhibitors imishonga inodzivisa kugadzirwa kweesrogen mumuviri. Mukuita kudaro, dzinoderedza dambudziko rekudzoka kwekenza yemazamu (uye kuwedzerwa kupona) kwevakadzi vane chekutanga-stroke-receptor chirwere chepachifu chiri nani uye vari postmenopausal. Zvinogonawo kuderedza ngozi yekudzokorora kune vamwe vakadzi vane kenza yepremenopausal yepamusoro kupfuura tamoxifen. Kune mishonga mitatu yakasiyana mune iri boka remishonga.
Aromatase inhibitor kurapwa inotanga mushure mekutanga kwekurapa kenza yemazamu kwapera. Izvi zvinosanganisira chirwere chepachifu chepamusoro uye zvichida chemotherapy uye / kana remishonga inonzi radiation . Mishonga inopfuurirwa kwemakore mashanu kusvika kune gumi zvichienderana nenjodzi yeumwe munhu yekudzoka uye kushivirira kwemigumisiro.
Hormone Therapy for Breast Cancer
Mishonga yekenza iyo ndiyo estrogen receptor positive inonyanya kudyiwa neestrogen. Masero emukenza wepabonde, sezvinowanzoitwa mazamu emazamu, ane esrogen receptors kumusoro. Cancers iyo inonzi "yakanaka" yeestrogen kana progesterone receptors ndiyo iyo inonzi iyo estrogen receptors inonyanya kukonzera kukura kwekenza.
Basa reestrogen mumatumbu aya ndeyekusunga kune estergen receptors kuti kukurudzira kukura nekuparadzaniswa kwemasero.
Kuti tinonoke kana kumira kukura kwemasero emukenza webema, saka tinoda nzira yekuderedza isrogen mumuviri kana kudzivirira maestrogen eestrogen kuitira kuti estrogen iyo iripo isasagoni kusunga.
Nzira dzeHormonal Therapy: Tamoxifen uye Aromatase Inhibitors
Musati mambomira, mavha mavari ndiwo nzvimbo huru yekugadzirwa kweesrogen mumuviri. Iyo mishonga tamoxifen inoshanda nekudzivirira maestrostro eesrogen pamasero emumabere echeche (nemamwe masero) kuitira kuti isrogen isasagona kusunga. Tamoxifen chaizvoizvo ane anti-estrogen migumisiro kune dzimwe nhengo dzomuviri dzakadai sezamu, asi pro-estrogen migumisiro kune vamwe, zvakadai samapfupa (inogona kuderedza kurasikirwa kwefupa). Kutanga kugamuchirwa muna 1998, tamoxifen yaive iyo yepamusoro yehutoni inorapa kenza yepamu kwemakore makumi maviri.
Mushure mekuguma kwemwedzi, inonyanya kunobva isrogen inobva kumativi ose ekushandurwa kwe androgens (varume vemahomoni mahomoni anowanikwa mumafuta masero) muestrogen. Izvi zvinoshandiswa ne enzyme inonzi aromatase. Aromatase inhibitors inoshanda nekuvhara aromatase kuitira kuti androgens isingashanduki ku estrogen mumuviri.
Sezvo chikonzero chekutanga chestrogen isati yasvika pakupera kwemwedzi ndeye mazai mavari, kwete mhirizhonga yekushandurwa kwe androgens, aromatase inhibitors chete inenge isingabatsiri kuvakadzi vanoramba vari premenopausal (uye mukadzi angangodaro ari murumeopausal kunyange kana nguva yake ichibva chemotherapy).
Kunzwisisa Aromatase Inhibitors: Arimidex, Femara, uye Aromasin
Ikozvino pane zvitatu zvakasiyana-siyana zve-aromatase inhibitors zvinogamuchirwa kuderedza dambudziko rekudzoka kwevakadzi nevana vekutanga, yesrogen receptor-positive kenza yemazamu. Izvi zvinosanganisira:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (exemestane)
Iyi mishonga inoratidzika kunge yakaita seyakagadzikana mukudzivirira kudzokorora asi kune zvimwe zvakasiyana. Aromasin is steroid, asi Arimidex uye Femara havasi. Icho chinonyadzisa chemishonga iyi mitatu inoita seinofanana.
Tamoxifen uye Breast Cancer Kudzoka
Isu tine ruzivo rwakakura rwehuwandu panguva ino tichitarisa kushandiswa kwe tamoxifen uye njodzi yekudzoka kwekenza yemazamu . Kakawanda, kana yakashandiswa kutanga kwechitambo, zvirwere zveestrogen-positive, mutachiona unoderedza ngozi yekudzoka neanenge 50 muzana. Tamoxifen inoderedzawo mararamiro amuchaita kuti muve neimwe maronda muzamu yenyu (kana iwe une lumpectomy) kana kuti iwe uchakurira kenza yepiri yechifu mune imwe mvere.
Aromatase Inhibitors uye Breast Cancer Kudzokorora
Aromatase inhibitors inoita kuderedza dambudziko rekudzokorora kunyange kupfuura tamoxifen uye iko zvino inonzi inodhaka yemishonga yevakadzi ve postmenopausal kana avo vari premenopausal uye vakawana kurapwa kwemaawa ovarian.
Updated Guidelines for Hormonal Therapy
Kune vakadzi vanotungamira vana vanotora aromatase inhibitor, mirayiridzo ye 2017 ikozvino inokurudzira kushandisa bisphosphonate Zometa (zoledronic acid) pamwe nearomatase inhibitor. Kubatanidzwa kwemishonga mbiri pamwe chete kunoratidzika kuderedza dambudziko rekenza yemazamu inopararira kumapfupa kupfuura iyo yearomatase inhibitor chete. Dzidza zvakawanda pamusoro pekushandiswa kwebhisiphosphonates kwekenza yepabonde pekutanga .
Aromatase Inhibitors mu Premenopausal Women With Ovarian Suppression
Mubvunzo wekuti kana kuwedzera maitiro ekuderedza chirwere (kushandisa gonadotropin kumagariro anokonzera kukanganisa) tamoxifen yave nyaya yeimwe gakava. Chidzidzo chakabudiswa muNew England Journal of Medicine muna 2015, zvisinei, chinoratidzika kuratidza kuti vakadzi vepremenopausal vanorapwa neavarian suppression therapy kuitira kuti vashandise aromatase inhibitor panzvimbo ye tamoxifen vangave nehupenyu huri nani.
Chimwe chidzidzo chakabudiswa mumagazini imwechete muna 2014 chakawana kuti Aromasin (exemestane) yakabatana nechirwere chekuvhara mavharesi chakanyanya kuwedzera kupona kufanana ne tamoxifen pamwe ne ovarian kuderedza chirwere.
Sezvo aromatase inhibitors ine zvirwere zvakanyanya uye zvinogona kutungamirira kumapfupa ekurasikirwa, vazhinji veoncologists vanokurudzira kuchengetedza nzira iyi kune vakadzi vepremenopausal vane Stage 2 uye Stage 3 mazamu emukenza, izvo zvingangodzokorora zvakare.
Zvikamu Zvakaoma zveAromatase Inhibitors
Kufanana nemishonga ipi zvayo, migumisiro nemigumisiro yakaipa inogona kuitika kune vamwe vakadzi pane aromatase inhibitors.
Zvimwe zvinowanzovhiringidza zvinokonzerwa nekuderedzwa kweesrogen mumuviri (menopausal zviratidzo) uye zvinosanganisira kupisa kunopisa, husiku hunoputika, humai hwekudzivirira, uye kubuda kwemudzimai. Kunyange zvazvo zviratidzo izvi zvingagumbura, zvidzidzo zvinoratidza kuti kupisa kunopisa chiratidzo chakanaka kuvakadzi vane kenza yemazamu, uye avo vanotarisana nemigumisiro iyi vane migumisiro yakanaka.
Kubatana uye kusuruvara kunorwadzawo kunowanzosvibisa chikamu che aromatase inhibitors. Izvo muviri uyu aches ndiyo imwe yezvikonzero zvikurusa zvekuti vakadzi vasiye mishonga iyi.
Chimwe chezvinonyanya kunetseka pamusoro pearomatase inhibitors isipo kurasikirwa, nekushandiswa kwemishonga iyi inogona kutungamirira kune osteoporosis uye kuputsika. Vakawanda veoncologists vanokurudzira kuongorora mashekeri emapfupa vasati vatanga mishonga iyi sechinhu chekutanga, uye kutevedza zvichienderana nemigumisiro yekutanga kwekuedzwa.
Kuwedzerwa kwe-bisphosphonates (Zometa) kune aromatase inhibitor therapy kunogona kuderedza zvakanyanya ngozi iyi. Bisphosphonates yakatanga kugamuchirwa senzira dzokurapa kwehuputi, uye Zometa yakawanikwa kuti inoderedza dambudziko rezvipembenene uye zviputi zvekuputika (uye urema hunowanzoenda nekuputsika uku). Zometa ndiyo yakakurudzirwa kuvanhu vane kenza yematenda, sezvo inogona kuderedza marwadzo emapfupa uye ngozi yezviputi zvakabatana nemasitaste emapfupa. Zvimwe zvidzidzo zvinoratidza kuti Zometa inoshandura microenvironment yemapfupa kuitira kuti masero ekenza yemazamu arege "kumira" nyore nyore. Mukushandiswa kwechipatara, zvinoratidzika kuderedza mukana wekuti kenza yemunhu yepamu ichapararira kumapfupa avo.
Aromatase inhibitors inobatanidzwawo nehuwandu hwezvinetso zvemwoyo. Kunyange zvazvo ichi chiri chokwadi, zvakawanikwa kuti zvirwere zvakakomba uye zvinotyisa zvehupenyu zvakadai sekurwadziwa kwemwoyo uye kurohwa hazvisi zvekare kune vakadzi vanotora aromatase inhibitors kupfuura kune avo vasingatori mishonga iyi. Mwoyo mamiriro ezvinhu anonyanya kuitika pamishonga iyi inosanganisira mwoyo rhythm disorders , zvinetso zvepfungwa dzemagetsi , uye pericarditis (kuputika kwemukati kumativi emoyo).
Kana Kushamiswa Kwakaitwa Kunoita Kuti Ude Kurega Mishonga Yako
Izvozvo zvinokonzerwa ne aromatase inhibitors, kunyanya mumuviri aches, inogona kuva yakaoma dzimwe nguva. Zvinosuruvarisa, izvi migumisiro inokonzerwa nevakadzi vakawanda vanoramba kurapwa kwavo nguva isati yasvika uye vachirasikirwa nekudzivirirwa kwekudzoka (nekuvandudza kupona) vanopa.
Kana iwe uri kutambura nemigumisiro, taura newe oncologist. Kunyange zvazvo kuchengetedzwa uye kutyisa kwemishonga mitatu iri mukirasi iyi yakafanana, inenge chikamu chimwe chetatu chemadzimai vanogona kubvumira mishonga yakasiyana mune iyi yechikoro.
Kuchinja kubva kuTamoxifen kusvika kune Aromatase Inhibitor
Vamwe vanhu vanonzi premenopausal uye vanorapwa ne tamoxifen vanogona kuva postmenopausal panguva yekurapa. Izvi ndezvechokwadi kunyanya kuvakadzi vanoita kenza yemvere nguva yose yekupera kwemwedzi. Sezvo chemotherapy inowanzokonzera aminorrhea (kusavapo kwenguva), kuongororwa kweropa kungada kuitika kuti uone kana iwe uri kunyatsopera. Zvidzidzo zvakawana kuti kuchinja kune aromatase inhibitor inotevera makore maviri kusvika ku3 emutambo weTamoxifen unobatsira mukurarama zviri nani pane kuramba uchiita tamoxifen.
Kureba Kwokurapa NeAromatase Inhibitors
Kunyange zvazvo zvakakurudzirwa kuti vanhu varambe vari tamoxifen kana kuti aromatase inhibitor kwemakore mashanu munguva yakapfuura, data itsva inoratidza kuti kutora mishonga iyi kwemakore gumi kunowedzera kuderedza ngozi yekudzokorora. Zvinonyatsozivikanwa kuti kenza yemazamu inogona kudzoka kwemakore mazhinji kana makumi emakore mushure mekunge tumoramu inotapwa inobatwa, uye iyi ngozi inonyanya kukwirira kuvakadzi vane zvirwere zveestrogen receptor-positive. Hatizivi kuti nei kenza yemazamu inodzoka mushure memakore kana makumi emakore, asi tinoziva izvi zvinoitika kakawanda.
Zvose tamoxifen uye aromatase inhibitors zvinoratidzira kuramba dzichishanda mushure mokunge dzichigumburwa, kunyange vamwe vatsvakurudzi vanodavira kuti kuenderera mberi kwemishonga inonzi hormone inogona kuwedzerwa kusvika nguva yakareba kupfuura gumi mumangwana. Izvozvo zvakati, zvingave zvinobatsira zvinoda kuenzaniswa nezvengozi.
Mutengo weAromatase Inhibitors
Kusiyana ne tamoxifen iyo yave iine makore mashoma emakore uye ine maitiro epo, iyo aromatase inhibitor inogona kudhura. Inishuwarenzi zvirongwa zvinowanzovhara chikamu chemari, kunyange zvingangopa kugoverwa kweimwe yemishonga iri mukirasi. Kana uri kuomerwa nekupa AI yako, tarisa mazano aya pamusoro pekutarisira zvinodhura zveHermonal therapy .
Shoko Rinobva
Aromatase inhibitors inoshanda nekudzivirira kugadzirwa kweestrogen mumafuta mashoma, iyo inonyanya kunobva isrogen mumadzimai emasopaopausal. Takaziva kwemakumi emakore mashomanana kuti tamoxifen inogona kuderedza zvakanyanya dambudziko rekudzoka kwekenza yepabonde uye nhamba idzi dzinoita kunge dziri nani nearomatase inhibitors.
Zvinosuruvarisa, uye sekune chero mishonga, migumisiro inowanikwa, uye muviri aches inogona kunge inonyanya kunetsa. Kana uri kutarisana neizvi, shanda pamwe newe oncologist. Dzimwe nguva zvinobatsira kuchinja kune imwe mishonga ino mukirasi. Mishonga inobatanidza kubva pakushambadza kusvika pakufungisisa inogonawo kubatsira. Zvakakoshawo kuzviyeuchidza kuti sei uri kutora mushonga. Migumisiro inogona kugumbura asi inosarudza kuva nekudzoka. Iye zvino iyo bisphosphonates inokurudzirwa pamwe chete ne aromatase inhibitors, kunetseka kwekuderedzwa kwemafupa emapfupa uye osteoporosis zvingasava nechinetso munguva yakapfuura.
Ramba uchifunga kuti mukadzi wese akasiyana uye hakuna "magic" nguva yekuti munhu wose atore mishonga iyi. Kune munhu mumwe nomumwe, zvakakosha kufungidzira zvingave zvingabatsirika kune avo vane ruzivo rwemigumisiro uye mikana inogona kuitika. Ita chokwadi chekubvunza mibvunzo yakawanda uye iva wako mumurevereri munhare yako. Hakuna munhu anokurudzira kuti iwe ugorarama hupenyu hwako husina kenza.
> Sources:
> Francis, P., Regan, M., Fleming, G. et al. Adjuvant Ovarian Kudzvinyirira mu Premenopausal Breast Cancer. The New England Journal of Medicine . 2015. 372 (5): 436-446.
> Hague, R., Shi, J., Schottinger, J. et al. Mwoyo Mumuviri Mushure meAromatase Inhibitor Use. JAMA Oncology . 2016. 2 (12): 1590.
> Pagani, O., Regan, M., Walley, B. et al. Adjuvant Exemestane neAvarian Suppression in Premenopausal Breast Cancer. The New England Journal of Medicine . 2014. 371 (2): 107-118.
> Tjan- > Hejinen >, V., Hellemond, I., Peer, P. et al. Yakawedzerwa Adjuvant Aromatase Inhibition Mushure mekufananidzira Endocrine Therapy (DATA): A Randomized, Phase 3 Trial. The Lancet Oncology . 2017. 18 (11): 1502-1511.