Bisphosphonates uye Denosumab yeT Bone Metastases uye Adjuvant Therapy
Kanzira yakapararira kumapfupa (bone metastases) yakawanda uye inogona kukonzera kurwadziwa kukuru nekuremara kwakabatana nemaputsi uye mamwe matambudziko. Mumakore achangopfuura mishonga inonzi "bone-modifying agent" yakakurudzirwa kune vakawanda kanzira yekurapa masastases emapfupa pakarepo pavanoongororwa. Mumamiriro ezvinhu aya, zvinodhaka izvi hazvirevi kungoita pangozi yezvipembenene asi zvinogona, mune dzimwe nguva, kuwedzera kupona.
Sezvimwe zvekubatsira, zvikamu zviviri zvepafupa-zvinodhaka zvinodhaka zvinopesana nekenza. Chii chaunoda kuziva pamusoro pezvinodhaka zvakadai seZometa uye denosumab kana uri kurarama nekenza yemastastra?
Bone Metastases vs. Bone Cancer
Apo vanhu vanonzwa nezvekenza mumapfupa, zvinogona kuvhiringidza. Nguva zhinji apo vanhu vachitaura nezve "kenza yemapfupa" ivo vari kureva mapfupa emasasa ; kanzira yakatanga mune imwe nzvimbo yomuviri ikapararira kumapfupa. Kunyange zvazvo vanhu ava vangashandisa izwi rokuti "kenza yemapfupa," mishonga inopararira kumapfupa haifungi nezvekenza yemapfupa. Semuenzaniso, kenza yemazamu yakapararira kumapfupa haitumidzi kenza yemapfu asi asi "kenza yemazamu yepabonde kumapfupa" "kana kenza yemazamu ine bone metastases. Kenza yepakutanga yakawanda isingasviki kudarika mafupa emasitema. Pasi pema microscope, kenza yemapfupa inogona kuratidza kenza ine bone masero. Kusiyana neizvi, neropa remasastase masero ekenza mumapfupa ari mhuka imwechete sekenza yekutanga; kenza yemazamu masero munyaya yekenza yemazamu, masero emukenza emapfupa mumapfupa (nemukenza wemapapu) nezvimwe zvakadaro.
Nekenza yepfupa yemapfupa, kazhinji kacho kune kamuviri kamwe mune rimwe pfupa. Nemapfupa emasitema, pane huzhinji hunoonekwa hwekenza munzvimbo dzakasiyana dzepafu kana mumapoka akasiyana-siyana.
Cancers Iyo Inogona Kuparadzira Kutema
Kune zvirwere zvakawanda zvekenza zvinogona kupararira kune pfupa rinowanzosangana nekenza yemazamu, kenza yemapapu, kenza yeprostate, uye myeloma yakawanda.
Zvimwe zvirwere zvinogona kupararira kune pfupa zvinosanganisira kenza yemutsvo, kenza yemudumbu, kenza yemukaka, chirwere chekuberekwa, kenza yekemikari, uye maharareti emarariya.
Bone metastases inowanikwa munenge makumi manomwe kubva muzana yevakadzi vane kenza yemazamu emasita (mapfupa ndiyo nzvimbo inonyanyozivikanwa yemasastases), uye masastases emapfupa kubva mucheche yemazamu ndeimwe chikonzero chinorwadza nekuremara kwevakadzi (uye varume). Kune vakawanda vevanhu ava, bone metastases ndiyo chiratidzo chokutanga chekenza yakadzoka mushure memakore kana makumi emakore ekuregererwa. Mimwe yemishonga inokonzerwa nekenza yemukati (yakadai se aromatase inhibitors) inogona kutungamirira kumapfupa ekurasikirwa, kuwedzera kuwedzera dambudziko racho. Mapfupa akawanda kwazvo iyo kenza yemazamu inopararira ndeyemutsana, mbabvu, mapapiro, uye mapfupa epamakumbo nemakumbo.
Bone metastases yemukenza yemapapu inowanzonzi, inokanganisa vanenge 30 kusvika ku40 muzana yevanhu vane kenza yemapapu yakakura. Mafupa anowanzosangana nawo ndiwo musana, mapepa, nepamusoro makumbo nemaoko mapfupa. Kenza yemaperembudzi yakasiyana zvakasiyana mumasisita aya anogona kuitika kumafupa ari mumaoko nemaoko. Pakati pevanhu vane mapfupa emapfupa emukenza wemapapu, 22 kusvika ku59 muzana vachawana "chiitiko chechikwata" chakafanana nekuputsika.
Bone metastases inowanzoonekwawo mune kenza yepamusoro yeprostate . Sezvakaitwa nevakadzi vane kenza yemazamu, zvirwere zvehommonal pamwe ne androgen inoshaiwa chirwere chinogonawo kuderedza mapfupa. Varume vanomwe kubva pavashanu vane kenza yemastrostate vachave nemasisita kuti vafukidze. Nzvimbo yakajairika yemasitasisita ndeyezviuno, musana, uye mapfupa emapfupa.
Bone metastases kubva kune myeloma yakawanda inowanzonzi. Pamusoro pei-ray, mapfupa anotora kutaridzika kwechitema. Apo myeloma yakawanda inopinda mapfupa masero emukenza anovhara mapfupa achiita masero (osteoblasts) uye anokurudzira masero emapfupa anoputsa bone (osteoclasts). Multiel myeloma inowanzowanikwa mumapfupa makuru zvakadai semusana, tsanga, mapira, nenyuchi, uye mapfupa makuru emakumbo.
Zvinyorwa zveBetastases
Iko kune mbiri miviri yepamusoro yemapfupa emasitema: osteolytic uye osteoblastic. Ne osteolytic metastases, tumorori inokonzera kuparara (lysis) yefupa. Osteolytic metastases inowanikwa neyingi myeloma pamwe chete nemakumbo akaoma akadai sekenza yemazamu. Osteoblastic metastases inokonzera kuwedzerwa kwemapfupa uye izvo zvinowanzoonekwa nekenza yeprotate. Kanzira dzakawanda dzine marudzi ose emasitema asi 80 kusvika ku85 muzana yemastastase ane kenza yemazamu ari osteolytic. Mitsetse yakawanda inowanzoitika mumapfupa nemaeastastic osteolytic kupfuura osteoblastic metastases.
Matambudziko Kubva kuPetamin Metastases
Bone metastases inogona kuderedza zvikuru mararamiro ako nehupenza nekenza, asi mushonga mutsva unoita mutsauko kune vanhu vazhinji. Haisi kungoita mapfupa emapfupa chete anoreva kuti kenza yakapararira uye haichagoni kurapwa, asi inogona kutungamirira kumatambudziko akawanda.
Nhamo kubva mumasitema epa bone inogona kuva yakaoma uye inowanzodikanwa kurapwa nemarwadzo anonyadzisa kunoderedza pamwe nemishonga inopesana nekuputira.
Bone metastases inowedzerawo mukana wekuputsika mukati memapfupa ayo ane simba nechirwere. Apo kuputsika kunowanikwa mumapfupa nekenza yemastastine inotumidzwa sechirwere chechirwere. Zvirwere zvinoputika zvinogona kuitika nekukuvara kwakanyanya. Mukuwedzera pane kugadziriswa kwemafupa, mapfupa emapfupa anogona kuita kuti zvive nyore kuti mapfupa akaputsika apore.
Apo metastases inowanikwa kumucheto wepasi, chirwere chinokurumidza chinonzi spinal cord compress chinogona kuitika. Kanzira mumiti yakasvibiswa inogona kuita kuti ivo vawande uye vanyengedze marwadzo achifamba kubva mumutsipa wepelinha kusvika kumucheto wechikamu chemuviri. Zviratidzo zvinosanganisira kurwadziwa kunorwadza kunokonzera pasi petsoka, utera, uye kupera kwemakumbo, nekurasikirwa kwemuviri uye / kana kutora chikwata. Emergent kurapwa nemirairo kana kuvhiyiwa kunogona kugadzirisa musana wechipfuva kuti urege kudzivirirwa zvachose.
Hypercalcemia yechirwere kana kuti yakakwirira ye calcium muropa inogona kuitika nekuda kwekusunungurwa kwe calcium kubva kune dzakaparadzwa zvikamu zvepfupa kusvika muropa. Zvinofungidzirwa kuti 10 kusvika ku15 kubva muzana yevanhu vane chirwere chepamusoro vachabatwa nemamiriro ezvinhu (ane zvimwe zvinokonzerawo pamwe nekuwedzera kumasitasase emapfupa).
Kurasikirwa kwekufamba nekuda kwezvipuka hakungoratidzi kuderedza hupenyu hwehupenyu asi kunogona kukuisa pangozi yemamwe matambudziko. Mukana wekuvhara ropa mukati mevanhu vane kenza kakatowedzerwa, uye kusagadzikana kunosimudzira dambudziko rekudzivirira hutachiona hwemapfupa kana mapurmita emboli
Mishonga yeTetas Metastases
Iko kune ikozvino mikana yakasiyana-siyana inowanika mukurapa masasa magetsi. Mimwe yemishonga yakawanda inoshandiswa pamusana wekenza yemasita inogonawo kuderedza mapfupa emapfupa. Izvi zvinogona kusanganisira chemotherapy , zvinotarisirwa kurapwa, monoclonal antibodies , uye immunotherapy mishonga. Iko kunewo marapirwo anotaura nezvemapfupa ematokisi zvakananga. Izvi zvinosanganisira:
- Radiation therapy: Radiation therapy inorapwa uye inogona kuderedza zvakanyanya marwadzo ose uye mukana wekuputsika kunoitika.
- Radiopharmaceuticals: Radiopharmaceutics inodhaka umo maitiro emirasi yakaiswa kune imwe ikemikari inogona kuiswa muropa. Mienzaniso inosanganisira Strontium-89 uye Radium-223. Sezvo izvi zvikamu zvemasvikiro zvichiendeswa kuburikidza neropa kusvika kumapfupa ose mumuviri, zvinogona kunge zvakanyatsoshanda kune vanhu vane maitiro akawanda kana akapararira.
- Kuvhiya: Kuvhiya kunogona kudiwa kuti udzike kuputsika kana kugadzikana mapfupa akaora kuti udzivise kuputsika.
- Steroetactic body radiotherapy (SBRT) uye proton bhidhiyo remishonga : Kune imwe chete kana mashoma masastases (oligometastatic disease), kupera kwemasastases nemishonga yakadai se stereotactic body body radiotherapy kana kuti chirongwa cheproton chinogona kuitwa nemuedzo wokurapa, asi ichi kazhinji.
- Mafupa-anogadzirisa: Aya achakurukurwa pasi apa.
Mishonga yeT Bone Metastases (Bone-Modifying Agents)
Kune mairi maviri emakirasi ekutanga emishonga inoshandiswa kurapa masetasti emapfupa. Izvi zvinosanganisira bisphosphates (dzakadai seZometa) uye denosumab. Mafupa-anochinja anoshandiswa kune chero munhu ane kenza yepabonde yemasasa kuti awane pfupa, uye inowanzoshandiswa nemamwe matumbo akaoma (akafanana nekenza yemapapu) zvakare. Mimwe mishonga (yakadai seyradio therapy) inowanzodiwa pamwe nemishonga yekudzivirira marwadzo.
Mafupa-anogadzirisa vanokwanisa kubatsira vanhu vane kenza munzira dzakawanda.
- Vanogona kusimbisa mapfupa akanganiswa nemasitasita kuti adzivirire marwadzo ose uye ngozi yezviputsi
- Mishonga yakawanda inoshandiswa mukenza wemvere uye kenza yeprotate, inogona kuwedzera kungozi ye osteoporosis, uye pamwe chete nemasitosita emapfupa anokonzera vanhu kuti vaputsike. Izvi zvinonyanya kukosha sezvo vanhu vari kurarama kwenguva yakareba nekenza.
- Pamusana pemigumisiro yavo pane microenvironment mapfupa, mapfupa-anogadzirisa mapfupa anogona kuderedza dambudziko remasitasasi emapfupa anowanzoitika (pakutanga nekenza yemazamu uye pamwe nekenza yeprotate ikozvino). Ngozi yemasitasase yepfupa yakaderedzwa kusvika kusvika kune chetatu, asi chiyero chekufa chakakonzerwa nechitanhatu.
- Mune zvidzidzo zvenguva ichangobva kutarisa mapfupa-anogadzirisa mishonga yemukenza yemapapu, zvinoratidzika kuti mishonga iyi inogona kuvandudza zvose zviri mberi-kusununguka uye zvachose kurarama.
Bisphosphonates (Zometa)
Bisphosphonates mishonga yakatanga kushandiswa kuporesa osteoporosis uye gare gare yakaratidza kubatsira nemapfupa emapfupa. Kana yakashandiswa kwekenza yakapararira kumapfupa inogona kuita mabasa maviri. Havasi kungoita chete kuderedza kurasikirwa kwemapfupa asi ivo vanopesana nekenza migumisiro zvakare. Vanoshanda nekudzivisa kuputsika kwefupa kunatsiridza mapfupa emapfupa.
Bisphosphonates inowanzoshandiswa pamapfupa emapfupa anosanganisira:
- Zometa (zoledronic acid): Zometa imishonga inopinza inoshandiswa pamasitema emapfupa emakondani akawanda akasiyana.
- Aredia (pamidronate) : Aredia is intravenous bisphosphonate. Inogamuchirwa nekenza yemvere uye multiple myeloma.
Zvose zvinowanzovhiringidzika zveZometa neAredia vane chirwere chechirwere-kufanana kwemazuva mashomanana okutanga mushure mekunyudzwa. Zvimwe zvikamu zvisingawaniki zvakawandisa zvinokonzerwa ne bisphosphonates inopa intravenously zvinogona kusanganisira kuora kwepvo, low calcium levels, musuru, kubatana, uye / kana kurwadziwa kwepfupa (iyo inogona kubuda chero nguva mushure mekurapa), kuputsika kusina kujairika kwemukadzi, uye yefriday fibrillation. Bisphosphonates haigone kurumbidzwa kuvanhu vane zvirwere zvepfungwa.
Chinhu chisingawanzoitiki asi chakakomba chakaitika chinoshandiswa neZometa kushandiswa (uye mamwe bisphosphonates) ndeye osteonecrosis yejaya. Ichi chiitiko chinoratidzwa nekuputsika kwepfuuriro mune imwe nzvimbo yefupa mune zvinyorwa kana kuti maxilla uye zvinogona kunge zvakaoma kwaIri hazvizivikanwe kuti nguva yakawanda sei mamiriro ezvinhu anoitika, asi pangozi yeanenge 2 muzana yakawanika kuvakadzi vaibatwa neZometa sean adjuvant therapy pamusana wekenza yepabonde. Osteonecrosis inogona kuitika nemishonga chero ipi zvayo muboka re bisphosphonates asi 94 muzana yematokari inowanikwa nemishonga inokonzera bhisiphosphonate uye hazvishamisi nemishonga yemuromo.
Osteonecrosis yetsanga inowedzera kana vanhu vachitambura nechirwere chemaini, vane uori hwehutano husina kunaka, kana kuti vanoita mazinyore akaita mazino akadai sokudhonza mazino. Kune humwe humwe uchapupu hwokuti urongwa hwekuongorora mazino humwe mwedzi mitatu uye uchishandisa mishonga inodzivirira maitiro akadai sokudhonza mazino kunogona kuderedza ngozi. Mishonga yekurapa inosanganisira kusanganiswa kwekuvhiyiwa, rinses, antibiotics, uye hyperbaric zorgenic treatments.
Bisphosphonates inogamuchirwawo kuvarume vanopinda mumizinopa musikana ane kenza yemazamu. Mumakiriniki ekuedzwa, Zometa yakawanikwa kuderedza dambudziko rekugadzira masastases ematatu nechetatu uye pangozi yekufa nemumwe wechitanhatu.
Denosumab (Xgeva uye Prolia)
Xgeva uye Prolia (denosumab) inonzi monoclonal antibody (anti-made antibody) iyo inogona kuderedza zvinetso (zvakadai sezviputsi) zvinosanganiswa nemasitosita emapfupa. Kune miviri miviri yechirwere ichi ine zvimwe zviratidzo zvakasiyana nekenza. Dzinopiwa nejojo mavhiki mana.
Denosumab inoshanda nekusunga pamwe nekusaisa chivako pamuprotini (RANKL) iyo inotungamirira bone kugadzirisa. Kune miviri miviri mikuru yemasero mumapfupa: osteoblasts inokonzera bone kukura, uye osteoclasts inoputsa bone. Denosumab inhibits osteoclasts uye inowedzera bone.
Mukuongorora kwe 2016 kwekuongorora, denosumab yakaongororwa mumatambudziko matatu akasiyana-siyana emakiriniki anotarisa basa rayo mukenza webonde, kenza yeprostate, uye chechitatu chekudzidza nevanhu vaive nevanorwara maeloma kana maitiro akaoma kunze kwekenza kana kenza ye prostate. Nekenza yemazamu nekenza yeprotate, denosumab yaive yakakwirira Zometa mukuderedza dambudziko rezvipembenene zvakabatana nemasitaste emapfupa. Ndiine myeloma dzakawanda uye mamwe maitiro akaoma (akadaro denosumab akanga akaenzana nekubudirira kuZometa.
Nekenza yemapapu, chidzidzo chegore ra2015 chakawana kuti kana ichienzaniswa neZometa, denosumab yakaderedza dambudziko rekuputsika kunowanikwa ne17 muzana. Inoratidzikawo kunonoka kubatanidzwa kwemafupa emapfupa, kuderedza chikwata chekukura kukura, uye kuwedzerwa kupona nguva kwenguva inopfuura mwedzi.
Denosumab akawanikwawo kuderedza dambudziko rehutano hwehutano hwehutachiona uye hwekenza yeprotate (yakabatana nekushandiswa kwearomatase inhibitors mukenza yemazamu uye androgen kubviswa kwekenza mukenza yeprostate),
Zvimwe zvinokonzerwa ne denosumab zvakafanana ne-bisphosphonates asi zvinodhaka izvi zvinowanzoita kuti pave nekasiki yepamusoro nekushandiswa kwenguva refu. Nokuda kwechikonzero ichi, kutora supplement ye calcium uye vitamini D inowanzokurudzirwa. Kusiyana ne-bisphosphonates, denosumab inogona kushandiswa kune vanhu vane utano hwepfungwa husina kunaka. Sezvakaita bhosphosphonates, pane ngozi shomanana yeasteonecrosis yejaya nemishonga iyi.
Mirayiridzo yeAsa-Kugadzirisa Nhengo Ne Bone Bone Metastases
Zvidzidzo zvemafupa-anogadzirisa mapfupa zvakatungamirira kune mazano ari munzvimbo dzevamwe kanzira.
Nekenza yemasitamende yepamuviri, ine metastases yemapfupa, American Society of Clinical Oncology mirayiridzo kubva muna 2017 inokurudzira vakadzi kuti vabatwa nemumwe wezvinotevera zvinodhaka nokukurumidza apo metastases yepafu inowanikwa:
- Xgeva kana Prolia 120 mg subcutaneously masvondo mana
- Aredia 90 mg IV mavhiki matatu kusvika mana
- Zometa 4 mg IV mavhiki gumi nemaviri kana masvondo matatu kusvika ku4
Nekenza yeprostate, 2017 kemikirwo yemitambo yakarongedzawo yakakurudzira kuti mapfupa-anogadzirisa mapfupa aitwe panguva yekuongororwa kwemasitema emapfupa. Zvimwe zvinosanganisira kana:
- Xgeva / Prolia (denosumab) 120 mg pasi pemasikati masvondo mana
- Zometa 4 mg IV mavhiki gumi nemaviri kana masvondo matatu kusvika ku4
Zvose zvipembenene zvakasimba nemasitasase emapfupa zvinogona kurapwa nechimwe chezvinotevera:
- Zometa 4 mg IV mavhiki matatu kusvika ku4
- Denosumab 120 mg pasi pemasvondo mana
Usati Watanga Kutanga
Usati watanga kurapwa pamwe nedenosumab kana bhisiphosphonates, zvinokurudzirwa kuti vanhu vaongorore mazhenesheni ekuongorora mazamu ezvirwere zvegum uye kuti chero basa rezvemeno rinodiwa rinofanira kuitwa musati watanga mishonga iyi.
Pasi Panyaya Pamapfupa-Kugadzirisa Mishonga yeBetasisase Kubva Mumiviri Yakasimba
Bone metastases inonetsa kune vanhu vakawanda vane kenza yemasita uye inogona kuderedza hupenyu hwehupenyu uye hupenyu. Mafupa-anogadzirisa mafungiro ari nzira itsva uye iye zvino anokurudzirwa nguva pfupi pashure pokunge aongororwa nemasitasase emapfupa akawanda emukenza.
Bisphosphonates yakadai seAredia uye Zometa inogona kuderedza dambudziko rezviputsi, uye zvinokonzerwa nekutambudzika uye kusagadzikana. Denusomab inoshanda mukuderedza fractures pamwe uye inogona kunge yakakosha kune bisphosphonates nokuda kwebonde uye prostate kanc. Makirasi maviri emishonga anonyanya kuisa njodzi yeasteonecrosis yejaya, uye kuongorora mazino akachenjerera kutsvaga zviratidzo zvechirwere chemaini kunorudzirwa usati watanga mishonga iyi.
Mukuwedzera pakuderedza ngozi yekuparara, mishonga iyi inogona kubatsira kukanganiswa kwefupa rakakonzerwa nehutachiona hwehutachiona hunoshandiswa muhutachi uye hutachiona hwe prostate. Zvose vese IV bisphosphonates uye denosumab inoratidzika seine basa rinopesana nekenza, zvichiwedzera zvipo zvevanhu vanosarudza kushandisa madhiragi aya. Izvozvi, kuwedzera kune vanhu vane kenza yemasitamende yepamusoro, Zometa ikozvino inokurudzirwa kutanga kwekenza yepabonde yepabonde sechirongwa chekugadzirisa adjuvant kuderedza mukana wekuti kenza yemazamu ichapararira kumafupa panzvimbo yekutanga.
> Sources:
> Beth-Tasdogan, N., Mayer, B., Hussein, H., naO. Zolk. Zvinyorwa zvekutarisira Mishonga-Yakaenderana neOsteonecrosis yeJaw. Cochrane Database yekuongorora kwakarongeka . 2017. 10: CD012432.
> Coleman, R. Impact yeT Bone-Targeted Treatments paSkeletal Morbidity uye kupona muKenza yeAsawere. Oncology (Williston Park) . 2016. 30 (8): 695-702.
> Dhesy-Seh, S., Fletcher, G., Blanchette, P. et al. Kushandisa Adjuvant Bisphosphonates uye Zvimwe Bone-Maitiro Akashandura muKenza Yemazamu: A CancerCare Ontario uye American Society of Clinical Oncology Clinical Practice Guideline. Nyaya yeCliniki Oncology . 2017. 35 (18): 2062-2081.
> Gravalos, C., Rodriquez, C., Sabino, A. et al. SEOM Clinical Guideline yeTetas Metasase Kubva Mumakumbo Akasimba (2016). Clinical and Translational Oncology . 2016. 18 (12): 1243-1253.
> Gul, G., Sendur, M., Aksoy, S., Sever, A., naK. Altundaq. Kuongorora Kwakakwana kweDenosumab yeT Bone Metastasis muVachipatara Vane Mishonga Yakasimba. Research Current Medical and Opinion . 2016. 32 (1): 133-45.