Ko osteoporosis zvinodhaka sei Zometa kana Bonefos dzinobatsira?
Kunyange zvazvo mishonga yemaperembudzi yakashandiswa kune vanhu vane kenza yemasitemasi neyamapfupa emasitema, mitsva mi 2017 inobva kuAmerican Society of Clinical Oncology inokurudzira kushandisa bhaphosphonate drug Zometa kune vamwe vakadzi vane kenza yepabonde kare. Ndezvipi chaizvo zvinonzi bisphosphonates uye zvinoshanda sei? Zvinogona here kuderedza mukana wekuti kenza yako yepamu ichapararira kumapfupa ako nekuvandudza kupona?
Iwe ungaziva sei kana mishonga iyi inogona kunge yakanaka kwauri?
Kanzvadzi yeChechi uye Njodzi yekudzoka zvakare
Nzira yekutanga yekenza yepabonde inoporesa zvikuru, uye kuwedzera kwehuwandu hunovandudzwa nekuwedzerwa kwechikwata chemudhiyamu uye chirongwa chemahomoni kune avo vanoda kuberekwa. Asi kunyange nekenza yekutanga-yesera yepamu ( chikwata I , chitubu II , uye gango rechitatu ), kudzoka kunowanzozara.
Dambudziko rekudzoka rinopesana nezvimwe zvinhu zvinokonzera danho rekenza yako, makore ako, kurapa kwaunogamuchira, nezvimwe zvinhu. Hatizivi kuti sei kenza kazhinji inodzokorora makore akawanda kana makumi emakore gare gare, kunyange maonero pamusoro pekuti sei kubuda kwekenza yemvere kunosanganisira pfungwa yokuti kune hutungamiri hwekenza masero, uye kuti kenza yemasero emasero (avo vakuru) angave akarara mumapfupa emapfupa kusvikira mamiriro acho ezvinhu atanga kuwedzera zvakare.
Chirwere chekenza chekare chinogona kuva chemarudzi matatu:
- Kudzokorora kwemukati , umo chironda chinoramba chichidzoka muzamu pedyo nenzvimbo yechipfuva chepakutanga.
- Kudzokorora kwemuhara , umo kenza inofamba iri pedyo nemakiriniki kana zvivako zviri pedyo.
- Kudzoka kwakanyanya , umo kenza inodzokera kune imwe nzvimbo iri kure yemuviri yakafanana nemapfupa, chiropa, mapapu, kana uropi. Pakati peizvi, mapfupa ndiyo nzvimbo inowanikwa yakawanda yemasastases.
Icho chiri kure kurereka-metastatic kenza yemazamu (chikwata chechina chekenza yebonde) -iyo inokonzera 90 muzana yevanhu vanofa nekenza yemazamu.
Ndiani Ari pangozi yeTatas Metastases Kubva paKana Breast Cancer?
Anenge munhu wose ane kenza yemazamu angave pangozi yekugadzira masastases emapfupa, asi pane zvirongwa umo huwandu huripo hukuru.
Bone metastases inowanzoonekwa kune vanhu vane chirwere chesaurogen chekugamuchira- chamuti. Estrogen receptor matumbo akanaka anowanzoita kuti awedzere nekudzokorora kwenguva refu, somuenzaniso, makore mazhinji kana makumi emakore mushure mekunge kenza yekutanga yakatorwa uye inobatwa. Zvimwe zvinhu zvinowedzera njodzi yokuti kenza yemazamu ichadzoka inosanganisira chirwere chemuviri chechiremera.
Vanenge makumi manomwe kubva muzana yevakadzi vane kenza yepamusasa yepaseti (chirwere chekenza yepamuti 4) ichava nemasitoshe emapfupa.
Basa reBisphosphonates muKenza yeAsawere
Bisphosphonates yakatanga kushandiswa muma1990 apo yaibvumirwa kuti iwane kurapa kwehuputi . Kubvira panguva iyoyo ivo vakagamuchirwawo kurapwa kwemasitema emapfupa kubva pamukaka wehasi (uye mamwe marariya) uye hypercalcemia inosangana nekenza.
Nzira dzinoverengeka dzingaita kuti bisphosphonates zvigone kubatsira kuvanhu vane kenza yemazamu vanosanganisira:
- Madzimai ane kenza yemazamu akapararira kumapfupa ( kenza yemazamu nemapfupa emapfupa ), bisphosphonates yakadai seZometa inoderedza ngozi yezvinetso zvakadai sefupa rakaputika. Sezvo pfupa rakaputika ndicho chikonzero chinokonzera kurwadziwa nekuremara, mishonga iyi inogona kuchinja zvakanyanya hupenyu hwevakadzi vane chirwere chetatu chechirwere.
- Aromatase inhibitors, iyo hormonal therapy yekenza yemazamu inowanzoshandiswa mumadzimai anonzi postmenopausal, inogona kukonzera kurasikirwa kwemapfupa kunokonzera osteoporosis. Uku kurasikirwa kwepfupa kunogona kutungamirira kumarara, asi kunogona kuwedzerwa kunetseka apo masetasita emapfupa aripowo.
- Mune zvidzidzo, kushandiswa kweZometa mumaratani emasitemita emuviri kunowedzera kupona.
- Kakawanda munguva pfupi yapfuura, kushandiswa kwebhisiphosphonates muestrogen receptor-positive pakutanga yekenza yemazamu yakabatanidzwa nehuwandu hwekugadzira masastase emapfupa panzvimbo yekutanga pamwe nehuwandu hwekupona (ona pasi apa).
Batsiro reBisphosphonates seAdjuvant Treatment for Early Stage Cancer Breast
Mune zvidzidzo kutarisa chetachiona chemuzamu kumatefu, zvakawanikwa kuti bisphosphonates haisi kungoita kuti pangozi yezviputi zvichibva pamasitema asi zvakaratidzwa kudzivirira kupararira kwekenza kumapfupa pakutanga.
Nepo isu tisina kunyatsoziva kuti vanoshanda sei, zvinodhaka izvi zvinoita kuti zvigadzirire microenvironment yefupa nenzira iyo masero emukenza emucheche asingakwanisi kugara.
Sezvo pfupa metastases inokonzera chikonzero chekufa nekenza yemazamu, kuderedzwa kwengozi yezviputi izvi zvinogona kuwedzera kuponesa kwevakadzi vane chirwere chekare-kutanga.
Zvidzidzo zvekupedzisira zvakasimbisa kuti idzi dzidziso dzaive dzakarurama. Kana ichipiwa mushure mekuvhiyiwa uye chemotherapy pamwe chete nemishonga inonzi hormonal therapy kushandiswa kwebhisiphosphonates kwekenza yepamuviri yepamuviri muvakadzi vane postmenopausal vakawanikwa kuderedza dambudziko rekugadzira masastases emapfupa nechetatu pamwe nekuderedza dambudziko rekufa nemumwe -chetanhatu. Kunyange zvazvo nhamba idzi dzichitaridzika, zvinoderedza kupera muhutano huri shoma kana tichitarisa mufananidzo mukuru, ne-bisphosphonates inopa inenge 1 kusvika ku2 muzana zvakanyanya kuderedzwa pangozi yekufa kwevakadzi vanozvigadzirira mushonga.
Mukuwedzera pakuderedza dambudziko remasastases nekuvandudza kupona, bisphosphonates inogona kushanda rimwezve basa. Aromatase inhibitors, rudzi rwehutachiona hwehutachiona hunotaurirwa vakadzi vanonzi menopausal (kana kuti vakadzi vanonzi premenopausal mushure mekuvhara maitiro ekurapa) kunogona kutungamirira kumapfupa ekurasikirwa uye osteoporosis. Izvi zvinotonyanya kunetseka iye zvino kuti mishonga iyi inorayirwa kwenguva yakareba kana mushure mekurapa ne tamoxifen. Zometa yakawanikwa kuderedza dambudziko rehasteoporosis inosangana ne aromatase inhibitors. Zvinodhaka zvinoshandiswa se aromatase inhibitors zvinosanganisira Aromasin (exemestane), Arimidex (anastrozole), uye Femara (letrozole).
Nhungamiro yeBisphosphonate mukutanga Mawere eChechi yeChechi
Nhasi mirayiridzo inokurudzira kushandiswa kweimwe yemishonga miviri yakasiyana mumamiriro ezvinhu aya:
- Zometa (zoledronic acid): Zometa iyo inopisa maitiro e-bisphosphonate. Chirwere ichi chinorudzirwa sechirongwa chekuchengetedza chirwere chemukaka wekamuti chekutanga chetamu rinokwana 4 mg IV mwedzi mitanhatu kwemwedzi mitatu kusvika kumashanu.
- Bonefos (clodronate): Bonefos ishoko bhosphosphonate inogona kushandiswa seimwe nzira yeZometa kana zvichidikanwa. Mukana weAdjuvant therapy ndeye 1600 mg piritsi inotorwa kamwe chete zuva rimwe nerimwe kwemakore maviri kusvika matatu. Bonefos haisi FDA inobvumirwa muUnited States.
Chirwere cheZometa chakashandiswa kare-kamuti yekenza yepabonde yakasiyana (ishoma kakawanda) kupfuura iyo inoshandiswa pamusana wekenza yemasita.
Ndiani Angashandisa Zometa kana Bonefos nokuda kweKukondwa Kwekenza?
Zometa (kana Bonefos) zvinokurudzirwa kuti chirwere cheAdjuvant chirwere chetrogen chinokonzerwa nemukati wemazamu. Inofanira kushandiswa chete kuvakadzi vane postmenopausal panguva yekuongororwa kana kuti avo vari premenopausal asi vakagamuchira ovarian kuderedza chirwere .
Vakadzi vazhinji avo vakabatwa nekenza yepabonde yepamberi pekutanga mushumo iyi vanogona kushamisika kuti havafaniri kutanga mushonga uyu kana kwete. Mhinduro ndeyokuti inogumira, uye pane zvakawanda zvingatora mukutarisa. Zvidzidzo zvakaitwa nevakadzi vakadzika bhisiphosphonates mushure mekupedza chirwere uye chemotherapy, uye hatina dhi rakanaka pamusoro pekuderedza mishonga kana kupona kubatsirwa nevanhu vanotanga mishonga iyi gare gare.
Tinoziva kuti bisphosphonates inogona kuderedza kurasikirwa kwefupa kune vanhu vane osteopenia uye osteoporosis, uye aromatase inhibitors inobatanidza nekukosha kurasikirwa kwefupa mune vamwe vanhu. Vamwe vanachiremba vanokurudzira bisphosphonates nokuda kweasteopenia kana mamwe mapfupa akarasikirwa (kunyange zvazvo maitiro akasiyana angashandiswa) kana kana munhu ane dambudziko guru rekuparara. Iwe unogona kuda kutaura neoncologist yako nezvekuita pfupa rekuwedzera kwepfupa usati waita sarudzo yako. Kana uchinge uine kana kuti uri pangozi yehutachiona, zvinogona kunge zvakakunakira kushandisa mishonga iyi.
Ngozi uye Migumisiro Yechechi yeBisphosphonates
Nzira yakanyanya kufanana nayo yeZometa chirwere chinotapukanana-chinetso chinogara kwemazuva mashomanana mushure mekudzivirira.
Zvimwe zvinokonzerwa nemuromo Bonefos zvinogonawo kusanganisira kuora mwoyo, indigestion, uye kuvhiringidzika kwesimba. Mishonga yemumuromo inofanira kutorwa nemvura uye vanhu vanorayirwa kuti varambe vakarurama kwemaminitsi makumi matatu nemakumi matanhatu kuti vaderedze njodzi yekutsamwa kukuru.
Zvisingabatsiri zvikamu zvinowanikwa zvakafanana zvebhasiphosphonates zvinoshandiswa mumuromo kana zvisingatauriki zvinosanganisira ropa rekusiya calcium level (hypocalcemia), musuru, kubatana, uye / kana kurwadziwa kwepfupa (izvi zvinogona kuitika panguva ipi zvayo panguva yekushandiswa kwemishonga), uye kushanda kwepfungwa kusina kunaka. Vanhu vane utano husina kunaka vasati vaongororwa vangasakwanisa kushandisa mishonga. Zvimwe zvisingawanzogadziriswa zvinogona kuitika zvinosanganisira atypical femur fractures uye atrial fibrillation.
Chinhu chisingazivikanwi asi chakakomba uye chinokonzera kukanganisa kwakashata kwesafisphates ndiyo osteonecrosis yejaya. Osteonecrosis inoreva kuparadzwa kwepafu uye inogona kuitika mune zvinogona kuitwa kana maxilla. Zviratidzo zvinowanzotanga nemarwadzo ejaya kana kurasikirwa kweino. Mune zvidzidzo zvakatarisa kushandiswa kweZometa seAdjuvant therapy nokuda kwekenza yepazamu, osteonecrosis yejaya yakaitika munenge 2 muzana yevakadzi vanotora Zometa.
Zvimwe zvinokonzera kukonzera osteonecrosis zvinosanganisira chirwere chegum, kuchenesa mazino, kana kushandiswa kwemishonga yemeno. Dzidzo dzave dzichitsvaga nzira dzekudzikisa dambudziko. Mune kumwe kuongorora, kuisa miongorori emeno kwemwedzi mitatu uye kushandisa antibiotic prophylaxis musati maitiro emishonga aibatanidza nehuwandu hwemamiriro ezvinhu. Apo osteonecrosis yejaya inoitika, inogona kuva yakaoma kurapa. Kazhinji kazhinji kusanganiswa kwemishonga inorwisa mabhakitiriya, kuvhiyiwa, muromo wemakumbo, uye hyperbaric oksijeni therapy inoshandiswa.
Kunyange zvazvo osteonecrosis yejaya inogona kuitika chero ipi zvayo ye bisphosphonate, inowanzoonekwa (94 muzana yenguva) ine bhosphosphonates.
Usati Watora Zometa kana Bonefos
Usati watanga Zometa kana Bonefos zvinokurudzirwa kuti uve neongororo yakakwana yezinyore zvakanyatsotarisa chero humwe uchapupu hwechirwere chemaini. Kana uchida chero basa remazino rakaitwa, rakadai sechigodo chezino, zvinokurudzirwa kuti upedze maitiro aya emishonga usati watanga bisphosphonates.
Bisphosphonates uye Metastatic Breast Cancer
Bisphosphonates uye imwe mhando yemishonga, denosumab (Xgeva kana Prolia) inonzi "bone-modifying drugs". Iyi mishonga inoshanda zvikuru mukuderedza dambudziko rezvipembenene zvakabatana nemasitasase emapfupa kubva pamukaka wehasi. Iye zvino yakakurudzirwa kuti bhisiphosphonates kana denosumab inotangwa apo bone metastases inotanga kuonekwa. Kana inoshandiswa pfupa remasitema, chirwere cheZometa chakakwirira uye chinopiwa se 4 mg kuputika kana vhiki gumi nemaviri kana vhiki nhatu kusvika mana.
Pasi pepamusoro paAdjuvant Bisphosphonates yekutanga kwepakati Chechi yepabonde
Bisphosphonates (Zometa) yakawedzerwa kusvika muna 2017 maitiro ekurapa maitiro ekurapa adjuvant yekutanga-strostro estrogen receptor-positive mazamu epamuviri mumadzimai emasopaopausal. Mishonga iyi inogona kuderedza dambudziko rekurapa-rinosangana ne osteoporosis, asi rinoratidzika kuderedza dambudziko rekugadzira masastasis emapfupa uye rinogona kuwedzera kupona.
Iyi mishonga inotanga mushure mekupedza chirwere uye chemotherapy uye panguva imwechete iyo hormonal therapy inotangwa.
Bone metastases nekenza yemazamu kwete kungoreva kuti kenza haigone kurapwa asi inokonzera kurwadziwa kukuru nekuremara. Matambudziko emasitasase emapfupa anosanganisira fractures, kugadzirwa kwemutsipa wesimbi, uye yepamusoro-blood blood calcium, iyo yose inoderedza hupenyu hwehupenyu uye inopedza kupona.
Bisphosphonates, semishonga yose, inogona kuva nemigumisiro. Zometa kazhinji inokonzera chirwere chinopisa-fanana kwezuva rimwe kana maviri mushure mekuderedzwa uye Bonefos kunogona kutungamirira kukutsamwiswa kwemasimba. Vamwe vanhu vanewo hutano husina simba kana hutsika yepamusoro. Chinhu chisingazivikanwi asi chakakomba nemigumisiro inonzi osteonecrosis yebasa, chirongwa chinofungidzirwa kuti chinokanganisa mumwe mugore makumi mashanu vakadzi vanoshandisa mushonga nenzira iyi. Utano hwemao hwakanaka uye kuongorora mazino musati watanga kurapwa kunogona kuderedza ngozi.
Kune vakadzi vakabatwa nokuda kwekenza yepabonde yepakutanga kare asi avo vangadai vakange vari mukana wokurapa adjuvant, pane ikozvino hapana mazano panzvimbo. Taura newe oncologist pamusoro pemafungiro ake uye zvaanofunga kuti ndizvo zvinobatsira uye zvisingabatsiri zvekurapa. Kuziva hutano hwepfupa uye kutarisa zvipembenene, kana kuti zvekudzoka kana kubva pamigumisiro yechipatara kunogona kubatsira kutungamirira sarudzo yako. Sezvo nekutarisira kwako kose, kuva iwe mumutevereri wako mukuchengetedzwa kwekenza kunoita kuti pave nekusiyana.
> Sources:
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> 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.
> Hadii, P., Coleman, R., Wilson, C. uye al. Adjuvant Bisphosphonates muBrazil Early Breast Cancer: Guidelines Consensus for Clinical Practice Kubva kuEurope Panel. Annals of Oncology . 2016. 27 (3): 379-90.