Chimwe chekufambira mberi kunofadza mukurapa mutsa wemapapu kwakabva pakunzwisisa kuchinja kwemajini mumasero emapapu emapapu. Sezvo munguva yakapfuura takaputsa makondomu emapapu kusvika kune mamwe marudzi mashanu, isu zvino tava kuziva kuti hapana mapepa maviri emapapu emapapu akafanana. Kana pakanga pane vanhu makumi matatu nemakumi matatu muimba nekenza yemapapu, vaizova nemhando 30 dzakasiyana uye dzakasiyana dzechirwere ichi.
Kana iwe uchangobva kuongororwa nemukenza wemapapu, kunyanya mapapu adenocarcinoma , oncologist yako inogona kunge yakataura newe pamusoro pekuongorora mazita (izvo zvisingazivikanwe se molecule kufungidzira kana kuongorora biomarker) yemarara yako. Iko zvino yakurudzirwa kuti varwere vose vemukenza yemapapu vane advanced kana metastatic lung adenocarcinoma (rudzi rwemwe musingaiti duku rwekenza yemapapu emapapu) vane maitiro ekuongorora maitiro ekutsvaga kuchinja kwe EGFR uye ALK uye ROS1 rearrangements.
Mukuwedzera, varwere vane dzimwe mhando dzisina muto mutsara wekenza yemapapu (somuenzaniso, adenosquamous carcinoma mune vasiri vasvuta) inofanirawo kuonekwa sekuedzwa.
Chii Chinonzi Genetic Testing?
Kuongorora maitiro ekuberekwa kunosanganisira kuongororwa kwakaitwa chirwere chekare murabhu uchishandisa muenzaniso wekenza yako yekenza. Iyi miedzo inotarisa kenza kubva pamatomu.
Mhuka yacho inogona kubuda kubva kuhuputi hwechirwere chako kana kubva kumatehwe kubviswa panguva yekuvhiyiwa yemukenza wemapapu . Chikonzero cheizvi ndechekuti marariya ane mararamiro ekuchinja uye mamwe maitiro "anotya" kana kuti kudzora kukura kwekenza.
Zviri nyore, kana kuchinja uku kunogona kuonekwa, zvino mazano anogona kushandiswa izvo "zvinotarisa" kuchinja uku, saka kumira kukura kwekenza. Izvo zviitiko izvi zvinotungamirira kukura kwekenza pakutanga.
Usati waenda mberi, zvinobatsira kutarisa chimwe chinhu chiri kuvhiringidza vanhu vazhinji.
Iko kune mbiri miviri yepamusoro yemashanduko ekuchinja kwemuviri:
- Herediness mutations. Izvo zvinonziwo germine mutations, izvi zvinoreva kuti iwe unotora nhaka yegenesisi nemutsiriro kubva kune mumwe kana vabereki vakawanda. Mienzaniso yakajairika yezviitiko izvi zvinosanganisira hemophilia pamwe nekuchinja-chinja kunogona kukonzera mumwe munhu kukura kenza yemazamu, sa BRCA1 ne BRCA2 .
- Yakagadziriswa. Chimiro chekuchinja kwezvinhu izvo masayendisiti anonyatsotarisa kune vanhu vane kenza yemapapu inonzi inonzi mutations, kana somatic mutation). Izvozvo hazvisipo pakuberekwa (uye musati mumhanya mumhuri), asi pane kukura mumagadzirirwo emasero kuva kenza .
Chii Chinonzi Gene Mutations?
Gene kuchinja kunochinja kune rimwe gene mu chromosome. Zvose zvemajini zvinoumbwa nenzira dzakasiyana-siyana dzemamine acid (dzinonzi mabhesi) -adenine, tyrosine, cytosine, uye guanine.
Apo geni rinoratidzirwa kune zvinodhaka mumhepo, kana kana njodzi inowanikwa muchitokisi, kuputika, kana kuchinja, kunogona kuitika. Mune zvimwe zviitiko, zvinogona kureva kuti imwe nheyo inotsiviwa kune imwe, saAdenine pane guanine. Mune dzimwe nguva, zvigaro zvinogona kuiswa, kubviswa, kana kugadziriswa neimwe nzira.
Zvinoreva Gene Mutations
Sei vana veoncologists vanoda kufanana nekuchinja kwemajeni mumuviri?
Chokutanga, tinofanira kutaura pamusoro pemhando mbiri dzekuchinja kwezvinhu zvakagadzirirwa mukenza yemapapu:
- Driver mutations . Izvozvo zvinoshanduka, kuburikidza nenzira dzakasiyana-siyana, "kutyaira" kukura kwemarara. Mumukenza wemapapu, nhamba yekuchinja kwevatyairi inoshanduka. Mune rumwe ruzivo, avhareji ye 11 kuchinja kwekutyaira nemukenza yakawanikwa.
- Kuchinja kwevatakuri. Kungofanana nemumwe munhu angave ari mutakari mumotokari, mazamu aya haadhanisi kenza, asi anowanzoita kuti atakure. Zvakare, hatinyatsozivi kuti vangani vanochinja mutengesi varipo mune tumarara (uye nhamba yacho inosiyana kubva mumakumbo kusvikira mumarara), asi mamwe matumire anokwanisa kuva nezviuru zvinopfuura 1 zvezvinhu izvi. Kuchinja kwemotokari kwete kungoita kutanga kwekenza, asi kushanda kuchengetedza kukura kwekenza zvakare.
Common Driver Mutations
Pane zvakawanda zvakasiyana-siyana zviri kuongororwa nevasayendisiti vachitarisa kumapupa emapapu. Kusvika ikozvino, kuchinja kwekutyaira kwakave kwakaratidzwa munenge 60 muzana yemapapu adenocarcinomas uye zvichida iyi nhamba ichawedzera munguva.
Vatsvakurudzi vari kuwana ikozvino kuchinja kwechifambisi mumagetsi echepamous emapapu emapapu zvakare. Nenzira yakawanda, kushanduka kwezvinhu izvi kwakagadzikana uye hakuwanzoonekwi mune tumarara imwe chete. Kazhinji kutenderera kwevatyairi mutapenza yemapapu kunosanganisira:
- EGFR mutations
- KRAS mutations
- EML4-ALK rearrangements
- ROS1 rearrangements
- MET kuwedzera
- HER2 mutations
- RET rearrangements
- BRAF mutations
Personalized Treatments
Kushandiswa kwe "zvinorapwa," mishonga inotarisa mararamiro akasiyana-siyana mumarara, yakagadzirwa mishonga chaiyo kana mushonga wakarurama. Zvinorevei izvi, kuti, panzvimbo yemishonga inokonzerwa nemakemikrasi inorwisa masero ose anokurumidza kuparadzanisa, zvinodhaka zvinodhaka zvinorwisa chimwe chinhu chisingaoneki chinowanikwa chete mumasero ekenza yako.
Kazhinji, zvinotarisirwa kurapwa zvine zvishoma zvisingabatsiri pane zvekare chemotherapy. Kusvika iye zvino, zvinotarisirwa kurapwa zvakagamuchirwa kuvanhu vane mutsa wemapapu zvinosanganisira:
- Tarceva (erlotinib) yevanhu vane chirwere chinonzi EGFR mutation (Cherechedzai: kune marudzi akasiyana eEGFR mutations uye kwete ose avo anoteererawo izvi.)
- Xalkori (crizotinib) kune vanhu vane chirwere chinonzi ALK4-EML rearrangement yegeneti (Cherechedza: FDA yakabvumira izvi muna 2011 uye yakabva yabudirira kurarama kweROS1 kenza yemapapu yakarongwa zvakare muna 2015.)
Mimwe mishonga yakagamuchirwa uye iri kuongororwa mumakiriniki ekuedzwa, kusanganisira zvakananga kurapwa kune avo vane chirwere chinopesana neTarceva kana Xalkori.
Kuramba Kurapa
Dambudziko rakakosha nemishonga inoshandiswa ikozvino ndeyokuti inenge wese munhu anongoramba asingagamuchiri mishonga yatinayo. Kune nzira dzakawanda izvo izvi zvinoitika zvichiita kuti zvive nyore kuwana imwe sarudzo. Kutsvakurudza kuri kuenderera mberi mumakiriniki-kuongorora zvose kushandiswa kwekuisa mishonga yechipiri kutarisa kuchinja kwemishonga uye zvinodhaka zvinoshandisa zvinangwa zvakasiyana kana nzira dzokurwisa kenza yemukenza.
Kuedzwa
Kuongororwa kwemashanduko emagetsi uye rearrangements inowanzoitwa pamashizha ematunhu akawanikwa kubva kune imwe nzira yemapapu biopsy kana biopsy yematastasis. Kubva munaJune 2016, zvisinei, kuedza kwemvura kunoshandiswa ikozvino kunowanikwa senzira yekuedza kuchinja kweEGFR mune vamwe vanhu. Sezvo izvi zvidzidzo zvingaitwa neropa risina kutora, iyi inofadza mberi pakuongorora kenza yemapapu.
Shoko Rinobva
Kukwanisa kunzwisisa maitiro emapapu emapapu inzvimbo inofadza zvikuru yekutsvakurudza, uye zvichida kuti mushonga mutsva kune dzimwe shanduko huchakurumidza kuvapo.
Muenzaniso wekuti nokukurumidza nzvimbo iyi yemishonga iri kufambira mberi ndeye ALK4-EML rearrangement yegene. Izwi iri "mutation" (chaizvoizvo rearrangement) rakawanikwa munguva pfupi yapfuura muna 2007. Nokukurumidza kuita, mishonga Xalkori (crizotinib) yakagamuchirwa mugore ra2011 kuitira kushandiswa kwakawanda neDFA kune avo varwere vane tumavara vane rearrangement iyi. Kune zvirwere zvekuchipatara izvo zviri kuenderera mberi kuongorora kushandiswa kwemishonga yechipiri yechizvarwa kune avo vakave vasina kukwikwidzana neXalkori.
Kana wakamboonekwa kuti une kenza isingaiti duku yemapapu emapapu, kunyanya mapapu adenocarcinoma kana chirwere chepamapu chemapapu, taura nechiremba wako nezvekuongorora mazita. Kunyangwe kuongororwa iko zvino kwakurudzirwa kune wese munhu ane chekuita chekenza yemukenza yemapapu asiri duku, kuongorora kwechangobva kuitika kwakaratidza kuti 60 muzana chete yevana oncologists varikurayira kuedza.
Iwe unogonawo kufarira kutaura nachiremba wako pamusoro pekuongororwa kwekliniki iyo inogona kunge iri sarudzo kwauri. Munguva ichangopfuura, chirwere chekliniki yemapirini chemapapu chinomirirana nehutano hwakatsigirwa nemasangano emakenza emapapu akawanda ave akawanikwa, zvakare. Nebasa iri rekusununguka, mukoti anodzidziswa anyanzvi anogona kukubatsira kuti uwane chero mishonga yekliniki iyo inogona kunge iri sarudzo kwauri.
> Sources:
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> Kim, H., Mitsudomi, T., Soo, R., uye B. Cho. Chirongwa chevanhu pachavo pamucheto we squamous cell carcinoma yemapapu. Lung Cancer . 2013. 80 (3): 249-55.
> Li, T., Kung, H., Mack, P., naD. Gandara. Genotyping uye genomic kufungidzirwa kwekasi-duku-kemukirini yemapapu yemapapu: zvinokonzerwa nemishonga yemazuva ano uye yeramangwana. Nyaya yeCliniki Oncology . 2013. 31 (8): 1039-49.
> Villaruz, L., Burns, T., Ramfidis, V., uye M. Socinski. Kuchengetedza utachiona muhutano husati huri duku memukiramu yemapapu. Seminari muKufuridza uye Inonyanya Kurapa Mushonga . 2013. 34 (6): 822-36.