Kunzwisisa ROS1 Gene Rearrangement muMusana-Small Cell Lung Cancer
Rar1 rearrangement inoratidzika mune chromosome inogona kuitika mumasero emukenza semakenza emukenza emapapu. Chromosomes-uye mazamu ayo anoumba makromosomes edu-atora code yezvinhu zvakadai semuvara wemeso edu. Vanonyorawo (kuita sezvinonzi blueprint) yepuroteti inotungamirira kukura nekuparadzaniswa kwemasero. Apo rimwe remakemikari aya kana ma-chromosomes akakuvadzwa, akashandurwa, kana kuti akagadzirisa zvakare, anotora puroteni isina kukwana, iyo inogona kuita zvisiri izvo zvinoshanda, zvakadai sekutyaira kukura kwekenza.
Nzira yekufunga nezvejeni ndeyekufungidzira ruzhinji rwemashoko anotsanangura mazwi. Apo tsamba idzi dzakasanganiswa, mazwi anobuda asina kunaka. Kana mazamu pane chromosome akagadziriswa mumasero akasiyana, mazwi anouya akaipa zvakare. Kana iwe uchinzwa mutsara we "gene translocation," izvi zvinongoreva kuti tsamba dzeROS1 geni dzinowanikwa zvisina kukodzera kune rimwe geni, zvakare rinoguma nekusanganiswa mune zvinyorwa "spell."
ROS1 Gene Rearrangement
Haasi ose kuchinja kwemajeni uye kuchinja zvakare kunokwana. Mamwe mapepa emapurotini anoshanda sevanotyaira. IROS1 jeni maitiro emapuroteni anoshanda semutyairi ndeye anogona kukwanisa kuratidzira kuratidza kana paine kuuya kwekukura nekuparadzaniswa. Apo geni rinogadziridzwa zvakare, mapuroteni asina kukwana anogona kuita kuti kukura kusina kuchena uye kugovana kwechitokisi.
Iyi proteinine imwe yemaprotiniti (enzymes) inozivikanwa se tyrosine kinases. Aya mapuroteni anotumira zviratidzo kumusero wekukura kwekuita kuti uzvizive nguva yekuparadzanisa nekuwanda.
ROS1 rearrangements kusvika ikozvino yakangowanikwa kune vanhu vasina kamudiki kenza yemapapu emapapu uye, yehuyu, vanhu chete vane mapapu adenocarcinoma . Hauna kuwanika kune vanhu vakashandura muEGFR kana KRAS kana ALK rearrangements.
Kuenzaniswa nemamwe marudzi emukenza wemapapu, chidzidzo che 2015 chakawana kuti:
- Nguva yepakati pevanhu vane ROS1 rearrangements yaiva 50.5. (Nguva yemunguva yemukenza yemapapu , kazhinji, ndeye 72.)
- Icho chakanga chiri chechidiki pane zvevakadzi mukuti 64.5 muzana vaiva vakadzi. (Kanza yemaronda mumurume inowanzowanikwa kupfuura vakadzi.)
- Chimwe chikamu chikuru-67.7 muzana-vakanga vasina kumboputa. (Kanzura yemaronda inowanikwa muvasingadi kusvuta, uye inenge 20 muzana yemukenza wemapapu mukati mevakadzi vari muvasamboputi.)
- Kunze kwevanhu vane mapapu adenocarcinoma, 3.1 muzana vaiva neROS1 rearrangement.
Kufungisisa kana tyrosine kinase inhibitor iyo inoshanda kune imwe geni rearrangement-lungha yemukenza neAARK rearrangement kana ALK-positive mapapu emapapu- ingashanda kuvhiringidza migumisiro yeprotini isina kukonzerwa yakagadziriswa neROS1 gene re gene? Zvakanaka, vatsvakurudzi vakaedza mishonga yakashandiswa zvakanaka kune vanhu vane kenza yemapapu emuAlk-positive. Zvinotoshamisa kuti zvakashanda neROS1 mishonga yemapapu yemapapu kunyange zvakanyanya.
Kuongororwa Kuongororwa
Pane nzira shomanana umo vanhu vane kenza yemapapu vanogona kuongororwa kuti vaone kana vane rearrangement yeROS1. Chiyero chacho chinoitwa pane imwe mienzaniso kubva mumuviri wepapupa kana chirwere chemapapu. Zvinotarisirwa kuti munguva yemberi kuedza kuchawanikwa kuburikidza nemvura yakasvibirira-chiyero chakaitwa paropa chinogona kuwanikwa neropa risina kutora.
Nzira dzokuedza dzinosanganisira immunohistochemistry uye fluorescence in situ hybridization (FISH). Zvidzidzo zviri kuenderera mberi kuti uone nzira dzakanakisisa dzekuedza.
Sezvo vanhu vane ROS1 rearrangements vasina KRAS uye EGFR mutations kana ALK rearrangements (kunyanya kwete mukuedzwa kunoitwa kusvikira zvino,) kuongororwa kunowanzoitirwa vanhu vasina kunaka nekuda kwekuchinja kwezvinhu izvi nekugadzirisa zvakare. Iwe unogona kunzwa izvi zvichitaura se "kanama katatu" isina-duku kenza yemapapu emapapu, kwete kuti irege kuvhiringidzwa nekenza katatu isina kunaka yepabonde iyo yakasiyana zvachose. Mune rumwe ruzivo, zvakawanikwa kuti, kunze kwevarwere vakaedza kusakanganiswa neKRAS neEGFR, 25 muzana yakanga yakanaka kune ALK kana ROS1 fusion gene.
Zvinofungidzirwa kuti ani naani ane kamudiki kadiki kemapapu emapapu, kunyanya mapapu adenocarcinoma, anofanirwa kuve nekuongorora kwemajini (kufungidzirwa kwema molecular) akaitwa pamakumbo avo emapapu. Kuedza kunonyanya kukosha kune vechidiki vakuru vane kenza yemapapu , avo vane huwandu hwakawanda hwekuchinja mishonga uye vanogona kupindura zvakanaka kune imwe yemishonga iri muchikwata che tyrosine kinase inhibitors. Mukuwedzera, zvakakosha zvikuru kuti vanhu vasingamboputi vese vanoedza kuitwa, sevamwe vasina kumboputa-fodya pane kuitika kwakanyanya kwekuchinja kwezvinhu nekugadzirisa zvakare.
ROS1 Positive Lung Cancer
ROS1 chirwere chemapapu chinotapira chirwere chemapapu chinotarisa chine ruzivo rweROS1 rearrangement yegene, imwe ye "kuzivikanwa kwekushandura" kunowanikwa mumukenza wemapapu. ROS1 mukana wekenza wemapapu wakanaka kune imwe chete yezana kusvika kune maviri muzana yemakenza emapapu. Asi, tichifunga kuti mutsa wemapapu unozivikanwa sei, unoramba uchimirira vanhu vakawanda vane chirwere ichi.
ROS1 rearrangements yakatanga kuwanika mu glioblastoma multiforme, rudzi rwekenza yeuropi, uye yakawanikwawo kune dzimwe dzimwe kenza, kusanganisira kenza yemaawa, colorectal carcinoma, kenza yemukati, uye cholangiocarcinoma.
Zvakakosha kusimbisa kuti rudzi rwegene rearrangement ratinenge tataura pamusoro apa ndechekuwana maitiro ekuchinja. Kusiyana nedzimwe shanduko dzezvemagadzirirwo uye kugadziriswa kwevanhu kunoberekwa, zvimwe zvacho zvinogona kukonzera vanhu kuti vawane kenza, ROS1 rearrangement gene haisipo kubva pakuberekwa. Iwe haufaniri kunetseka kuti vana vako vachagara nhaka yekugadzirisa zvakare.
Kurapa
- Kuvhiya -Kana vanhu vane chirwere chepakati pekutanga ini kuenda kune imwe nzvimbo IIIA, kurapwa kwekenza yemapapu kunogona kusarudzwa. Hasi dzose zviremara zvezvikamu izvi zvinoshanda, asi pazvinenge zviripo, kuvhiyiwa kunogona kupa mukana wekurapa.
- Chemotherapy -Zvirokwazvo zvinotarisirwa kuongororwa, mamwe makemikrasi maitiro anoshandawo muROS1 zvakanaka tumorum. ROS1 chirwere chemapapu chinotaridzika chinoratidzika sechinonyanya kufarira chemotherapy drug Alimta (pemetrexed) nepamusoro pe50 muzana yevanhu vanopindura kune mishonga mune imwe chidzidzo.
- Targeted therapies -Xalkori (crizotinib) inonzi tyrosine kinase inhibitor iyo yakatanga kugamuchirwa neACT-positive chenza yemapapu. Inokurudzirwa mutsara wekutanga-ndiko kuti, zvisati zvaitika kune dzimwe mishonga (kunyange mamwe mishonga ingashandiswa panguva imwechete) uye kune ani zvake ave akafanirwa kurapwa chirwere ichi. Iyi mishonga yakagamuchirwa nekenza yemapapu emuAlk muna 2013 uye yakashamisa gare gare apo chikamu I kliniki yekuedzwa kwevanhu vane ROS1 yemukenza yemapapu yakagadzirisa zviri nani kune mishonga. Mune mimwe miedzo yekliniki, nhamba yevanhu vakagamuchira kumushonga uyu yaiva pakati pe70 ne80 muzana. Mushonga uyu wakapiwa kukanganisa kurapwa kwekodzero yekurapa ROS1 yakanaka mumuviri wemapapu munaApril 2015. Loratinib kana yakagamuchirwa kune avo vane kenza yakafambira mberi kuXalkori. Ignyta (entretinib) haafaniri kushanda kune avo vane Xalkori vakakundikana, asi inogona kubatsira kune avo vane brainsted metastases.
- Mishonga yemakiriniki- Mimwe mishonga, kunyanya inotarisirwa mishonga, iri kuongororwa mumakiriniki ekuedzwa kwevanhu vane ROS1 yakanaka yemukenza yemapapu. Zvimwe zvacho zvinosanganisira Zykadia (ceritinib), imwe mishonga yakafanana ne crizotinib inogamuchirwa nekenza yemapapu emuAlk-positive. Mimwe mishonga inodzidziswa mapepa emapapu akanaka kune reRrang1 rearrangement inosanganisira Cometriq (cabozantinib) nevamwe. Kuti udzidze zvakawanda nezvekuongororwa kwemakiriniki emukenza wemapapu, funga kuonana nechirwere chechirwere chepachena chakatarisana nehutano hunoonekwa kune vose varwere vemukenza yemapapu
Brain Metastases
ROS1 zvirwere zvakanaka zvemapapu zvinowanzopararira kune uropi. Inofungidzirwa kuti 25 kubva muzana kusvika makumi mana kubva muzana yevanhu vanorwara nekasaiti duku kenza yemapapu emapapu kuchaita kuti uropi huve nehutachiwana mukati memakore maviri ekutanga kurapwa.
Zvinosuruvarisa kuti, Xalkori (crizotinib) haishandi zvakanaka kwazvo pamakemikari europi muvanhu vane ROS1 yakanaka yemapapu emapapu. Iyi mishonga, yakawanda, haifaniri kuyambuka ropa-brain brain barrier . Ropa-uropi hunopfigira urongwa hwehutachiona hunoshandiswa kuti hudzivirire uturu (pamwe chete nemakemikrasi yemishonga) kuti urege kupinda munzvimbo dzakaoma dzeuropi.
Kurapa kwechirwere chemasimisita kuuropi kuvanhu vane chirwere chemapapu vanogona kushanda zvakanaka. Uye zvakawanikwa kuti vanhu vane ROS1 rearrangements vane matamu angave akanyanya kufunga nezvezvirapa izvi. Mishonga inogona kupiwa nenzira dzakasiyana-siyana:
- Stereotactic radiotherapy -Munzira iyi, yaunogona kunzwa inonzi "cyberknife" kana kuti gamma knife, kupisa kwemavara kunowanikwa kune nzvimbo dzakagadzirwa muuropi.
- Ubongo hwose radiotherapy -Kubata kwehuropi hwehutano hwehutano, huropi hupi hunobatwa nemirairo.
Kusarudzwa pakati pemishonga miviri iyi inzvimbo yekukakavadzana. Stereotactic radiotherapy-sezvo inongobata chikamu chiduku cheuropi-ine madhara mashoma. Asi, uropi hwose radiotherapi inogona kuderedza mukana wekudzoka kwehutano hwemashupusi-chimwe chinhu chinowanzoitika kune vanhu vakambova nemastasisita europi kare.
Nhamba ye "mavara" inobatsirawo mune izvi. Vanhu vane zvishoma-kusvika kune zvitatu kana mana-zvinoshandiswa nyore nyore nenzira ye stereotactic kune avo vane metastases akawanda.
Drug Resistance
Vanhu vakawanda vanozopedzisira vasingagamuchirwi neXalkori (crizotinib) pamusana pekuchinja mutsva. Mushonga mutsva munharaunda iyi, Cometriq (cabozantinib), inowanikwa chaizvo mune zvidzidzo zvekutanga. Zvinoratidzika kuti zvinokwanisa kukurira kusagadzikana kubva kunezviitiko zvechipiri mune zvidzidzo zvekutanga.
Kuchenjerera Nezve Vitamin E uye Crizotinib
Zvidzidzo muna 2017 uye muna 2018 zvinoratidza kuti chikamu che vitamini E chinonzi--copyrol rinogona kuderedza zvakanyanya kukwanisa kwe crizotinib. Sezvo mavitamini E akawanda akawanda, uyewo mavitamini ane vitamin E zvimwe kana akawanda-a-tocopherol, izvi zvinotsiviwa zvinofanira kudziviswa kunze kwekunyatsorongedzerwa neoncologist yako.
Prognosis
ROS1 zvirwere zvemapapu zvakanaka zvinowanzova nehasha uye dzinokura uye dzinopararira zvakakodzera nokukurumidza, asiwo dzinopindura nenzira inenge isati yakamboitika yekurapa kurapwa. Kubvira pakurapwa kwachangobva kugamuchirwa, zvakaoma kuziva kuti kutarisira kwehupenyu hwemunhu kuchave kwakadini. Asi, mhinduro dzakaratidzwa kusvika ikozvino dzinokurudzira.
Mune rumwe ruzivo nguva yakareba yenguva iyo Xalkori akashanda (nguva yakatevera iyo yainge yarega kushanda kwehafu yevanhu asi yakanga ichiri kushanda kune imwe hafu) yaiva mwedzi 17; vazhinji vevanhu vakabata zvakapindira kumushonga.
Zvinotarisirwa kuti kana vanhu vasingakwanisi kurwisa mishonga iyi iyo vamwe vachave varipo, vanobvumirwa, kana mumakiriniki miedzo iyo inogona kushandura mishonga yakamira kushanda. Sezvakataurwa, kune zviratidzo zvekuti izvi zvinogona kunge zvakadaro.
Munguva yemberi iri pedo, tarisiro, kenza yemapapu ine zvigadziriswa izvi uye zvekugadzirisa zvekare zvichabatwa sechirwere chisingagumi, sekuti tinobata sei chirwere cheshuga. Kunyangwe kana kenza isati yaporeswa, inenge ichida kutaridzika.
Kutsigira uye Nharaunda
Iboka rakanaka revanhu vane ROS1 vane utano hwakanaka hwemapapu vakaungana pamwechete. IROS1Ders yakabatana nekukurumidza kutsvakurudza mukurapwa kweROS1 positive tumorum. Sezvo ichi chiri chimiro chisina kujairika chemuviri wehutachiona, vazhinji vemagariro evecologist havazive nekutsvakurudza kwakapfuura uye kuongororwa kwekliniki kunowanikwa. Panzvimbo yavo yepainternet ivo vanobatana nevanoriniki vepamusoro uye vanotsvakurudza vachidzidza ROS1 yakanaka yekenza yemukenza kana chiremba wako achida kutaura kune mumwe munhu mumoyo wekutsvakurudza. The Global ROS1 Initiative ishamwari inobatanidza vanotsvakurudza, varwere, vanochengeta, uye vanachiremba munyika yose kuvandudza zviitiko zvevarwere nekukurumidza kutsvakurudza.
Shoko Rinobva
Hapana munhu anofanirwa kupfuura nemukenza wemapapu oga. Kana mudiwa wako aonekwa kuti ane kenza yemapapu, tarisa pfungwa idzi pamusoro apo apo mudiwa wako ane kenza yemapapu .
Kubatanidzwa munharaunda yemukenza yemapapu kunogona kubatsira zvikuru, kunyange kune avo vanowanzovhara mapoka. Sezvo ROS1 chirwere chemapapu chakanaka chisina kujairika, hazvigoneki kuti uchawana vanhu vazhinji munharaunda yako vari kutambura nematambudziko emuviri uye emanzwiro mauri.
Muna 2015, paLUNGevity HOPE Summit, boka rakaumbwa rinosanganisira vanhu vakatarisana neROS1 yakanaka yekenza yemapapu. Ino inguva inonakidza yevanhu vane mutsa wemapapu, sezvo varwere vari kushanda pamwe-pamwe-navana navanachiremba kwete kungoziva chete chirwere chavo, asi kupa rupo pane tsvakurudzo inoda kuitika.
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