Utano hutsva hutsva-kuwedzera, Zvinyorwa , Zytiga , Xtandi, Xofigo, uye Jevtana- vanove vakawanikwa pakurapa kenza yeprostate mumakore mashanu apfuura. Nenzira inofadza, mishonga yekare yokurapa yakadai semayero, Lupron, uye Taxotere inoramba ichishandawo zvakare. Kazhinji, kenza yeprotate inofambira mberi zvishoma nezvishoma, zvinoreva kuti kufa kunogona kuchinjwa kwenguva yakareba.
Pasinei nezvose izvi zvinotarisira, varume 28 000 vanopinda kenza yeprostate gore negore. Muzviitiko zvakawanda, kufa kunoitika nokuti kenza inozoguma isinganzwisisiki kune yese yemishonga inoratidzwa pamusoro apa. Kana izvi zvikaitika, danho rakatevera rinotevera nderokufunga nezvekurapa-mazita emishonga yakadai semishonga iyo FDA-inogamuchirwa kune mamwe maitiro ekenza, inotaura kuti kanzera yempfungwa kana kenza yemapapu, somuenzaniso. Dambudziko ndiro kusarudzwa pakati pezvimwe zvizhinji. Kana iwe uri kuenda kundotora bundu murima, ndeipi pfuti yaunofanira kusarudza?
Kubvisa-Mavara Emavara: Nyaya Yevarwere
Kutsvaga kwekubudirira kune-label agent kunogona kuwana mubhadharo mukuru kana iwe uine lucky. Kubva pane maonero eDFA, mishonga inogamuchirwa inogona kushandiswa kushandiswa kusingagamuchirwe apo mupi wehutano anofunga kuti yakakosha murwere wavo, kana kuti nokuti hapana mvumo yakagamuchirwa yekurapa mamiriro akapiwa kana kuti murwere akaedza zvose zvinogamuchirwa mishonga pasina kuona mhinduro.
Regai nditaure nyaya yaBill. Akatanga kuongororwa kumagumo kwegore ra2012 ne PSA ye 4.2 uye chikwata cheGleason cha 3 + 4 uye akabatwa nekuvhiyiwa kubvisa prostate. Chiratidzo chekutanga chekuwedzera dambudziko ndechokuti mushumo wake wehutano wakaratidza kenza kunze kwekumucheto kweprostate. Chikwata chake cheGleason chakasimudzirwawo kusvika 4 + 5 = 9, uye PSA yake haina kumbotsika kusvika zero mushure mokunge prostate yabviswa.
MunaMugore 2011, akawana mazaisai akaendeswa kunzvimbo yemuviri apo prostate yaimbova iyo, asi PSA yakaramba iri pasi kwenguva pfupi. Akabva atanga Lupron, asi chironda chake chakasagadzikana mukati megore. Kwemakore matatu akatevera, akarapwa nemishonga yakanyorwa pamusoro apa, Zvinyorwa, Zytiga, Xtandi, uye Taxotere. Pakazosvika gore ra2014, kenza yake yakapararira zvakanyanya mumufupa wake wose. Kurapa ne Xofigo kwakatanga muna February 2014. Nhamo, yakatanga kufambira mberi kwemafupa ekushaya mararamiro, kufambira mberi kwakafanana pakati pevarume vane kenza yeprostate isina kudzora. Kuitwa kwake kwemasero matsvuku eropa kwakanga kwakanyanya kushaya simba aigona kungochengetwa ari mupenyu nekuwedzerwa kweropa pamwedzi. Apo Xofigo yakamira munaAgasti 2014, PSA yakasimuka kusvika kudarika 120. Chinyorwa chaBill chekugara mamwe mwedzi mitanhatu chaive pasi peiyo gumi.
Kusvikira pano, mumwe chiremba aive achitonga nyaya yake. Pamwe asati ashandura kutarisa kwekurapa kwake kuhofisi yangu chiremba wake wekare akatanga Bhiri pamushonga unenge uri kunze kwerapi unonzi Mekinist. Mekinist ipiritsi inonzi FDA-inogamuchirwa kuti iwane metastatic melanoma. Sezvo kushandiswa kwekenza yeprostate (kunze kwe-label use) hakufukidzwe nehushuwarisi, Bill akatenga piritsi pachake pamutengo we $ 10 000 pamwedzi.
Zvisinei, kubhadhara kwake kwakabhadhara. Pakazosvika December 2014, PSA yakaderera kusvika pa18,96, mafuta aro eropa akatanga kushanda zvakare, uye akanga asisadazve kuwedzerwa ropa.
Utano hwaBill hwakavandudzwa zvikuru zvokuti akadzoka kubasa rake nguva yakazara uye akatotora nguva nenguva nemhuri yake kuenda kuEurope uye nzvimbo dzakasiyana-siyana muUnited States kwemakore maviri akatevera. The Mekinist yakanyatsorambidzwa pasina chero maitiro akaoma. Zvinosuruvarisa, kenza yake yeprostate yakaguma isingaendi neMekinist uye kenza yakatanga kufambira mberi. Kuwedzera kwekuedza kwakasimba kwekuwana imwe kunze kwe-label magic bullet yakakundikana uye akakundwa nechirwere kutanga kwegore ra2016.
Bill's Mekinist yaiva chishamiso chinoshamisa. Mushure mokuratidza mhinduro yakadai yemukenza, akange akwanisa kugutsikana nekambani ye inshuwarisi yekuvhara mari. Kubudirira kwekuregererwa kwekenza panguva yakadaro yekupedzisira kwechirwere kunoshamisa zvechokwadi, chirevo chezvinhu zvinokonzera kugadziriswa zviri kushandiswa mumakambani emishonga. Tichifunga kuti vazhinji vatsva vashanduri vari kukurudzirwa, maitiro ehupfumi, sezvakaitwa naBill, kudzokorora zviri kuwedzera.
Genetic Testing: Zvinoreva Smart Selection
Dambudziko ikozvino nderokuti kune nhamba yakakura yevashandi vatsva iyo inobvumirwa mumhando dzose dzekenza. Iwe unoziva sei kuti inyanzvi ipi inofanira kusarudza? Takaedza kugovera Mekinist kune vamwe vashoma vashoma, asi pasina chero chinhu chinoonekwa chinopesana nekenza. Izvi hazvishamisi tichifunga kuti kenza yeprotate haisi chirwere chimwe chete. Isu tagara tichitarisa kusiyana kwakasiyana-siyana umo varwere vanoita sei kune avo vakasiyana-siyana. Zvisinei, pane imwe nzvimbo yekufambira mberi kwekambani yekutsvaga iyo inogona kutibatsira kuti tive varwere kune mamwe mazano ekurapa. Kuuya kweiyo genetic kuongorora kwemasimba emarara kunogona kupedzisa kuguma panguva yekunyora kurapwa nemaitiro.
Mhedziso ndeyokusarudza kurapwa nekutsanangurira mazita ekurapa masero nemaitiro ekugadzirisa. Kudzora kusingadzorwiki kwemasero, "kenza," kunokonzerwa nekusava nemafuta. Zvimwe zvakasvibiswa zvemajeni zvakabatana nekukura kwemasero zvinogona kuvharwa mu "pane" nzvimbo. Izvozvo zvinogadziriswa zvinogona kuzivikanwa nemaitiro ekugadzirisa. Majini anopfuura makumi mashanu ave akaonekwa kuti kushanda kwekenza yeprostate. Genetic analysis of tumor tissue inoratidza kuti mumusero wekenza masero anenge mana emajini inowanikwa kuchinjwa. Zvisinei, nhamba yemafuta akaipa anoonekwa inogona kubva kune vashomanana imwe chete kusvika kune gumi.
Sezvinonakidza sevimbiso ye "yakachenjera" sarudzo yakasarudzwa, kune zvimwe zvinetso zvekukunda. Gene kusarudzwa kunogona kuramba ichinyatsoziva maitiro emagetsi asingashandisi nemazita, asi kwete nguva dzose gene chaiyo basa. Apo patinoziva basa racho, isu kazhinji hatina mishonga chaiyo yekugadzirisa dambudziko iro geni rinogadzira. Kunyange kana mishonga inoshandiswa iripo yekurapa gweta rinoshandiswa zvisina kukodzera mune rumwe rudzi rwekenza, hapana chivimbo chokuti hutungamiri hwayo huchava hunobudirira mukenza yeprostate. Somuenzaniso, Mekinist inofungidzirwa kuti inobudirira mukurwisana nekusava nemafungiro ejeni rinonzi GNAS kune varwere vane melanoma. Zvisinei, sezviripo, hatina deta inoratidza kuti Mekinist ichave yakakwanisa varwere vekenza yeprotate neGNAS .
Nzira Dzokuenzanisa Maitiro
Isu takaedza kuwana masero emukenza kuongororwa kwemajini muBill kuburikidza ne scan-directed directed bone biopsy. Zvinosuruvarisa, bhiopsy haina kubudirira nokuti hapana mishonga inokonzerwa nemavhenda yakawanikwa. Chiitiko chedu nechirwere chokuwana tumarara masero kubva pfupa rekuberekwa kwema genetic muzvirwere zvekenza yeprostate yakangobatsira kubudirira munenge hafu yevarwere vatakaedza kuita biopsy. Kusvikira munguva pfupi yapfuura, pfupa remapfupa ndiyo yaiva nzira chete yekuwana mazita ekuberekwa kwemasero mumarara. Bhuti inoputika, zvisinei, inotyisa uye isinganzwisisi inoda bhuru-refu nenyuchi. Nenzira yakanaka, teknolojia inoramba ichienderera mberi nekukurumidza kukurumidza kufamba. Izvo zvinowedzera kuitika ndeyekuwana kuti DNA yakakosha yakabudiswa muropa kubva pamasero erafa anofa inogona kuonekwa uye kuongororwa nekuongorora ropa.
Kuedza ropa reDNA kunonyanya kuwanda kupfuura kuita pfupa. Kunze kwechinhu chiduku, DNA iri muropa inoumbwa neDNA yakabudiswa kubva mumakumbo ose mumuviri wose. Izwi remagetsi rinobva muhupenyu hwechirwere chimwe chete haruzorevi nyaya yose nokuti kenza haina kusimba isina kukwana kuti zvikamu zvekenza zvakasiyana kubva kune mumwe murwere zvinogona kunge zvakasiyana.
Nyore yeRopa yeDNA yemahara ikozvino inotengeswa. Iko kambani inobata chiyero chinonzi Guardant Health. Vanodana ropa ravo reyero rinotarirwa nekenza yemaronda Guardant360. Ikokuenzanisa kwemasayiri makumi manomwe ekuchinja kukuru kunoonekwa mukenza. Zvidzidzo zvakaitwa kuti zviongorore kana majini asina kuonekwa akawanikwa muropa achifananidza maitiro evanhu vasina kuonekwa akaonekwa nekodhi yemakumbo mune mutezo mumwechete. Nhamba yeropa inoita seinoita zvakanaka kwazvo.
Mushure meGene Isina Kuipa Inowanikwa
Saka ngatidzokere kumusoro wedu mukuru wekushandisa mazita ezvibhedheni-akawanikwa kuti asarudze marapirwo emakirini emakirini muvarume vane kenza yeprotate avo vakaneta zvirongwa zvavo zvekurapwa kweDAA-approved. Apo gwesi risingawanzooneki inowanikwa pane zvikamu zvina zvinogoneka zvinoitika:
- Hapana ruzivo rwunozivikanwa runobatanidza neiyi inenge isingawanzo kenza yemuviri.
- Kune chirwere cheDAA-chinogamuchirwa chekenza yeprostate inowanika kune rimwe geni
- Kune chirwere chinogamuchirwa neDAA chinowanikwa kune rumwe rudzi rwekenza (mapapu, impso, melanoma, nezvimwewo) zvinogona kuva nebasa rekudzivirira mukenza yeprostate uye ichi chinonzi gene chisina kunaka.
- Kune vatsva vatsva vari kuongororwa nekuda kwechimiro chechimiro chisina kujairika mumakiriniki emakiriniki mune kenza yeprostate kana rumwe rudzi rwekenza. Varwere vane rudzi urwu rwekuchinja-chinja kunogona kunge vachida kutarisa kune iyo sendimi inofunga nezvemajairi anozivikanwa.
Kurondedzera zviri pamusoro apa nenzira inoshanda, matambudziko maviri okutanga haasi kuzobatsira zvikuru varwere. Kunyanya, mune zvechipiri chekupedzisira, varwere vakawanda vanowana maitiro ekuongorora maitiro ekenza yeprostate vatove vakaneta nehutano hweprotate-yakabatana neCDA-inogamuchirwa kurapwa chero zvakadaro. Mhedzisiro yechitatu uye yechina ndiyo iyo inogona kureva rudzi rwechirapa iyo ingangodaro yakarasika mushure mehuzhinji hwema-off-label dzinogona kuonekwa.
Zvinosuruvarisa kuti Bill mazita ega haana kukwanisa kuwanikwa pasinei nekuedza kwatinoita. Izvo zvakaita maMekinist pamazuva ake ehupenyu uye hupenyu hwehupenyu hwakanga husina maturo. Panguva ino, hatizivi kana kupindura kwake kwakanaka kwakaitika nekuda kwekushaya kushanda kweGNAS, imwe geni kana kuti kusanganiswa kwemajini. Zvisinei, iye zvino nekunyoresa nyore kweruzivo rwehutano kuburikidza nokuongororwa ropa neWarantant360, tichakwanisa kudzidza kuti zvipi zvingarapwa zvinogona kukonzera mhinduro dzekenza zvichienderana nemararamiro ega ega.