Hormonal therapies inowanzova danho rokutanga mukurapa kenza yemasasa, zvichida kune avo vane zviremera zvinonzi estrogen receptor positive . Kusarudzwa kwemishonga kunobva pane iwe uri premenopausal kana postmenopausal, uyewo kana kenza yako yakadzoka apo iwe waive uchishandisa imwe yemishonga iyi. (Kana kenza yako ichidzoka paunotora rimwe remishonga iyi inofungidzirwa kuti kenza yako inogona kunge isina kukwanisa kumushonga.)
Basa reEstrogen
Kune estrogen receptor-positive kanzvadzi dzechirwere, estrogen inoshanda semafuta, kusunga nevetrogen receptors panzvimbo yekenza masero uye kukurudzira kukura uye kupararira kwekenza. Ichi chiito che estrogen pamasero emukenza chinogona kugadzikana nenzira shomanana dzakasiyana; kuburikidza nekuderedza kuwanda kweesrogen mumuviri, kana nekudzivirira maitiro eestrogen saka estrogen haigoni kukurudzira kukura kwemasero. Kusiyana nemakemikrasi yemishonga inouraya zvakananga machechi emukenza zvakananga (nyore), hormonal therapies inoshanda zvikuru "kushaya nzara" masero ekenza yeserogen.
Usati waenda kumwedzi, mazai ako ndiwo mazai makuru eestrogen. Mushure mekuguma kwemwedzi, iyo yakakosha inobva kune estrogen mumuviri inobva pakutendeuka kwe androgens kune estrogen. Uku kutendeuka kunogadziriswa ne enzyme aromatase inowanikwa mumafuta nemasumbu. Aromatase inhibitors imishonga inodzivisa aromatase kuitira kuti uku kutendeuka kwe androgens kune estrogen isingagoni kuitika, nekuderedza kushaya yeserogen mazinga.
Hormonal therapies haisi yakakosha kune avo vane estrogen receptor uye progesterone receptor matumbo asina kunaka.
Zvakakoshawo kuziva kuti mamwe maitiro eestrogen receptor-positivewo HER 2 akanaka . Mumatumbu akanaka kune ose aya aya, maanti-anti-estrogen anogona kushandiswa kana kuti pasina madhiragi anoshanda paHER 2.
Premenopausal Therapy
Kana iwe uri premenopausal, maavoes ako achiri chikonzero chikuru cheestrogen, uye naizvozvo mafuta, nokuda kwekenza yemazamu. Chinangwa chekurapa mumadzimai e-foremenopausal ndechekuderedza kukwanisa kweesrogen kukurudzira kukura kwekenza yako nekuderedza kuwanda kweesrogen inowanikwa (ovarian suppression therapy) uye kunopesana nekwanisi yesrogen kusunga nesrogen zvakagadzirwa nekenza yebele masero.
Mishonga yakadai sa tamoxifen inonzi inonzi SERMS-inosarudza estrogen receptor modulating agents, uye inoshanda nekusungira kenza masero kuitira kuti isrogen iri mumuviri isingagoni kusunga kusero uye kuratidza kuti sero rinokura.
Inofungidzirwa kuti aromatase inhibitors inogona kuva yakakosha kupfuura tamoxifen, asi izvi hazvigoni kushandiswa mumadzimai e-premenopausal nokuda kwebasa reivha. Kuti kuderedze isrogen inokonzerwa nemaovari, uye kukubvumira kushandisa aromatase inhibitor, yako oncologist inogona kukurudzira ovarian kuderedza chirwere.
Kudzvinyirirwa kweOvarian kunogona kuitwa ne:
- Kushandisa mishonga yeZoladex (goserelin) - Uyu mushonga unopiwa zvishoma uye unopedza kugadzirwa kwestrogen nemuviri, uye unozivikanwa segonadotropic rinobudisa hormone inopikisa. Mavhaiyo anoita kuti isrogen inopindurwa nehomoni inozivikanwa segonadotropin inosimudzira hormone yakachengetwa nehutu hwepituitary. Zoladex inhibisa kukwanisa kwegonadotropin inokonzera hormone kuti ikurudzire mazamu.
- Oophorectomy - Zvishoma zvishoma, vamwe vakadzi vanosarudza kuva nemazamu avo abviswa (kuburikidza nenzira inonzi oophorectomy) pane kushandisa Zoladex. Kuvhiyiwa kunowanzoitwa kashoma kazhinji nekuda kwezvipingamupinyi zvakakura zvinosangana nekuvhiyiwa, asi vamwe vakadzi vanogona kusarudza nzira iyi, kunyanya avo vane maitiro ekufanirwa nekenza yevarivha pamwe nekenza yengamu.
An oophorectomy inowanzoitwa senzira inosaroscopic uye inowanzoitwa zuva rimwechete kuvhiyiwa. Mune laparoscopic oophorectomy, zvishomanana zvisinganzwisisiki zvinoitwa mudumbu uye mazai acho anobviswa pamwe nekubatsirwa kwezvinhu zvakakosha.
Kutevera chirwere chekuvhara maawa, vana vemenmenopausal vanogona kushandiswa nemishonga sevakadzi ve postmenopausal vakurukura pasi kana ne tamoxifen.
Postmenopausal Therapy
Mushure mekuguma kwemwedzi, iyo yakakura inobva kune estrogen mumuviri inobva kumativi ose ekushandurwa kwe androgen kune estrogen. Kenza yemapentopaopausal yepamu inogona kurapwa ne tamoxifen (kubvisa ichi chinogadziriswa isrogen kubva pakisungwa nekenza masero) asi rutivi rwemishonga inonzi aromatase inhibitors inoratidzika kuva yakakosha uye zvishoma nezvigumisiro.
Inowanika aromatase inhibitors inosanganisira:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (exemestane)
Aromatase inhibitors inogona kushandiswa yoga, kana kusanganiswa nekemotherapy mishonga . Somuenzaniso, kusanganiswa kwevakadzi (letrozole) uye Ibrance (palbociclib) uye Aromasin (exemestane) neAfinitor (everolimus). Iko kune nguva dzose kuenzanisa kana kuwedzera imwe mishonga. Kunyange zvazvo kusanganiswa kungave kwakanyatsobudirira, kunewo kuwedzerwa kwemigumisiro paunosangana zvinopfuura mimwe mishonga.
Zvinobatsira kucherechedzazve kuti chinangwa chekurapa kazhinji kacho chakasiyana nekenza yepamusasa yemasasa kupfuura iyo inotanga nekamuti yekenza yepabonde. Nenguva yekutanga kenza yebonde, chinangwa chacho chinorapa, uye uzivi ndeye "kubvisa zvipfuti zvikuru" kuti zvigone kuporesa chirwere chacho. Ifiyofiyo nekenza yemasasa inomusana, zvakasiyana, inowanzotarisa kukura kwekenza ine mishonga yakawandisa yemishonga inogona kuitika, kuchengetedza mamwe mishonga kwenguva iyo mishonga yekutanga isingashandisi.
Zvimwe Hormonal Treatments
Mukuwedzera kune tamoxifen uye aromatase inhibitors, pane zvimwe zvishoma mishonga inokonzerwa nehommone inogona kushandiswa kugadzirisa kenza yemasasa. Kana kenza yemazamu inoramba ichingokura kana kupararira pamishonga inopfuura ino inowanzoonekwa isinganzwisisi nemishonga iyi. Chirwere chematenda cheMetastatic kazhinji chinoramba chisingawirirani nemishonga iyi munguva. Kana izvi zvikaitika, zvisarudzo zvinosanganisira:
- Faslodex (fulvestrant) -Nokuti vakadzi vanotangira vana vanopinda muchechi yavo pane tamoxifen kana kuti aromatase inhibitor, chisarudzo chiri kushandisa mushonga waFaslodex. Faslodex iye zvino ndiyo chete mishonga inogamuchirwa nekenza yemazamu mune rimwe boka rinozivikanwa seSERD's-selective estrogen receptor downregulators.
Iyi mishonga inonzi "pure antiestrogen" uye inovhara migumisiro ye estrogen kune esrogen receptor-positive mazamu emasepa emvere asi nenzira yakasiyana neyo tamoxifen (iyo inopesana nesrogen inopikisa.) Faslodex inogona kushandiswa yoga kana inosanganiswa ne Ibrance (palbociclib), chemotherapy mishonga, uye inopiwa sejojo.
Kakawanda Kushandiswa Mishonga
Kune dzimwe mishonga dzemahomoni dzinoshandiswa zvisingaiti asi dzimwe nguva dzinofungidzirwa se 3rd line kana 4th line treatment. Izvi zvinosanganisira:
- Fareston (inremifene) - Fareston imishonga yakafanana neye tamoxifen uye inofungidzirwa kuti isrogen receptor modulating agent inguva dzimwe inofungidzirwa kuva vakadzi ve postmenopausal vane estrogen receptor-positive kanzvadzi dzekamu, zvikurukuru kuvakadzi vasina uro enzyme iyo inoshandura tamoxifen kune mafomu ayo mutumbi.
- Progestins - Megace (megestrol) inogadzirwa nemaitiro eprogesterone anowanzoshandiswa kune vanhu vane chirwere chesergia-receptor-positive chave chisingawirirani ne tamoxifen. Yakashandiswa kakawanda munguva yakapfuura mishonga mitsva isati yasvika yavapo.
- Zvepabonde steroid hormones - Mahomoni akadai seestrogen uye androgens haasati ashandiswa nekenza yemasitemasi yepamuviri, asi dzimwe nguva ingashandiswa apo mamwe maitiro ehomoni akundikana.
Mishonga Yevanhu
Varume vane kenza yemasitamende yebonde iyo inonzi hormone receptor positive inowanzobatwa ne tamoxifen.
Migumisiro Yechiri
Tamoxifen
Tamoxifen ine mabasa akasiyana, ose ari kutevedzera zvinoitika zveesrogen mune dzimwe nhengo dzomuviri uye achizvidzivirira mune vamwe. Zviratidzo zvakanyanya zvinosanganisira kupisa kunopisa uye muviri aches iyo yakave yakagadzirwa "yekare amai vane chirwere" kunyange zvazvo miviri iyi aches inowanzova yakaoma kudarika nearomatase inhibitors.
Zvinokonzerwa nemigumisiro inosanganisira kuwedzera kwengozi yeropa mumakumbo (venous thromboembolism) iyo, kana isingateereri, ine mukana wekusununguka uye kuenda kumapapu (mishonga yepummonary emboli.) Nokufamba kwenguva, tamoxifen inogona kukonzera uterine kubuda ropa uye inosanganiswa uye kuwedzera kwechidiki mukuvandudzika kwechirwere chinonzi uterine.
Vamwe vakadzi (uye varume) vanotora tamoxifen vanogona kuwedzera kukura kwezviratidzo zvavo (somuenzaniso, kuwedzera kuchena kwemashuga eganda kana kuwedzerwa marwadzo emapfupa kubva kumapfupa emapfupa) mumazuva mashomanana kutanga mishonga.
Kana iwe ukakura zviratidzo izvi, zvinowanzogadzirisa mukati memavhiki mana kusvika matanhatu, asi dzimwe nguva mushonga unoda kubviswa. Iko sirivha iyo yakagadzirirwa kana iwe uchiita izvi ndeyekuti kupisa kwemavara kunofungidzirwa sechiratidzo chokuti mishonga iri kushanda uye ichave yakabudirira. Zoladex inogona kukonzera kufanana kwakadaro.
Cherechedza kuti Tamoxifen inogona kukonzera chiropa chisingawanzoshanda chekushanda, chirwere chekushaya ropa, uye mapeletletsi epasi uye inobatanidzwa nehuwandu hwekenza yemukenza wepemetrase. Kurukura nachiremba wako kana izvi zvingakunakira iwe.
Aromatase inhibitors (AI's)
IA inogonawo kukonzera muviri aches, uye inenge makumi mana kubva muzana yevanhu vanocherechedza humwe hutano hwemitsipa uye kugunun'una. Kurasikirwa kwepfupa kunobatsira, uye oncologist yako inogona kukurudzira kuwanda kwepfupa kuti ikuongorore kuti iwe osteoporosis, zvose pakutanga kokurapa uye nguva nenguva pashure. Kuputsika kunogona kuitika nekuda kwekurasikirwa kwefupa, kunyange pasina mafupa emasitasi. IA inogonawo kuwedzera njodzi yehosha yemoyo.
Faslodex
Faslodex inowanzonyatsorambidzwa zvakanaka, uye zvinowanzova nemigumisiro inopisa inopisa uye kuwedzerwa kwechiropa chekushanda.
Zoladex (goserelin)
Chimwe chezvinhu zvinowanzova nemigumisiro yemishonga iyi ndiyo chaiyo inogadziriswa inoda. Chinangwa chekurapa ndechekudzivisa mavha mavari, mune mamwe mazwi, simisa mavha mavari kubva pakusunungura isrogen. Mukuita izvi zvinonyanya kukonzera kushandiswa kwemishonga kunokonzera mishonga uye saizvozvo, zviratidzo zvinowanzoitika pakuenda kumwedzi zvakadai sekupisa uye kupisa kwemadzimai zvinowanzoitika.
Sezvo ne tamoxifen, vamwe vanhu vangave vane ruzivo rwekutadza pavanotanga mishonga, somuenzaniso, kuwedzera mune marwadzo emapfupa mune avo vane metastases.
Oophorectomy
Zvimwe zvinokonzerwa nemigumisiro inobatanidza nekubvisa mazai evanhu, sezvakaitwa nehutachiona hwekurapa therapy, zviratidzo zvinowanzoitika pakuguma kwemazuva zvakadai sekupisa kunopisa uye kuoma kwemadzimai. Iko kunewo migumisiro yechipfuva uye njodzi ine chokuita nekuvhiyiwa. An oophorectomy inogona kuitika iye zvino nekuvhiyiwa kusinganzwisisiki (a laparapikisi) kuburikidza nemakwenzi maduku mashoma paganda uye inowanzoitwa sezuva rimwe chete rokuvhiya.
Faslodex (fulvestrant)
Sezvo ichi chiri mishonga inorwisa-estrogen, dzakawanda zviratidzo zvakafanana kune izvo zvinowanikwa nekuguma kwemwedzi, kufanana ne tamoxifen uye aromatase inhibitors. Anenge chikamu chetatu chevanhu vanoona unyoro husina kunaka, asi kana zvakadaro, mishonga iyi inowanzoremeswa.
> Sources:
> American Society of Clinical Oncology. Cancer.Net. Hormonal Therapees for Metastatic Breast Cancer. Updated 05/2016. https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/hormonal-therapy-metastatic-breast-cancer
> Martin, M., Lopez-Tarruella, S., uye Y. Gilarranz. Endocrine Therapy yeHormone Treatment-Naïve Advanced Breast Cancer. Breast . 2016. (Epub mberi kwekudhinda).