Masimba edu emasikirwo echokwadi anoshamisa-anochengeta mabhakitiriya edu emukati ari pasi pesimba; vanorwisana nehutachiona hwemapirusi anopinda, uye vanobudirira kupedza kanzura dzakawanda pakuvamba kwenguva refu vasati vambova dambudziko. Kukosha kunowanikwa mumunda we immunotherapy pamusoro pemakore makumi maviri ekupedzisira kwakakonzera kukura kwezvinhu zvitsva mukurapa kunowedzera kuwedzera zvirwere zvemuviri.
Evolution ye Immunotherapy
Usati watarisa maitiro ekugadzirisa zvirwere zvekenza yeprostate, ona kuti kune dzakawanda zvenhema dzinotangira uye kuzivisa kusati kwasvika kwokukunda mumugwagwa unoenda kuhutano hwekudzivirira immunotherapy. Somuenzaniso, FDA inobvumira interleukin 2 ye melanoma makore makumi maviri adarika. Pasinei ne10 chete muzana yehuwandu yehutano uye yakaipa kwazvo, interleukin 2 yakapa ruzivo rwetariro panguva iyo melanoma metastatic yakanga isina tariro uye isingatambudziki. Chirwere chacho chaiva chiduku asi chikurudziro cheramangwana, chinoshanda, kurapa.
Iye zvino tiri kunzwa nezvekuchinja kunoshamisa mumunda wekurapa kwechironda. Somuenzaniso, munguva pfupi yapfuura vatapi venhau vakatitaurira kuti tigadzirire kuguma kweMutungamiri Jimmy Carter-wake melanoma yakanga yapararira muuropi. Zvadaro chiitiko chisingaoneki-chimiro chemishonga inopindira-chakanga chaita kuti ave nekenza-isina. Fake news? Kana. Mazuva ano immunotherapy inogona kuita kuti mhaka dzisina tariro dzigadziriswe.
Kufambira mberi kwakakura kwakasvika sei? Pakave nekuwedzera kwakadzika mukunzwisisa kwedu kwemuviri wekudzivirirwa kwezvirwere zvemuviri. Muchidimbu, isu zvino tava kuziva kuti maitiro ezvirwere zvezvirwere zvezvirwere anosanganisira zvinhu zvitatu zvakakura:
- Masero ekudzivirira, anonzi TRegs, chengetedza-kuita mabasa echirwere chemuviri kubva pakusununguka.
- Masero anouraya-T anorwisa masero emukenza ndokuauraya.
- Masero eDendritic anoshanda semasikisi masero, achizora uye awana kenza uye achitungamirira masimba ezvirwere kuitira kuti azive kuti masero anoparadza. Masero eDendritic, mushure mokunge vaona kenza, vatungamirire masero ekuuraya kuti "apinde mukati" uye varwise chirwere.
Gadzirirai Cancer yaProstate
Chirwere cheprostate chaive chichimbotanga kupinda muchikwata cheMumune apo Chigadzirwa chakagamuchirwa neRDA muna 2010. Chirongwa cheDAA chaibva pamigumisiro yechiratidzo, yepamusoro-bofu, ye-placebo-yakarongedzwa, chirwere chechipatara chakaratidza kuti Zvimwe zvinowedzera hutariro hwehupenyu hwe varume vane kenza yepamusoro yeprostate ne 22.5 muzana.
Rongedza mabasa nemaitiro matsva anowedzera dendritic cell activity. Sezvambotaurwa kare, masero eDendritic ndiwo "bloodhounds" emuviri wechirwere chemuviri, anogona kukonzera kunze nekuwana kenza yemukenza. Izvo Zvirongwa zvinotsigira kuwedzerwa kweropa ne leukapheresis kubvisa masero e dendritic. Aya masero anobva ashandiswa murabhu, achiita kuti vazive prostatic acid phosphatase (PAP) -iwo mashesi anooneka ari pamusoro pekenza yekenza yeprostate. Kana ikashandurwa, masero eDendritic anoshandiswa zvakare muropa remurwere apo anokurudzira masero emuurayi T kuti awedzere kutarisa nekurwisa masero ekenza, sezvo akwanisa kugonesa PAP pamusoro pezvinhu uye anoishandisa sechinangwa.
Kuronga kunogona kuonekwa seyekupedzisira mumakwenzi echirwere chinokonzerwa nemunhu oga nokuti masero e dendritic anonatswa kubva muropa reumwe murwere, anowedzera mu laboratori kurwisa masero ekenza yeprostate, ndokubva adzorerwa zvakare mumurwere iwoyo. Sezvinonakidza sezvo teknolojia iyi inonzwika zvingave zvisingashamisi kunzwa kuti vanachiremba nevarwere vanongopisa zvishoma nezvishoma kune pfungwa yekushandisa Zvimwe. Iyi maonero akajeka pamusoro pekutora Zvigadzirwa zvakanga zvisingatarisirwi apo Zvinyorwa zvakatanga kusvika pamusika, zvichipiwa mukurumbira kwezvimwe zvirwere zvisingagadziriswi zvakasiyana-siyana zvakadai seGraviola, shiitake mushroom, pau de arco, uye tei Essiac.
Nei zvichifanira kuva nekushamisika kushandisa FDA kubvumidza rudzi rwekudzivirira zvirwere?
Kururamisa
Vatsoropodzi vakaratidza kuti Zvigadzirwa zvinodhura uye kuti muwani wekugamuchira anongogara oga kwemwedzi mitatu kana mina. Zvisinei, munyika chaiyo yekenza remapirisa (kwete nyika yemakiriniki miedzo), ichi chikonzero chisina kururama. Varume vanotora zviitiko mumakiriniki emakirini havasi kumiririra maitiro evanhu vanorwara nekenza yeprostate vanogamuchira FDA vanobvumirwa kurapwa. Kazhinji, varume vari kutarisana nemakiriniki anoona zvirwere zvakanyanya kwazvo. Ichi ndechokuti varwere vanononoka kupinda muchipatori chekuedza kusvikira mushure mokurapa kwemazuva ose kusakundikana.
Nokudaro, kupona kwevarume muchirwere chechipatara kunowedzera kuva zvishoma, zvisinei nokuti rudzi rwekurapa hunoitwa sei. Kunyange zvakadaro, chero mishonga inopupurirwa yekuwedzera kupona pasi pemamiriro aya asina kunaka inofanira kuva yakakosha. Ndicho chikonzero mishonga inoratidza kurarama kwenguva refu inogamuchira FDA kugamuchirwa. Pfungwa ndeyokuti mishonga icharatidza mhinduro dzakanaka kana dzichishandiswa kubata vanhu pane imwe nguva yapfuura.
Chirapa paMamwe Matanho
Chirevo chekuti Zvigadzirwa zvine zvakakosha zvikuru kana zvinoshandiswa kurapa kenza yeprostate pane imwe nguva yapfuura yakatsvakurudzwa kuburikidza ne reanalysis yemashoko ekutanga akaendesa kuvvumirano yaVicenge yekutanga naDFA. Kuongorora zvakare kwakaratidza kuti varume vane chirwere chekutanga-chetachiona vakange vaine nguva yakawanda yekupona kwenguva refu. Mukati, chiyero chekugara kwenguva refu chakawedzera kukura apo Zvinyorwa zvakatanga nokukurumidza.
Muchikamu chino reanalysis, mapoka mana evarume, akarongerwa nemazinga avo akasiyana-siyana ePSA pakutanga kwekupa kurapa, akaongororwa: varume vane PSA mazasi pasi pe22, varume vane PSA pakati pe 22 ne50, varume vane PSA pakati pe50 ne 134, nevarume pamwe nePSA mukuru kupfuura 134.
Tafura iri pasi apa inopfupikisa kupona kwevarume vanobatwa neChipo, kana vachienzaniswa nevarume vanobatwa ne placebo, vakapatsanurwa nehuwandu hwePSA pakutanga kweZvirevo. Misiyano yokupona mambure (mumwedzi yakawanda) pakati peZviro uye placebo yakarongedzwa pakupedzisira.
PSA Level | ≤22 | 22-50 | 50-134 | > 134 |
|---|---|---|---|---|
Nhamba yevarwere | 128 | 128 | 128 | 128 |
Pro venge | 41.3 | 27.1 | 20.4 | 18.4 |
Pla cebo | 28.3 | 20.1 | 15.0 | 15.6 |
Kuponeswa Kusiyana | 13.0 | 7.1 | 5.4 | 2.8 |
Sezvo tafura inoratidza, kuponesa kwaivepo kune mapoka ose anogadziriswa achienzanisa nevarume vanobatwa ne placebo. Zvisinei, muwandu wekuvandudza kupona waiva mukuru kune varume vakatanga Kupa apo PSA yaiva yakaderera. Varume vakatanga Kuronga apo PSA yavo iri pasi pemakumi maviri nemaviri yakararama kwemwedzi gumi nemakumi masere kupfuura varume vari pachiitiko chakafanana avo vakanga vari kutongwa ne placebo. Varume vari pamatanho akareba kwazvo, nePSA mazinga anopfuura 134, vakangorarama kwemwedzi mishomanana kupfuura varume vakagamuchira placebo.
Kushanda
Naysayers Mubvunzo Kurudzira kuti uite zvakanaka kune imwe chikonzero. Mhando dzakawanda dzehutano hwakanaka hweprostate, dzakadai semarmonal therapy uye chemotherapy, dzinoita kuderera kwemazinga ePSA. Asi neZvipo, izvi kazhinji hazvisizvo. Vanhu vanoshamisika, saka, vanogona sei Kuronga kwenguva yakareba kupona?
Vanokanganwa kuti kubudirira kwehutachiona hwekenza ye prostate, yakadai semakemotherapy uye hormone blockade, inongotsigirwa chete nekushanda kushandiswa. Kamwe kana kurapwa kuchigadziriswa maitiro anorega kuguma uye kenza inotanga kukura.
Zvirwere zvekudzivirira muviri, kune rumwe rutivi, zvakamboitwa, zvine chinoramba chiripo. Nokudaro, kunyange kana Kurongedza kunongokonzera kukanganisa kwakanyanya mukufambira mberi kwezvirwere, sezvo chiitiko chacho chinopfuurira kune kuwedzera kwekuwedzera pamusoro pezvasara zvehupenyu hwomurwere. Uye kana munhu akagara kwenguva refu, hukuru hukuru hwebatsiro.
Kuchengetedza Kanzira Metastases
Kubva pane zvinyorwa zvinowanikwa mutafura iri pamusoro, imwe zvine musoro inogumisa kuti Zvigadzirwa zvinotanga kutangwa pakarepo kune munhu chero upi zvake akawanikwa ane kliniki inokosha yekenza yeprotate . Zvinosuruvarisa, makambani einishuwarenzi anongotanga Kupa mushonga wekurapa mushure mekunge varume vatange hutachiona (Lupron) kushorwa uye metastases yekenza. Sezvo kakawanda maitiro ekurwisana kwehomoni kunoitika vasati vasangana, varume vane kenza yekare yezve prostate avo vari kudzora PSA yavo neLupron vanofanira kutarisira chero kuwedzera kwePSA. Utachiona hunopikisa hunotsanangurwa sekumuka kwePSA apo paLupron kana chero mishonga yakadai yeLupron.
Pachiratidzo chekutanga chekuti PSA inotanga kubuda, varume vanofanira kutanga kutsvaga kwakasimba kwemasimisita. Parizvino, kuongorora kwePET ndiyo nzira yakanakisisa yekuwana metastases apo PSA inenge ichiri pasi, zviti pasi peviri. Kune marudzi akasiyana-siyana emhando dzakasiyana-siyana dzePET dzinoongorora kugadzirisa kushandisa: F18 bone scans, Axumin, C11 acetate, C11 choline, kana Gallium68 PSMA. Kana zvikwangwani izvi zvisingakwanisi kuona chirwere chetachiona pakutanga, chinofanirwa kudzokororwa kanenge mwedzi mitanhatu kusvikira chirwere chetachiona chiripo, mushure mokunge Chipo chinofanira kuiswa pakarepo.
Chimwe Chinyorwa che Immunotherapy
Mumakore makumi matatu apfuura, vazhinji vanoedza kuisa maitiro ezvirwere zvekuzvidzivirira pasi vakakundikana. Tiri kutanga kudzidza kuti kukanganisa uku kunokonzerwa nekudarika-mabasa emuviri wekudzivirira muviri. Chero pose apo muviri unoita chero chinhu chipi zvacho chechirwere chemuviri, basa racho pachako rinokurudzira kuzvidzora kwekudzivirira kubvisa mhinduro dzekudzivirira mumuviri. Izvi zvinodzivirira kukura kwezvirwere zvinokonzera zvirwere zvakadai se lupus, rheumatoid arthritis, kana multiple sclerosis.
Iye zvino vatsvakurudzi vadzidza kuti mazai ekenza vanoshandisa ichi chikamu chekudzivirira chemuviri wechirwere chemuviri kuburikidza nokugadzira immune suppressive hormones. Aya mahomoni anoderedza masimba ezvirwere zvezvirwere kuti ararame, nokudaro kubvumira masero emukenza kuwedzera kuburikidza nekuchengeta mhondi yeT killer. Masero ekudzora, maTreg masero, ari nenzira "yakabatwa" uye anoshandiswa senhovo kuderedza basa redu rekudzivirira zvirwere. Uku kusakwanisa kwechirwere chemuviri chekuzvidzivirira kurwisa chirwere hachisi nekuda kwekushaya simba mumuviri; pane kudaro, zvinodzivirira zvirwere kubva pakuwedzera basa rinotungamirirwa nekenza masero. Neku kunzwisisa uku kwatsva, mamwe mazvikwata emishonga anogadzirirwa kugadzirisa dambudziko iri.
Yervoy mishonga yakadai, iyo iyo FDA inobvumirwa kuti irapwe nekaramoma. Yervoy inoshanda nekudzivirira CTLA-4, mutemo we "switch" uri pamusoro peTreg masero. Kana kuchinja uku kuri "kuenderera mberi," basa rekutungamirira rinowedzera uye maitiro ezvirwere zvemusununguko anodziviswa. Apo Yervoy ichishandura CTLA-4 "ichibva," chiito chekudzivirira cheTreg masero chiri kubviswa uye mutezo unowedzera hunosimbiswa nemaitiro epune system.
Pakutsvaga kutsvakurudza kuongorora Yervoy mune varume vane kenza yeprostate inoratidza kuvimbiswa, kunyanya kana ichibatanidzwa nemirairo (ona pasi apa). Zvisinei, dzimwe nyanzvi dzekupedzisira dzinoratidza kuti imwe mishonga yekudzivirira-inodzivirira inonzi Keytruda inogona kushanda zviri nani.
Keytruda inogadzirisa rimwe shanduro yekugadzirisa inonzi PD-1. Zvidzidzo zvepakutanga mumakirini ekenza yeprostate zvinoratidza kuti Keytruda inogona kukurudzira kunyanya kufanana neJervoy, uye kuita kuti zvishoma zviremera zviitwe. Kana izvi zvakatanga kuwanikwa neClétruda zvakasimbiswa, chirongwa chekubatanidza neClétruda pamwe Zvimwe zvinogona kuva nzira yakanaka yekuvandudza basa rekare rekudzivirira muviri.
The Abscopal Effect
Mazairo, anotungamirirwa nechirwere chemaitiro chinowanikwa ne-scan, ndiyo imwe nzira inogona kuita kuti simba rekudzivirira zvirwere rive nesimba kuburikidza nenzira inonzi Abscopal effect. Apo danda remirairo rinokanganisa masero emarara, masero ezvirwere zvedu zvemagunha anotarisana nechirwere chinouraya uye kubvisa zvasara zvinosvibisa masero. Iyo Abscopal effect inosanganisira, saka, masero ezvirwere zvekuzvidzivirira anonyanya kuzivisa tumor-specific molecules pamarara ekufa kwemasero uye zvinovhima masero emakemikari mune dzimwe nzvimbo dzomuviri achishandisa izvochete mutezo-mahwendefa chaiwo sezvinangwa.
Pane zvakawanda zvinonakidza zvinokonzera kujekesa-induced immune therapy:
- Apo rinoshandiswa kusarudzwa uye nounyanzvi kune zvakanyanya pasina madhara.
- Mushonga unovharwa nemhando dzose dze inshuwarisi.
- Iyo miviri yakawanda inowanzova nesimba zvakakwana kubvisa tsvina iyo iri kutarirwa.
- Zviri nyore kusiyanisa mavara emhara neChipo, Keytruda kana maviri.
Shoko Rinobva
Nzwisiso yedu yekudzivirira zvirwere zvemuviri kwekenza yeprostate iri kufambira mberi nokukurumidza asi ichiri mucheche. Kunyange zvakadaro, zvinonakidza kuziva kuti isu tatova nemichina yakawanda yatinogona kushandisa. Dambudziko riri mberi mberi nderokudzidza kuti zvishandiso izvi zvitsva zvinogona kushandiswa sei zvakakwana, zvichida nega kana kuti pamwe chete. Ramba uchikurukurirana pachena nechiremba wako pamusoro pekugadzirisa zvirwere zvemuviri kuti uone kana zvakakunakira iwe.
> Sources:
> Higano, Celestia S. "Sipuleucel-T: Autologous Cellular Immunotherapy yeMatastatic Castration-Resistant Cancer Prostate." Mumishonga yekurapa kweProstate Cancer , pp. 321-328. Springer New York, 2010.
> Kantoff, Philip W., Celestia S. Higano, Neal D. Shore, E. Roy Berger, Eric J. Small, David F. Penson, Charles H. Redfern et al. "Sipuleucel-T immunotherapy nokuda kwekenza yeprotate isingagadzirwi." New England Journal of Medicine 363, kwete. 5 (2010): 411-422.
> Lipson, Evan J., Patrick M. Forde, Hans-Joerg Hammers, Leisha A. Emens, Janis M. Taube, naSuzanne L. Topalian. "Antagonists yeP PD-1 naP-PD1 mukurapa kwekenza." Mumasangano mune oncology , vol. 42, kwete. 4, mapeji 587-600. WB Saunders, 2015.
> Silvestri, Ida, Susanna Cattarino, Sabrina Giantulli, Cristina Nazzari, Giulia Collalti, naAlessandro Sciarra. "Maonero ekudzivirira immunotherapy kwekenza yeprostate." Cancers 8, kwete. 7 (2016): 64.