Mishonga inofadza kune avo vane mhumbu yakapfupa yemapapu
Kunyange zvazvo chemotherapy inoshungurudza masero akaita sekenza masero ari kukurumidza kuparadzaniswa mumuviri, immunotherapy inotarisana nemasikirwo emunhu, achikurudzira kuti aone nekurwisa masero emukenza ari oga. Mune mamwe mazwi, immunotherapy inobvumira munhu kushandisa sachigaro chake chakanakisisa (utano hwavo hwemagunisi) kuti varwise kenza.
Kune vanhu vane kenza yemukirini yemapapu isiri duku (NSCLC), nhau dzakanaka ndeyekuti inozivikanwa nemunyanzvi dzemuviri dzakange dziri uye dziri kuramba dzichigadzirwa nevasayendisiti.
Iko kurapwa, hongu, hakuporese mukenza wemapapu wakapfuura, asi vanogona kukubatsira iwe kana mudiwa wako kunzwa zviri nani uye kurarama kwenguva refu.
Lung Cancer Terms
Usati wapinda mu immunotherapies kushandiswa kurapa NSCLC yakatangira, zvakakosha kutsanangura mazwi mashomanana ane chokuita nemukenza wemapapu.
Ndeipi Isina-Small Cell Lung Cancer (NSCLC)?
Kune mhando miviri mikuru yemukenza yemapapu : kwete-duku kemukirini yemapapu emapapu nemukenza mutsva wemapapu emapapu, uye isina-duku kero iri kuva rakawanda. Ichokwadi, inenge 80 kusvika ku85 muzana yemakenza emapapu isiri duku duku rekenza maperembudzi.
Paunonzwa izwi rokuti "menza yemapapu" rinoshandiswa, munhu anowanzotaura kumusana wechidiki wemukenza wemapapu, kunyange izvi zvisingaitiki nguva dzose.
Chii Chinonzi Chakanga Chakasimudzwa Chakanga Chakasati Chidiki-Chidiki Chirwere Chinonzi Cancer (NSCLC)?
Mune misiki duku yekenza yemapapu mapfupa, zvinouraya (kenza) masero anokura nokukurumidza uye asingadzorwiki kuti aite chirwere mukati memaviri emapapu. Sezvo kenza inokura, inogona kutanga kupararira kune lymph nodes, uyewo kune nzvimbo dziri kure mukati memuviri sehuropi, mapfupa, chiropa, kana mamwe mapapu.
Kubva pane miedzo yakawanda (somuenzaniso, biopsy yemakumbo uye mifananidzo yekufungidzira yakafanana neT CT scan), danho reNSCLC rinotsanangurwa. Nhepfenyuro NSCLC inowanzoreva padanho rechitatu kana kenza yemukana wechitanhatu, izvo zvinoreva kuti kenza yakapararira kune dzimwe nhengo dzemakirini uye / kana kune nzvimbo dziri kure (iyi inonzi metastasis ).
Chii Chinonzi Immune System Checkpoints?
Kuti unzwisise immunotherapy, zvakakosha kunzwisisa chikonzero chekuti zvirwere zvekuzvidzivirira zvezvirwere zvezvirwere ndezvipi, sezvo izvi zviri mamolekoropi emukenza wemapapu immunotherapies chinangwa.
Immune system checkpoints inowanzowanika pamasero evanhu, uye inodzivirira masimba evanhu kuti varwise masero ane utano, chete, kune dzimwe nyika, masero asina kukwana (akafanana nemasero ane utachiona).
Kanzira inonyangadza, zvisinei, nokuti imwe nzira iyo inorambidza kurwiswa nehutachiona hwemunhu ndeyokuita uye kuratidza mapuroteni aya ekuongorora. Asi kenza immunotherapies inoshandiswa kudzivirira mazhenje aya kuitira kuti mutumbi zvechokwadi uone kenza sevatorwa uye unotanga kurwisa kwahwo.
Immunotherapy yeLung Cancer: PD-1 Antibody
Chimwe chikuru chekuchengetedzwa kwemasimba omumunyoresa kunotungamirirwa neNSCLC immunotherapies ndiyo inorongwa kufa 1 (PD-1), iyo inowanikwa zviri mumatare eT asi inogona kuitwa uye inoratidzirwa nemasero emukenza emapapu.
Kazhinji, izvi zviratidzo zvekudzivirira zvirwere zvinosungwa panzvimbo yepamuviri yemapapu, saka maitiro ezvirwere zvezvirwere anodzivisa kurwisana nekenza. Asi nemishonga inodzivirira PD-1, maitiro ezvirwere zvemuviri anogona kupindura nekurwisa masero emukenza.
Ikozvino pane mishonga miviri inonzi PD-1 antibodies (kana PD-1 checkpoint inhibitors), uye iyo FDA-inogamuchirwa yekurapa NSCLC yakatangira.
Zvose izvi zvinodhaka zvinopiwa sechirwere (kuburikidza nemuviri) kwemavhiki maviri kusvika matatu. Aya mapiritsi maviri ndeaya:
- Nivolumab
- Pembrolizumab
Nvolumab
Somunhu anonzi PD-1 antibody, nivolumab yakadzidzwa mune mimwe miedzo muvanhu vane NSCLC yakakura. Semuenzaniso, rimwe gore ra2015 chidzidzo chechitatu muNew England Journal of Medicine yakafananidza kurapa nevevolumab nekurapa ne docetaxel kune vanhu avo vakakurumbira NSCLC vakange vafambira mberi kana kuti mushure mekunge vaine platinum ine chemotherapy regimen. Mhinduro yakaratidza kuti avo vakagamuchira nivolumab vakapona kwenguva yakareba kupfuura avo vakagamuchira docetaxel-kupona kwemazuva mapfumbamwe mumutambo wa nivolumab mushure memwedzi 6 muboka re docetaxel.
Sezvakasiyana, Taxotere (docetaxel) inonzi chemotherapy inowanikwa kune vanhu vakamborapwa zvakanyanya NSCLC, saka chidzidzo ichi chiri kuenzanisa nhoroondo ye immunotherapy kune zvinodiwa zvekuchengeta chemotherapy.
Mukuwedzera kune kubatsirwa kwekuchengetedzwa, nivolumab yakaonekwa sechengetedzeka pane docetaxel mune chidzidzo-icho chakanaka, nokuti kunetseka kwakanyanya nema immunotherapies ndechokuti masimba evanhu acharwisa kwete chete masero ekenza asi nhengo dzakanaka zvakare.
Imwe yemigumisiro yakaipa iyo vanachiremba vanonetseka nayo nekenza kurapwa ipo pneumonitis, iyo iyo apo mishonga inokonzera maperembudzi kuvhiringidza (kwete chirwere, icho chaunoona ne pneumonia). Vanachiremba vanonyanya kunetseka pamusoro pepneumonitis nokuti inobata mapapu ekushanda, ayo atoita kuderera mukenza yemapapu. Muchidzidzo ichi, pneumonitis yakaitika nguva isati iri muboka re nivolumab uye yaiva yakaderera zvakanyanya apo yakaitika.
Izvozvo zvakati, zvimwe zvinokonzera kuipa (kunze kwepneumonitis) yakabatanidzwa na nivolumab iyo vanachiremba vanocherechedza kuti vanosanganisira:
- Zvinetso zveganda (somuenzaniso, kupisa nekuchenesa)
- Dambudziko rekucheka (zvakadai, chirwere)
- Abnormal inorarama enzyme blood test
- Matambudziko echitendero
- Kugadziriswa kwakasanganiswa kwepamuviri
Nhoroondo yePembrolizumab
Pembrolizumab ndiyo FDA yakagamuchirwa kuti iite NSCLC yakasimudza kune vanhu vasina ruzivo rwakasiyana rwemapfupa emapapu avo ( EGFR mutation kana ALK translocation ) uye mukati mavo anenge hafu yemasero avo anenge akanaka kune PD-L1. PD-L1 ndiyo protein inowanzobatanidza PD-1 paT cells, kudzivirira kuti vasarwisa masero ekenza.
Pembrolizumab yakagamuchirwawo kubata mushonga wepamusoro weNSCLC ( lung lung adenocarcinoma ) pamwe chete nechemotherapy, pasinei nokuti zviremara zvinokonzera PD-L1.
Mukudzidza muna 2016 muNew England Journal of Medicine , vanhu vane NSCLC uye PD-L1 kutaura kwakanyanya pamusoro pe50 muzana yemasero avo vane ruzivo rwusingaperi rwekupfuurira-kusununguka kusingaperi (10,3 mwedzi zvichienderana nemwedzi 6) uye zvishoma zvisingabatsiri ( zvakachengeteka) kupfuura vanhu ivavo vaitenda tsika yeplatinum-based chemotherapy.
Kunyanya, kupona-kusununguka-kusina rusununguko kwakatsanangurwa seyo nguva iyo varwere vainge vachinjwa kuti vawane pembrolizumab kana chemotherapy, kune imwe pfungwa iyo chirwere chavo chaifambira mberi kana kufa kwakaitika.
Muchidzidzo ichi, migumisiro yakaipisisa yakaonekwa muna 27 muzana yevaya vanogamuchira pembrolizumab kusvika 53 muzana yevaya vanogamuchira chemotherapy.
Pasi pose, migumisiro yakaipa zvikuru yakawanda kune avo vari kurapwa ne pembrolizumab vaiva:
- Diarrhea
- Kuneta
- Fever
Pneumonitis yakaitika muboka repembrolizumab pane imwe yepamusoro kupfuura chemotherapy boka (5.8 muzana kusvika 0.7 muzana).
Immunotherapy yeLung Cancer: PD-L1 Antibody
Atezolizumab chirwere che FDA-chakabvumirwa kuporesa vanhu vane NSCLC yakakura iyo chirwere ichi chinoramba chichiwedzera kana panguva kana mushure mekunge vaine dipatinum ine chemotherapy .
Atezolizumab yakasiyana zvakasiyana neyivolumab kana pembrolizumab mune kuti inonzi PD-L1 antibody. Mune mamwe mazwi, inonyanya kunyorera PD-L1, protein inowanzosunga kuP-PD (1 receptor paT cells), ichidzivirira kuti irege kurwisa kenza masero. Kufanana nedzimwe mishonga mbiri, atezolizumab inopiwa sechikamu.
Mukudzidza muna 2017 muLancet, vanhu vakanga vagamuchira peplatum-based based chemotherapy yepamusoro yeNSCLC vakashandurwa kuti vawane kana atezolizumab kana docetaxel.
Zvimwe zviitiko zvinokosha zvakaratidza kuti kuwedzera kwehuwandu hwehupenyu hwakavandudzwa kune vanhu vakagamuchira atezolizumab neuscetaxel, pasinei nokuti chiremara chemasero kana masero ezvirwere zvemumunyi mukati memaronda aive akanaka kune PD-L1 (median yemwedzi 13.8 ne atezolizumab uye 9.6 mwedzi ne docetaxel ).
Mukuwedzera, zvinokonzera kushungurudzwa zvakanyanya-zvakashata zvakaratidzwa zvishomanana muboka la atezolizumab, richienzaniswa neboka re docetaxel (15 muzana kusvika 43 muzana).
Izvozvo zvakati, migumisiro yakaipisisa inowanzoitika kune vanhu vanogamuchira atezolizumab vaiva:
- Kuneta
- Nausea
- Kuderedza kudya mwoyo
- Kushaya simba
Pneumonitis yakaitika mu6,6 muzana yevarwere muboka la atezolizumab, iro rakaderera, uye pasi pe1 muzana yakanga yakaoma (gorosi 3 kana 4) pneumonitis.
Immunotherapies pa Horizon
Zvakakosha kuziva kuti kune dzakawanda dzimwe zviratidzo zvekudzivirira zvirwere zvekudzivirira zvirwere. Chinokosha chekugadza basa ravo pakuchengetedza iwe kana mukomana wemudiwa wako wepamupa inonyatsotsanangurwa nemaitiro aya madhiragi anoita muchidzidzo chechikamu chechitatu.
Semuenzaniso, imwe immunotherapi mune pipeline inonzi ipilimumab yakawanikwa kuti iwedzere kupona muvanhu vane metastatic melanoma . Ichi chemishonga chinokonzera cytotoxic T-lymphocyte antigen 4 (CTLA-4), iyo inonyanya kuisa mutemo wekuti masero eT anoshanda sei mumuviri wemuviri. Ipilimumab iri kuongororwa semushonga wepamusoro peNSCLC pamwe chete nekemotherapy.
Shoko Rinobva
Hazvinyanzwisisiki kuti mamwe marariya (semukenza wemapapu) haangoregi kukurumidza uye asingadzorwi asi anogona kunyatsotsvaga kana kunyengera, kutaura, munhu chaiyo pachake kuzvidzivirira, masimba avo ezvirwere.
Izvozvo zvakati, nyanzvi dzekenza iye zvino dzine simba nekuwana kwe immunotherapies-chiitiko chekuchinja chinoramba chichishandura nzira yatinobata nayo kenza mune ramangwana.
Pakupedzisira, kusarudza nzira yekurapa nayo mupenza wemapapu yako yakaoma uye inobhadhara mitero, uye dzimwe nguva, mamwe mishonga haisi nguva dzose mhinduro yakarurama. Ndapota iva nechokwadi chekukurukura zvaunoda, kutya, uye kunetseka nemhuri yako uye chiremba.
> Sources:
> America Cancer Society. (2017). Immunotherapy yeChina Isina-Small Cell Lung Cancer.
> Gettinger S. (June 2017). Immunotherapy yekuti kwete-duku kemukirini yemapapu emapapu nema immune checkpoint inhibition. Mu: UpToDate, Jett JR, Lilenbaum RC, Schild SE (Eds), UpToDate, Waltham, MA.
> Reck M et al. Pembrolizumab nekusachimotherapy kwaP PD-L1 Nemaoko Asingadiki-Masero Anopinda Muchirwere. N Engl J Med . 2016 Nov 10; 375 (19): 1823-33.
> Rittmeyer A et al. Atezolizumab versus docetaxel kune varwere vane chirwere chekare chisingaregi-chemapapu chemapapu (OAK): chikamu chechitatu, chizaruriro, chirafu chinonzi randomised controlled trial. Lancet . 2017 Jan 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. Nivolumab muNSCLC: huchapupu huripo uye hutachiona hunokwanisa. Ther Adv Med Oncol . 2015 Mar; 7 (2): 85-96.