Kucherechedza Kupararira Tumor Cells uye Cell Free DNA
* Musi waJune 1, 2016, FDA yakabvumira kuedza kwemvura kunokonzerwa nekuona kuchinja kwe EGFR kune vanhu vane kenza isiri duku yemapapu emapapu. Iyi ndiyo yekutanga "kuongororwa kweropa" yakabvumirwa kuti iongorore uye inobata chirwere chemapapu.
Chii chinonzi liquid biopsy? Wako oncologist angadaro akambotaura iyi nzira itsva yekuongorora mutsa wemapapu kana iwe unogona kunge wakanzwa nezvenzira iyi uchitsvakurudza kenza yako paIndaneti.
Ndeipi nzira yekuita iyo, iyo inogona kuitwa rini, ndezvipi zvinobatsira uye zvisingabatsiri, uye tiri kupi kwatinoenderera mberi nechirongwa ichi chemishonga yakakwana yekenza yemapapu?
Chii Chinonzi Liquid Biopsy?
Iwe unogona kunge uine ruzivo rwekenza yenguva dzose yekenza yemapapu. Kuti uongorore mutanho wemapapu , samuenzaniso wemuviri unowanikwa mune imwe nzira. Zvadaro, sezvinoitwa kurapwa, humwe huwandu hunodiwa hunofanira kuitwa kuti uone kana bundu racho "rakashanduka" -kunge kana rakagadzirisa mutsva mutsva inoita kuti igone kushandiswa ikozvino.
Hazvingave zvakanaka here kana izvo zvinyorwa zvechigarire (zvimwe zvingave zvakadaro) zvingashandurwa neropa risiri nyore? Kwemukenza wemapapu, zvichida kutarisa vamwe vanhu vane humwe huwandu hwema molecular, izvo zvinoshuva zviri kuitika.
Kune zvakawanda zvatisingazivi kana zvasvika kune zvinoita zvehupenyu hwemhepo yekuongorora kenza yemapapu kuongororwa uye kurapwa, asi tichagovera zvimwe zvatinodzidza nhasi.
Parizvino muUnited States, zvose zvinokonzerwa nemvura zvinonzi inofungidzirwa kuongororwa uye kutungamirirwa kwekenza yemapapu uye hazvifaniri kushandiswa dzoga kutungamirira kuongororwa kana kurapwa kwechirwere ichi.
Mitauro yeLiquid Biopsies
Ropa raigona sei kubvisa rubatsiro kuongorora kenza?
Masero anosvika seiko? Zvinobatsira kutanga nekutaura nezveizvo izvo vanachiremba vanotarisa mumvura yakasviba (ropa) samuenzaniso kune mumwe munhu ane kenza. Tinoziva kuti masero emuviri, uye kakawanda kazhinji zvikamu zvemarara masero, anowanzomukira kubva mumarara uye kupinda ropa. Izvi hazvirevi kuti chirwere chinokonzerwa nemasikita uye zvidimbu zvemasero emukenza zvinogona kuonekwa muropa mune kunyange matanho ekutanga ekenza. Mukutsvakurudza kusvika ikozvino, masayendisiti ave achitsvaka chimwe chezvinotevera:
- Kupararira tumor cells (CTCs) - Izvi zvinoreva tumor cells zvinogona kuwanikwa muropa revanhu vane kenza. Kubva ikozvino CTCs inonyanya kukosha mukenza kune imwe isiri duku duku yemukenza wemapapu uye inoshandiswa kunyanya kusarudza kufungidzira kweavo kanzira. Kune humwe humwe uchapupu hwekuti CTCs inogona kubatsira nekamudiki kenza yemapapu emapapu uye, mune imwe yedzidzo, 85 muzana yevarwere vane kechidiki chekenza yemapapu vane CTCs. Kuongorora kweizvi CTCs muvarwere vaduku chemapapu emapapu zvinoratidzika kuva kufanirwa kwehupenyu hwose.
- Nhengo dzisingabviri (dzinopararira) DNA (ctDNA) - Kusiyana nemasero emakumbo ose asingawanzowanikwi muropa, idzi samples dzinogona kuona zvidimbu zvemasero emarara izvo zvakaputsika kubva mumarara uye zvinodururwa muropa. Izvi zvinogona kuitika kubva kune chiremera chekutanga kana chemarara. Ichi ctDNA yakawanikwa mune imwe chidzidzo kuti ivepo muna 82 muzana yekenza varwere vasina maitiro ehutachi hwakasimba. Yakawanikwa mumakumbo ezvikamu zvose asi yaive yakanyanya kuwanika nemitezo yakakwirira yekenza.
- Tumor RNA muplatelets - Zvichida wakanzwa zvishoma nezvirwere RNA mumaplatelet kupfuura CTCs uye ctDNA, asi iyi ndeimwe nzvimbo inofadza iri pasi pemusoro weiyo biopsies. Platelets anozivikanwa nokuda kwekugona kwavo kutora RNA kubva mumatumbu uye inogona kuita basa mukupararira kwekenza.
Kusvika ikozvino, FDA mvumo yakangopiwa chete nekushandiswa kweCCTCs sechiyero chekufungidzira kufungidzira (uye ikozvino ctDNA kuti ione kuchinja kweEGFR) asi kushandiswa kweCtNA uye tumor RNA mumaplatelet zvingangopa rubatsiro rukuru pakuongorora kenza sezvo nguva inopera on.
Mishonga Inopesana neChirungu Chechigunwe Chine Nyuchi-Nei Chiitiko Chinofadza uye Chii Chingaita Sezvinoita?
Iwe unogona kunge uri kushamisika kuti nei kune mufaro mukuru kwazvo mumhepo pamusoro pekukwanisa kutevera mamwe kanzira ine mvura yakasvibirira.
Ticharondedzera zvimwe zvingabatsirika uye zvisingabatsiri pasi apa, asi ngatitangei kuenzanisa muenzaniso wekuti mapapu emapapu anogona kuongororwa uye kurapwa sei uye pasina kushandisa zvinyorwa izvi.
Ko Mungozi Ingano Inogona Kuchinja Sei paKutsvaga?
Fungidzira kuti iwe uchangobva kuongororwa neine musikana muduku wemukenza wemapapu. Kazhinji, kuongororwa kunoitwa kuburikidza nekushandiswa kwekenza yemapapu yemapapu nemapundu anotorwa kana:
- A sindano biopsy
- An endobronchial ultrasound uye biopsy (nheyo yakaiswa muchitemumata kuburikidza nebronchial tube munguva yebronchoscopy)
- Chivharo chakasununguka chepopu (kana thoracoscopy, umo chiridzwa chine chiedza chinowanikwa kuburikidza nemakomba maduku mubhokisi, kana kuti thoracotomy, inosanganisira kusungirirwa kuburikidza nerusvingo rwechifuva kuwana mapapu)
Aya maitiro ezvino anonzi biopsy ose anotakura njodzi yehutachiona, kubuda ropa, kuputsika kwemapapu (pneumothorax), uyewo kunetseka.
Kana imwechete iyo inowanikwa, inotumirwa kuti chirwere chetachiona chitarise pasi pe microscope uyewo kune miedzo inokosha inotarisa maitiro chaiwo emagetsi mumatomu masero. Izvi zvinowanzoita mavhiki mashomanana (kazhinji kusvika mashanu kusvika matanhatu) zvisati zvawanikwa. Kana maitiro asina kufanana (zvakadai sekuchinja kweEGFR) anowanikwa, kurapwa kunogona kutangwa nemishonga inotarisirwa, yakadai sa tyrosine kinase inhibitor Tarceva (erlotinib.)
Nekombiyamu yemvura yakasvibirira, panzvimbo yekuita bhizinesi inopesana yakadai seyano rebiopsy kuwana mishonga yekunyatsorudza geni (kunyanya gene gene mutation kuedzwa kwechimiro chechimiro icho chiitiko chinogona kuongororwa iye zvino), kuronga kweropa nyore kunogona kuitwa - zvakawanda muedzo unowedzereka. Uye panzvimbo yekumirira masvondo kuti zvive nemigumisiro, nokukurumidza plasma genotyping inogona kupa mhinduro mumazuva matatu. Saka panguva yekuongororwa, varwere vane mutsauko we EGFR vanogona kunge vakachinja mutongo kwete chete kuburikidza nekuedzwa kwakanyanya kudarika asi kunogona kutanga pamishonga yekugadzirisa iyo mutation mumazuva mashoma. (Hatisati tine teknolojia kuti tiwane "mamwe maitiro ekusaremara akadai seAARK rearrangements uye reRrang1 rearrangements .)
Kuona Kuongorora Muchiri Muchengetedzo Kwakaita Sei?
Kunyanya kufadza kunogona kunge iko kukwanisa kushandisa mvura yakasvibirira kuti iongorore vanhu avo vari kutotanga kurapwa nemishonga inotarisira kuchinja kwe EGFR.
Panguva ino, kana mumwe munhu atanga paEGFR inhibitor yakafanana neTarceva, iyo yechirwere ichi inoongororwa nekuita nguva dzekuongorora CT kuti ione kukura kwemarara. Tinoziva kuti chinenge chiremera chose chichawedzera kusagadzikana kwemishonga iyi munguva, asi nguva iyoyo inopesana zvikuru pakati pevanhu vakasiyana. Iwe ungaziva sei kana nguva iyoyo yasvika? Nenzira, tinodzidza kuti pamakumbo mave nekurwisana apo shanduro (yakadai seT CT scan kana PET scan) inoratidza kuti tumarara yakatanga kukura zvakare. Nguva zhinji (kunze kwekuti zviratidzo zvinoratidza kuti kenza iri kuwedzera) varwere vanodzidza kuti mishonga yavo yakamira kushanda pavanogamuchira migumisiro ye scan iyo inoratidza kuti tumarara inokura zvakare.
Panguva iyoyo, mishonga inomiswa uye vanhu zvakare vanotarisana nekuita imwe biopsy kuti vaongorore tumarara kuti vatarise kuchinja kwakagadzirisa kusinga. Sezvakataurwa pamusoro apa, zvinowanzoitika pamapapu emapapu zvinokonzera njodzi dzekuwedzera kunopisa, uye zvakare, zvinotora mavhiki pasina mushonga kuti uzive zvinoguma uye unzwisise kuti unoenda kupi.
Kusiyana neizvi, nechaopi yemvura yakaitwa nguva nenguva, vanachiremba vaizogona kutaura zvakawanda nekukurumidza kana chiremara chave chisingawirirani nemishonga. Yakawanikwa mune zvidzidzo kuti kuchinja uku kunoratidzika mu ctDNA nguva refu zvisati zvaitika kushandurwa kunosangana nekurwisana kunoonekwa pa CT scan. Munguva iyi yenguva - pakati pekunge ropa rekuongorora rinoratidza kurwisana uye rinowanikwa paT CT scan - vanhu vangadai vachishandisa mushonga usingachagoni uye kurarama nemigumisiro yemishonga isingadiwi. Zvinoreva zvakare nguva yakareba vasati vashandurwa kuhutano hwakanaka.
Nechirongwa chemvura chinonzi biopsy chinoratidza kusagadzikana, tumoramu inoshandiswa (kubva mumvura yakasvibirira) inogona kuongororwa uye murwere anogona kuchinjwa kuva chizvarwa chinotevera chemishonga chinotarisa kuti kuchinja kwemajini kana kuti mamwe marapirwo emishonga, zvakadai sedhemotherapy kana immunotherapy .
Tumor Heterogenicity uye Liquid Biopsies
Imwe nzira inobatsira iyo inonzi liquid biopsy inogona kuva nepamusoro pemapapu emapapu emapapu anokonzerwa nemapapu anokonzerwa nehutu hunopisa. Tinoziva kuti makondomu emapapu ane hutano husina maturo, zvinoreva kuti zvikamu zvakasiyana zvechirwere (uye kunyanya zvipembenene zvakadai semakumbo makuru uye metastasis) zvingave zvakasiyana zvakasiyana mumasikisi avo. Semuenzaniso, kushanduka kuripo mumakirini emukenza mune imwe chikamu chechirwere hazvifaniri kuva mumasero mune imwe chikamu chechirwere. Kuti uchinzwisise izvi, zvinobatsira kuziva kuti kanzura inoramba ichichinja, kuvandudza mamiriro matsva uye kuchinja.
A biopsy inowanzosarudzwa mune zvishoma nokuti inongoratidzira imwe nzvimbo chaiyo yezvigunwe. Mvura yakasvibirira, nenzira yakasiyana, inogona kuva yakanyanya kuratidza maitiro echiremara zvachose. Izvi zvave zvatoonekwa mune zvidzidzo, umo mutsika unogona kuchinja mutyairi unogona kuonekwa nehuwandu hwemvura inenge isina kukanganisa pane biopsy yemaviri.
Makomborero eEquid Biopsy Pamusoro peChiopsy inowanikwa
Kunyatsonzwisisa kufara, asiwo zvingave zvisingakwanisi kuita sopling yemvura yakasvibirira, inogona kubatsira kunyora zvimwe zvezvinobvira zvinobatsira uye kusagadzikana kwehutano.
- Migumisiro yemvura yakasvibirira iri pedyo ne "nguva chaiyo." Mune mamwe mazwi, vanogona kubvumira kutsvaga kwekubudirira kwekubudirira nekudzivisa kwechirwere panguva yekurapa. Apo bhiopsy yenyama inogadzirwa, zvigumisiro zvema molecular profiling (gene profiling) pamubhedha zvinowanzodikanwa mavhiki mashoma (kazhinji kashanu kusvika matanhatu) asi kuongororwa kwemugadziri wegadzirisheni mumvura inoshandiswa mumvura inotora mazuva matatu chete. Ino ndiyo nguva iyo mushonga chaiwo unogona kushandiswa kana panguva iyo chizvarwa chinotevera chakatarwa nemishonga chinogona kushandiswa kana chironda ichi chikawanikwa chisingawiri.
- Nzira yemvura inonzi biopsy inofanirwa kukurumidza kupfuura inowanzoitwa biopsy.
- Mishonga yemvura yakadzika haina kuwanda.
- Mamwe matumire ari munzvimbo dzisingabvumirwi kuwanika kuitira kuti uite chigadzirwa chinowanikwa chinowanikwa.
- Mamwe matumbo uye metastases haisi mienzaniso yakanaka yekuita zvinyorwa zvemajini - somuenzaniso, masetasti emapfupa
- Mishonga yemiti inobvumira chiremera heterogenicity. Sezvakataurwa pamusoro apa, zviremara zvakawanda hazvina maturo. Mvura yakasvibirira inogona kukwanisa kupa sampuli zvingangodaro inomiririra chirwere zvachose zvakasiyana nekuenzanirana kwechimiro chechipiopi iyo inogona kunge yakamirira chete yemasero ari chikamu ichocho chechirwere.
- Zvichida kuti maitiro emvura anonyanya kushandiswa achange asina kudhura kudarika zvinowanzoitwa biopsies.
- Zvirwere zvinokonzerwa nehutachiona zvinotakura njodzi shomanana yezvinetso kupfuura yeiwo maitiro anowanzogadzirwa nehupopi, akadai sengozi yehutachiona, kubuda ropa, uye kuparara kwemapapu (pneumothorax.) Izvi zvinetso hazvingori kuderedza hupenyu hwehupenyu asi zvinogona kuita kuti kurapwa kunonoke zvakare (uye migumisiro yekukurumidza kunogona kureva kufambira mberi kwechiremera.)
- Mishonga yezvinyorwa hainyanyi kunetseka.
- Kana chidimbu chinoda kudzokororwa pamusana pemakumbo asina kukwana, zviri nyore zvikuru kudzokorora kuwedzerwa ropa kudzokororazve chiitiko chinowanzoitika.
- Kufambira mberi kwesayenzi yemukenza. Nokucherechedza migumisiro yemafuta emvura inowanika kakawanda munguva yakareba, vatsvakurudzi vanogona kudzidza zvakawanda pamusoro pekuti matumusi anoshandura zvakadini pane nguva.
- Zviratidzo zvinoshandiswa zvinogona kutora kuchinja kwezvinhu zvinenge zvisingabatsiri mutsamba.
- Mishonga yemvura - kana ichiona kusagadzikana nokukurumidza - inogona kubatsira kubvisa kurapwa zvisina kufanira (uye chero mimwe migumisiro inoenda neyoyo kurapwa) uchiwedzera kuwanda kwenguva iyo mumwe munhu ari kushandisa mushonga unoshanda.
- Mishonga yezvinyorwa zvinogona kuderedza chiyero chemaawa anopiwa zvichienderana nezvinodiwa zvezvinodiwa kuongorora kuenderera mberi.
Kukanganisa Kwemiti Inoputika
Panguva ino, kune zvakawanda zvokudzidza pamusoro pemafuta emvura. Ikozvino iye zvino anongogumira pakuona kuchinja kwemashoko akaita seaya ari muEGFR (kunyange zvazvo pane hurukuro kuti vangakurumidza kushandiswa kugona kutengesa uye dzimwe shanduko.) Muzhinji mhando yemukenza yemapapu, kupararira kwemasero emukenza kana kenza DNA inowanzoitika mune zvishoma zvishoma zvemapukenza emapapu uye inoshandiswa nemhando uye chirwere chekenza. Mhinduro isina kunaka kubva mumvura yakasvibiswa haina kureva kuti kenza haisi mumuviri.
Mamiriro Emazuva Ano Ekuti Mishonga Yemvura Inokonzerwa neLung Cancer
Mishonga yezvinyorwa iri kushandiswa kunyanya kutsvakurudza muUnited States, kunyange zvazvo vamwe veoncologists vari kushandisa izvi kuti vaone kana kutarisa varwere vane mutsauko weEGFR. Izvozvo zvakati, kuedza kwemvura inonzi biopsy - kuedzwa kwekutanga kwerudzi rwekenza yemapapu - kwakagamuchirwa musi waJune 1, 2016, kuongorora kuchinja kwe EGFR kune varwere vane kenza isiri duku yemapapu emapapu.
Pane imwe huru inokonzera chirwere chekenza ikozvino inopa muedzo pamwe chete nekukurumidzira plasma genotyping kune vose varwere vane kenza isiri duku yemapapu mumapapiro kana panguva yekuongororwa kana mushure mokudzokazve / kudzokorora kwekenza yemapapu .
MuEurope, iye zvino ari kushandiswa kuvanhu vane musana muduku wechikweremu wemapapu kuti vaongorore kuchinja kweEGFR uye vanoonekwa sevanodiwa kuti vaone kana vanhu vachida kurapwa ne tyrosine kinase inhibitor.
Chii Chikutitora Kudzoka?
Zvinogona kuvhiringidzika paunodzidza pamusoro pemafuta emvura, kuti nei chikonzero ichi chisati chaitwa zvakanyanya. Izvo zvatisati tatiziva ndezvokuti mvura yakasununguka ichazadzisa zvidimbu zviviri: kunyatsoziva uye kuvimbika. Inofanirwa kutsungirirwa kuti mvura inoshandiswa mvura inogona kupa ruzivo rumwechete (kana kuti zviri nani) kupfuura zvinyorwa zvemavara uye nguva dzose inounza iyo mashoko.
Ramangwana
Zvakaoma kuziva zvakajeka zvinokonzerwa nemafuta emvura zviri panguva iyi yekutsvakurudza sezvo ichitsva. Pakupedzisira, zvinotarisirwa kuti nzira yacho haingabatsiri chete pakufungidzira kufungidzira uye kutarisa kwekudzivisa asi sechirongwa chekuongorora kuongorora kenza - kunyange zvakadaro ichiri nzira. Imwe nzira kana imwe, iyo inonakidza yehutsva yekutsvakurudza munguva yechirwere yakarurama.
Sources:
Bettegowda, C., Sausen, M., Leary, R. et al. Kuziva kufambisa dum DNA mukutanga-uye pakupedzisira-kutadza kwevanhu. Sayenzi Inoshandura Mishonga
Imamura, F., Uchida, J., Kukita, Y. et al. Kuongororwa kwehutano mhinduro uye clonal kushanduka kwemakumbo masero kuburikidza nekupararira DNA yeronda yemafuta anokonzerwa neEGFR ane mutsa mumusana wemapapu. Lung Cancer . 2016. 94: 68-73.
Jiang, T., Ren, S., uye C. Zhou. Basa rekupararira-tumor DNA kuongororwa mucheche musikana muduku wemukenza wemapapu. Lung Cancer . 2015. 90 (2): 128-34.
Karachaliou, N., Mayo-de-las-Casas, C., Molina-Vila, M. et al. Real-time liquid biopsies inoitika pakurapa kwekenza. Annals of Translational Medicine . 2015. 3 (3): 36.
Mahaswaran, S., Sequist, L., Nagrath, S. et al. Kuziva kushanduka kwemuviri muEGFR mukuparadzira masero emukenza emapapu. The New England Journal of Medicine . 2008. 359 (4): 366-77.
Sacher, A., Paweletz, C., Dahlberg, S. et al. Kubvumirana kunofanirwa kwePurd Plasma Genotyping yeKutsvaga kweEGFR uye KRAS mutations mu Advanced Lung Cancer. JAMA Oncology . Yakabudiswa paIndaneti April 7, 2016.
Santarpia, M., Karachaliou, N., Gonzalez-Cao, M. et al. Kukwanisa kwemajeri kusina kubuda kwechirwere cheDNA kuongororwa nemukenza wemapapu. Biomarkers mu Medicine . 2016. 10 (4): 417-30.