Zvinodhaka zvinorambidza nzira dzekenza dzenhema
Kenza yemukemikari yemasero yemusoro nemutsipa ndiyo yechitanhatu inowanzosangana nekenza munyika uye inoratidzira kusvika chikamu chimwechete kusvika zviviri kubva muzana zvevose vanouraya kenza. Imwe dambudziko guru riripo mukurapa kwevanhu vane metastatic kana vakadzokorora musoro nemukati wemutsipa, sezvo mukana wokupona kazhinji usina urombo.
Mashoko akanaka ndeokuti kutsvakurudza kuri kufambira mberi, uye vanachiremba vanotanga kushandisa immunotherapies muhuwandu hwevarwere.
Immunotherapy inorapwa mutsva inooneka yakachengeteka uye inovandudza zviratidzo uye kunyange kupona nguva yevamwe vanhu, zvichibva pane zvidzidzo zvesayenzi zvokutanga.
Kunzwisisa Zvinotangira Musoro uye Neck Cancer
Usati wanyatsonzwisisa kuti ma immunotherapies anobata sei, zvakanaka kuti tibate pane izvo "mamwe musoro nemutsipa" zvinoreva.
Chii Chinonzi Cell Squamous?
Masero ane mashoma ane mapepa, mapapiro masvikiro anotarisa pamusoro peganda, matoro uye mapfupa ekufema, uye dzimwe nhengo mumuviri.
Mienzaniso yenzvimbo apo squamous cell carcinoma (kansa) inogona kuwedzera inosanganisira nzvimbo idzi:
- Musoro nomutsipa
- Ganda
- Cervix
- Vagina
- Lung
- Anus
Zvinorevei Zvinorevei?
Chirwere chinotyisa (zvakasiyana nechirwere chinotapukira, chisina kenza) mumusoro nemutsipa munharaunda inoreva kuunganidza kwekenza masero ari kukura asingadzorwi uye anogona kana kuti asati asvika mhuka dzoutano dzakanaka.
Immunotherapy uye dzimwe nzira dzokurapa sechem chemotherapy dzinoshandiswa kurapa zvirwere zvinouraya, sezvo izvi zvinokuvadza uye zvinogona kuuraya.
Ndepi Musoro uye Neck Cancer Iripo?
Izwi rokuti "musoro nomutsipa" rinogona kunge rakavhiringidzika, sezvo rinofukidza nzvimbo huru yepamusoro.Kumwe mamwe mazwi, unganetseka kuti zvinorevei kana mumwe munhu akawanikwa ane chirwere ichi.
Mucherechedzo wemusoro neyemutsipa unoreva zviremara zvinokura mune chimwe chezvinhu izvi zvakawanda:
- Miromo / muromo
- Kudzoka mumuromo kana pamutsipa (unonzi oropharynx)
- Chikamu chezasi chehuro apo iri shure uye pedyo nezwi bhokisi (rinonzi hypopharynx)
- Kumusoro kwehuro pahuro mushure mehuni (inonzi nasopharynx)
- Voice box (inonzi larynx)
Chii Chinokonzera Musoro uye Neck Cancer?
Munguva yakapfuura, kukura kwekenza yemukati uye yemutsipa kwakabatanidzwa nefodya nekushandisa doro. Asi mumakore gumi apfuura kana zvakadaro, kukurudzirwa kweimwe musoro uye mutsipa wekenza zvakabatanidzwa kune utachiona nemamwe marudzi evanhu papillomaviruses ( HPV ). Semuenzaniso, dhizinesi dhiyabhorosi yakaratidza kuti rudzi rweHIVV runonzi HPV-16, runokonzera kenza yemumuromo uye kenza yemunhu mune vakadzi nevakadzi, inobatanidzwa nekenza ye oropharynx.
Kuvharirwa neHIVV kwakajairika zvikuru, asi huwandu huwandu hwevanhu hunova nekenza kubva kwahwo. Ichi ndechokuti vazhinji vemaitiro ezvirwere zvevanhu vanoderedza chirwere.
Kunyanya kufadza kudarika kuwana hukama pakati pe HPV nemukenza wemukati nemutsipa, ndiko kuwana kuti kuitika kwemusoro nehuro yekenza kunonzi neHIVV kwawedzera. Ukuwo, rumwe rutivi rwemusoro nemutsipa makondombera anonzi fodya uye kushandisa doro zvakaderera. Nei ichi chichinje? Nyanzvi dzinofungidzira kuti dzinogona kuitika nekuda kwekuchinja kwehutano mune zvepabonde-kunyanya, kuti zvepabonde zvepabonde zvave zvakajairika.
Pari zvino, pane kufarira kwakanyanya nzira yekurapa zvakanakisisa HPV-positive musoro uye makumbo emhanza, sezvo biology yavo yakasiyana nemakumbo eHIVV-negative. Nezvo, nyanzvi dziri kutarisisa zvakasiyana-siyana maitiro e-immunotherapy akasiyana-siyana ekurapa hutachiona hweHIVV.
Chii Chinonzi Immune System Checkpoints?
Immune system checkpoints ndiwo mapuroteni anowanzowanikwa pamunhu wemunodzivirira masero (anonzi T masero). T masero akafanana nemapurisa anotsvaka dambudziko (kenza kana utachiona) mukati memuviri. Apo T cell inosangana neimwe sero, inoongorora masero anoshandisa mapuroteni ari pamusoro payo kuti aone kana sero "rinowanzo" kana kuti "risina kujairika." Kana zvisina kujairika, T cell inotanga kurwisa sero.
Asi panguva yekurwiswa uku, masero akaenzana, ane utano akachengetedzwa sei? Apa ndipo panoita mapuroteni ekuongorora. Checkpoint mapuroteni akaisa pamusoro pemasero eT uye anoona kuti masero ane utano akasiiwa ari oga.
Kanzira inonyengedza pakuti inonyatsoita mapuroteni ekuongorora (a copycat wechokwadi) kuti arege kurwisa kubva mumuviri wemunhu. Imwe mapuroteni anoonekwa pamusoro pekenza masero kunodedzwa nemusikirwo wemasitadhindi PD-1.
Asi iye zvino masayendisiti akawana kuti anogona kudzivisa PD-1 pamasero ekenza, kuitira kuti kenza inowanikwa nehutachiona hwemunhu. Apa ndipo apo immunotherapy inouya, uye aya madhiragi anodzivirira PD-1 anonzi immune system checkpoint inhibitors.
Immunotherapy Kubata Musoro uye Neck Cancer
Pane maviri maune immune system checkpoint inhibitors ayo aive FDA akagamuchirwa muna 2016 pakurapa vanhu vane metastatic uye / kana kuti vakadzoka musoro nemutsipa squamous cell carcinoma.
Mutachiona wemetastatic unoreva mutanha wemusoro uye wemutsipa wakapararira kune dzimwe nzvimbo dzomuviri, asi mutachiona wepamusoro nomusoro wemutsipa unoreva kenza yakafambira mberi pasinei nekurapwa ne platinum-based chemotherapy regimen (somuenzaniso, cisplatin).
Aya maviri immunotherapies anonzi Keytruda (pembrolizumab) uye Opdivo (nivolumab).
Pembrolizumab
Zvidzidzo zvepakutanga zvinoratidza pembrolizumab ine maitiro akanaka ekuchengetedza uye inogona kubudirira mukuderedza kenza yevanhu.
Muchikamu chechipiri chechipiri, vanhu 171 vane kenza yemusoro neyemutsipa yakafambira mberi pasinei nokuti yakambobatwa nekemotherapy uye cetuximab (a monoclonal antibody therapy ) yakagamuchira kuiswa kwepembrolizumab vhiki nhatu dzose.
Zvose zvinotarisana nehuwandu hwaive makumi mapfumbamwe kubva muzana, uye nguva yepakati yemhinduro yaive mwedzi 8. Mhinduro yekuremekedza inoreva huwandu hwevatori vechikamu avo vane kenza inopera kana inopera mukupindura kurapwa.
Nekuchengeteka, 64 muzana yevatori vechikamu vakave nemigumisiro yakaipisisa yakarapwa, asi 15 muzana chete vakawana chikamu chechitatu kana chechina chiitiko chinotambudza (chakanyanya kana chinopisa upenyu).
Mhinduro dzakaipa kwazvo dzakawanda dzaive:
- Kuneta
- Hypothyroidism (inopindwa muropa yekrojeni gland)
- Nausea
- Kureba kwechiropa chinokonzera
- Diarrhea
Pasi pose, zvirwere zvinokonzerwa nehutachiona hwehutachiona hwehutachiona hwakanga huri hutachiona, hyperthyroidism, uye pneumonitis.
Pachirongwa chemashure, zvirwere zvekudzivirira zvirwere zvinoshungurudza zvirwere zvakanyanya kunetseka nezvirwere zvema immunotherapies, sezvo pane kunetseka kuti masimba evanhu achakurwisa kwete chete masero emukenza asiwo maronda ane utano zvakare. Mune mhaka yepneumonitis, mapapu emunhu anorongerwa, izvo zvinogona kuita kuti kufema kuome.
Mufananidzo mukuru ndewokuti kugamuchira immunotherapi inzira yakashata, sezvo muviri nemishonga inoshanda pamwechete kuti ione chakaipa (kenza) uye chii chinowirirana uye chine utano.
Chidzidzo cheChikamu III chepembrolizumab chiri kuenderera mberi. Chikamu chechitatu III chinoreva kuti pembrolizumab ichaenzaniswa nehutano hwemishonga yekurapa kuti uone kuti inofanirwa sei, sekunge kana isiri yakabudirira.
Nivolumab
Muchikamu chechipiri chechitatu, vanhu vanopfuura 350 vanowanzochera / metastatic squamous cell carcinoma yemusoro nemutsipa, vane chirwere chakanga chafambira mberi mukati memwedzi mitanhatu yekugamuchira platinum-based chemotherapy, yakashandurwa kuti iwane nivolumab vhiki mbiri mbiri kuburikidza nemuviri) kana chirwere chemaitiro (methotrexate, docetaxel, kana cetuximab ).
Mhinduro dzakaratidza kuti nguva yakareba zvakanyanya kupona muvanhu vakagamuchira nivolumab kune avo vakagamuchira chirwere chemazuva ose (kuponeswa kwemazuva manomwe kusvika kumwedzi 5.1, zvichienderana).
Mukuwedzera, gore rimwechete rinoponeswa raiva 36 muzana muchikwata cha nivolumab chinopesana ne16,6 muzana muhutano hweboka. Mune mamwe mazwi, gore rimwe chete rinopona rinopfuura kaviri.
Mukutaura kwekuchengeteka, chikwata chechitatu kana kuti 4 zvakashata zvakakonzerwa zvakaitika mu13 muzana yeboka yevolumab inopesana ne35 muzana yehutano hwemazuva ose. Muchikamu cheva nivolumab zvinowanzovhiringidza zvakaipa ndezvi:
- Kuneta
- Nausea
- Mapundu
- Kuderedza kudya mwoyo
- Itching
Muzhinji, migumisiro yakaipa yakabatana nehutachiona yaive yakajairika muboka re nivolumab (7.6 muzana yakagadzirwa ne hypothyroidism ne 0.9 muzana muhutano hwemazuva ose).
Pneumonitis yakaitika mu 2.1 muzana yevanhu vaibatwa nevevolumab, uye vanhu vaviri vakafa (imwe kubva pneumonitis uye imwe kubva pamakwikidzi akakwirira muropa). Mumwe munhu ari muhutano-hutachiona akafa kubva kumapupa emapapu ane chokuita nemishonga inopiwa.
Zvinofadza kuti mubvunzo wemibvunzo yakaongorora hutano hwehupenyu pakuguma kwekudzidza, hauna kuwana kuderera kukuru muhupenyu hwehupenyu mushure mekurapwa nevinivolumab. Kune rumwe rutivi, kwaiva nekuderera kukuru kwehupenyu hwehupenyu munzvimbo dzakawanda (somuenzaniso, marwadzo, mumuviri uye mumagariro evanhu, zvinetso zvepfungwa) mushure mekurapwa nechemotherapy.
Shoko Rinobva
Immunotherapy yava kutochinja chiso chekenza kurapwa. Ichokwadi, "inonzwisisika," uye iri kuvimbisa.
Yeuka zvakadaro, kubata mutachiona wepamusoro uye wemutsipa inzira yakaoma. Pane zvinhu zvakawanda zvinoenda mukugadzirisa kuti chiremba wako anoda sei kubata chirwere chako, semuongorori wezvokurapa, zvisinei nokuti une zvimwe zvinetso zvezvehutano, uye zvinodhaka zvakabatana nechimwe chirwere.
Ramba uri mubatsiri wehutano hwako hwekenza nekuwana ruzivo. Rwendo rurefu uye rwakaoma, asi edza kutsvaga nyaradzo uye mufaro pane nzira zvakare.
> Sources:
> Bauml J et al. Pembrolizumab yeplatinum- uye ye-ceuximab-refractory musoro nomukati wemutsipa: Zvigumisiro kubva kune imwe-ruoko, chikamu II chekudzidza. J Clin Oncol . 2017 May 10; 35 (14): 1542-49.
> Brockstein BE, Vokes E. Kurapa kwekenza yemukati uye yemukati mutsva. Mu: UpToDate, Posner MR (Ed), UpToDate, Waltham, MA.
> Economopoulou P, Perisanidis C, Giotakis EI, Psyrri A. Kubuda kwemajoni ekudzivirira immunotherapy mumusoro uye mumutsipa squamous cell carcinoma (HNSCC): anti-tumor immunity uye zvipatara zvinoshandiswa. Ann Transl Med. 2016 May; 4 (9): 173.
> Ferris RL et al. Nivolumab yekare inonzi squamous-cell carcinoma yemusoro nemutsipa. N Engl J Med . 2016 Nov 10; 375 (19): 1856-67.
> National Cancer Institute. (2017). Musoro uye Neck Cancer. Health Professional Version: Ongororo.