Batsiro uye Migumisiro Yechechi yeTamoxifen mu Premenopausal Breast Cancer
Tamoxifen, iyo inozivikanwawo nezita rokuti Nolvadex, ndiyo imwe yemishonga inowanzonyatsorongedzerwa kuti isapedzisira kugadziriswa nekenza. Chii chinobatsira kushandisa izvi zvinodhaka mushure mekutanga kurapwa kwekenza yemucheche , chii chinowanzova nemigumisiro, uye chii chiri ngozi?
Overview
Tamoxifen imishonga ine zvose zvinorwisa-estrogen uye isrogen-yakafanana nemigumisiro, zvichienderana nemhando chaiyo yezviviri mumuviri iyo inoshanda.
Inosarudzwa sechisarudzo chestrogen receptor modulator (SERM) pamwe nemishonga Evista (raloxifene).
Ikoko pane zvitatu zvakanyanya kushandiswa zve tamoxifen:
- Vakadzi nevarume vanoongororwa vane estrogen-receptor-positive , kenza-yekutanga-kenza yepamu mushure mekuvhiyiwa, chemotherapy kana kuti rayation kuti kuderedze ngozi yekudzoka zvakare.
- Vakadzi nevarume vanoongororwa vane chikwata chepamusoro kana chetachiona chemasamendi chinonzi hormone receptor-positive
- Kuchengetedza kenza yepamuviri yepamuviri kune avo vari kuwedzera mungozi yekuvandudza chirwere chacho.
Tamoxifen kazhinji haifaniri kufungidzirwa inobatsira kune avo vane estrogen kana progesterone isina kenza yemazamu.
Tamoxifen inouya mumapiritsi gumi nemashanu kana 20 mg ane chirwere chinowanzova 20 mg kamwe pazuva. Kune hutano hwakakosha hwekushandisa kwezvinodhaka izvo zvinogona kuderedza kushanda kwechirwere. Inowanzoendeswa zuva rimwe nerimwe kwemakore mashanu kusvika kune gumi kana kusvika munhu achinjira kune aromatase inhibitor.
Batsirwa
Tamoxifen yakagamuchirwa muna 1998 uye yakabva yawanikwa ichishanda pakurapa kenza yemazamu kune mamiriyoni evanhu. Iyo ichiri kuonekwa sarudzo yakanaka kana iwe uri premenopausal kana uri postmenopausal uye haugoni kutora aromatase inhibitor.
Kana ukashandiswa pashure pokutanga kurapwa kunogona kuderedza dambudziko rako rekudzoka kwekenza yemazamu nehafu, kana bundu rako raiva estrogen receptor positive.
Inogonawo kuderedza dambudziko rako rekuwedzera imwe kenza mune imwechete kana muchirwere chitsva mune imwe mvere kusvika kusvika ku50 muzana. Iyi njodzi yakaderedzwa inobata chokwadi kune avo vane ngozi yepamusoro uye yakadzika 70-gene.
Zvinogona kubatsira kubvuma kuti tamoxifen inoramba ichibatsira kune kuderedza dambudziko rekudzoka kunyange mushure mokunge makamira kutora mishonga.
Mukuwedzera kumigumisiro yaro mukuderedza ngozi yepabonde yehadzi kana kudzokazve, tamoxifen ine zvimwe zvinobatsira zvakare. Kusiyana nemarwadzo ayo anorwa-estrogen pamakumbo emvere, tamoxifen ine estrogen-yakafanana nemigumisiro pfupa. Nokudaro tamoxifen (pamwe naEvista) inogona kubatsira kuderera kana kumira kurasikirwa kwefupa. (Kusiyana neizvi, aromatase inhibitors inowanzoita kuti pfupa rirasike). Tamoxifen inogonawo kuderedza cholesterol mazinga, kunyanya LDL cholesterol.
Iyo Inoshanda Sei
Masero emukenza webereki ayo anonzi estrogen receptor positive anonyanya kudyiwa neestrogen. Estrogen mumuviri unosunga kune mapuroteni ari pamusoro penzvimbo idzi (estrogen receptors) kuratidza kuti sero rinoparadzanisa nekukura. Tamoxifen inonamatira kune ichi chinogamuchirwa saka estrogen haigoni, inonyanya kushaya nzara masela ekenza.
Migumisiro Yechipfuva uye Ngozi
Zvizhinji zvinowanzova nemigumisiro ye tamoxifen inonyanya kuve nemigumisiro yekuve nechikamu chiduku cheweserogen mumuviri (kumisa kwemimba).
Saka kupisa kunopisa, usiku hunotiza, kubuda kwemudzimai uye kukwira mvura, uye kuderedza libido kwakajairika. Sezvinyorwa zvinokurumidza, kana izvi zvichikushungurudza, kupisa kunopisa kunobatanidza nekurarama zviri nani kubva pabonde remuti). Zvirwere zvinogonawo kuitika.
Zviratidzo zveTamoxifen pane uterine (endometrial) tissue zvinogona kukonzera njodzi yekenza yeukitiri . Iyi njodzi inotsamira pakureba kwenguva yauri pamushonga. Iyi njodzi inopfuura vakadzi vakawanda vanopfuura makore makumi mashanu asi asiri pasi pezana.
Tamoxifen inogona kuwedzera mungozi yako ekugadzira ropa kana mumakumbo ako (yakadzika yevhein thrombosis) kana mapapu ( pulmonary embolism ). Hatina chokwadi panguva ino, asi tamoxifen inogonawo kuwedzera njodzi yekurwadziwa kwemwoyo kana kurohwa.
Nguva Yekudaidza Chiremba Wako
Zvakakosha kudana chiremba wako kana uine zviratidzo zvaunofunganya nezvazvo, asi kunyanya, iwe unofanirwa kudana kana iwe ukavaka chero chekutevera:
- Kusasvibiswa kwepabonde kubuda ropa
- Pain mu pelvis yako
- Mhembwe kurira
- Chipfuva chepfu
- Kupfupika kwemhepo
- Kushayiwa simba, kupera kana kurira
- Zviratidzo nyaya
Tamoxifen vs. Aromatase Inhibitors
Tamoxifen uye aromatase inhibitors dzinosiyana kana zvasvika kune zvose zviripo uye zvinokonzera. Kune vakadzi vanonzi postmenopausal kana avo vari premenopausal uye vakagamuchira ovarian kuderedza chirwere, anromatase inhibitor inogona kupa zvikomborero zvakakura mukuderedza dambudziko rekudzoka. Aromatase inhibitors inokonzera menopausal zviratidzo asi inogona kukurumidza kupfuudza bone kurasikirwa pane kuideredza se tamoxifen. Kutambura kwepfupa uye pamwe chete kunogona kuitika nekirasi yezvikwata zvinodhaka asi zvinonyanya kufanana nearomatase inhibitors.
Manyevero
Kubatana Kwemishonga
Nemhaka yenzira iyo yakagadziriswa nayo, tamoxifen inogona kuwirirana pamwe chete nemishonga yepamutemo uye kupfuura-the-counter. Taura nechiremba wako pamusoro pemamwe mishonga yaunoshandisa uye iva nechokwadi chokuti wemhizha wako anoziva zvakare. Kunyanya, zvirwere zvakasiyana-siyana zvinotapukisa, pamwe chete ne----anti-allergies mishonga, inogona kuderedza kubudirira kwe tamoxifen.
Kuberekwa
Nokuda kwehuwandu hwakareba hwekuremara kwekuberekwa, tamoxifen haifaniri kushandiswa pakuzvitakura , uye mishonga inofanira kumira kwemwedzi miviri isati yatanga kuve nemimba.
Inguva Yakadii Yaunofanira Kuitora
Kubva pauchapupu hwakajeka hunobva kumadziro makuru maviri emakiriniki emakiriniki emakiriniki (ATLAS neATTom), gore rechigumi panzvimbo yehutano hwemakore mashanu adjuvant neTamoxifen inobatanidza nehuwandu hutachidzo hwekudzoka uye kuderedzwa kwekufa kwekenza yemazamu.
Izvi zvishoma nezvishoma mukudzoka kwekenza yemazamu inofanira kuyerwa pamusoro pemigumisiro inogona kuitika kumunhu mumwe nomumwe semunhu oga. Kana iwe uri premenopausal, chiremba wako angakurudzira tamoxifen kwemakore matatu kusvika mashanu asati ashandura kune aromatase inhibitor kwemamwe makore mashanu.
Zvakakosha kubatana nemishonga yako. Zvinosuruvarisa, vanhu vazhinji vanorasikirwa nemishonga kana kuti vanorega mishonga iyi nguva pfupi, zvichiita kuti pangozi yakakwirira yekudzokorora.
The Bottom Line
Tamoxifen inogona kuderedza zvakanyanya dambudziko rekudzoka kwekenza yemazamu mushure mekurapwa kwekare nekuvhiyiwa, chemotherapy uye / kana remishonga inonzi radiation. Kufanana nemishonga chero ipi zvayo, tamoxifen ine njodzi nemigumisiro uye zvipo zvekurapa zvinofanira kuenzaniswa nezvisungo izvi. Iva nechokwadi chekukurukura zviratidzo zvako nachiremba wako uye taura naye kana iwe uchinge uine chero migumisiro. Chengetedza mitsetse yekukurukurirana yakavhurika kuti uone kuti tamoxifen inoshanda kwauri pasina zvipingamupinyi zvinokosha.
> Sources:
> National Cancer Institute. Breast Cancer Treatment (PDQ) -Health Professional Version.
> Sahebkar, A., Serban, M., Penson, P. et al. Migumisiro yeTamoxifen paPlasma Lipoprotein (a) Kufungisisa: Ongororo yakarongeka uye Meta-Kuongorora. Zvinodhaka . 2017. 77 (11): 1187-1197.
> Yu, Z., Guo, X., Jiang, Y. et al. Adjuvant Endocrine Monotherapy yePostenopausal Early Breast Cancer Patients with Hormone-Receptor Positive: A Systemic Review uye Network Meta-Analysis. Chirwere chepabonde . 2017 Jul 28.