Ndeipi Mishonga Yakanakisisa Yegadziriro 4 HER2-Positve Breast Cancer?
Kana iwe wakamboonekwa kuti une chirwere chetachiona cheHER2-positive, zvichida kuti ruzivo rwehuwandu hwaunowana hunoreva kutanga kwekenza yemukenza kana chirwere chekenza yepabonde kazhinji. Chii chaunoda kuziva pamusoro pekurapa kwemukati wekenza yepamu 4 iyo HER2 yakanaka?
Metastatic HER2 Positive Breast Cancer
Iwe ungangodaro wakadzidza kuti une chirwere chepakati chechina (metastatic) chepachifu pawakatanga kuonekwa kuti une chirwere ichi, asi kazhinji kacho, mastasti dziri kure zvinowanzoitika sekudzoka kwechirwere chekutanga chakanga chiri chekutanga chepamuviri makore apfuura.
Sezvo zvakadaro, kuongororwa kunowanzosvika sekutya uye kunogona kunzwa kuneta.
Hazvirevi chete kuti kufungidzira hakusi kwakanaka apo kenza yemazamu yakapararira, asi pfungwa yekuenda kuburikidza nemishonga zvakare inogona kukusiya iwe uchinetseka. Kunyange zvazvo chikwata chechina cheHER2 chirwere chepachifu chakanaka hachirapa, chinorapwa, uye kurapwa kwakagadzirirwa kutarisa HER2 kunoramba kuchiwedzera nekuvandudza. Aya maitirowo anowanzove ane zvishoma zvisingabatsiri kupfuura chemotherapy mishonga.
Muchikamu chimwe muzvikamu zvishanu zvekenza ndeye HER2-positive kenza yemazamu . Izvi zvinorevei kuti mamwe mazamu ehapa ane maHER2 emagetsi anonyanya kuderedza HER2 mapuroteni. Aya mapuroteni anosunga kumasepa echetere emvere, zvichikonzera kukura kwezviremera izvi. Muzhinji, HER2 mazamu matema ane utsinye uye anokura nokukurumidza matumbu.
Kusvikira muna 1998, apo Herceptin yakabvumirwa, HER2 matumbo akanaka aiva nehurombo hwakanyanya, kunyanya kune avo vaive nesrogen uye progesterone receptor matumbo asina kunaka.
Kubvira panguva iyo mamwe mishonga yakakonzerwa yakave yakagadzirwa iyo inotarisa HER2, ichisiya zvisarudzo kunyange kana imwe chirwere, kana kunyange zviviri, ichikundikana.
Receptor Status Changes
Vanhu vazhinji vanoshamisika kuziva kuti nzvimbo yekugamuchira yekenza yavo yakashanduka mushure mokudzoka. Kana iwe uine anrogen receptor chiremara chakanaka pawakaonekwa kuti une chirwere chepachifu chepakutanga kushanduka kunogona kuva nesrogen receptor negative (kana zvimwewo).
Saizvozvowo, kana iwe waive neHER2 / neu chitubu chakanaka pakutanga, zvingave zvisina kunaka ikozvino uye zvakasiyana.
Ichi ndicho chikonzero chiitiko chekuongorora uye kuongorora zvakare chiitiko chekugamuchira chinhu chakakosha kana iwe uchidzoka kure nehosha yako.
General Management
Izvo zviongorori zvekenza yemasasa inowanzoita sechishamisi kune avo vakave nekudzoka kure mushure mokunge vachangotanga kurwara nekenza yemazamu munguva yakapfuura. Nenguva yekutanga kenza yepati, kurapwa kunowanzova nehasha. Chinangwa chekutsamwiswa nechisimba nekuvhiya, chemotherapy, chinotarisirwa kuongororwa, uye / kana kupiswa kwemavara ndiko kuchengetedza kudzokorora kana zvichikwanisika.
Nechitsauko 4 kenza yemvere nzira yekurapa inowanzosiyana, uye vanhu vakawanda vanoshamisika kuti sei nzira yacho isinganyanyi kurwisa (uye inonzwa kuchinetseka nokuda kweizvi). Chinangwa nekenza yemasasa inowanzoita shanduro shomanana yekurapa chirwere chacho. Kune chikamu chikuru, kushungurudzwa kwakanyanya kwechikamu chechina chepenza chepamu hazvisi kuwedzera kuponesa asi kunowedzera migumisiro. Izvi zvinorevei kuti kazhinji kacho rudzi rwemhando imwechete yekurapa panguva runoshandiswa (kana runonoka kukura kwekenza) panzvimbo yehutano hwakawanda hunosanganiswa sekutanga kwechirwere chirwere.
Treatment Options
Mutsara wokutanga mushonga wekenza yemasasa inokonzerwa netastatic inowanzoenderana nemamiriro ekugamuchira, uye kana ichidzoka, zvose zviri zveweserogen uye progesterone receptor uye HER2 / neu chiitiko chinofanira kuongororwa (sezvo zvataurwa pamusoro apa, izvi zvinogona kuchinja.)
Kana chirwere chako chese estrogen receptor chakanaka uye HER2 chitubu, kurapa kwokutanga kunogona kusanganisira hormonal therapy , HER2 inorapwa, kana kuti zvose zviri zviviri. Ichi chisarudzo chichawedzerwawo nemishonga yawakabatwa nayo usati waita zvakare (kana kenza yako irikudzoka kure pane kungova nechirwere chiri chiitiko chechina panguva yekufungidzirwa.) Chemotherapy inogona kushandiswawo kwemwedzi mina kusvika kwitanhatu .
Kana usina kumbobvira watapwa neHER2 inotarirwa nemishonga, kurapwa kunowanzotanga naHerceptin (trastuzumab) kana Perjeta (pertuzumab). Kune avo vakamborapwa neHerceptin, imwe nhengo yeHER2 inotarirwa inogona kushandiswa, yakadai sePerjeta (pertuzumab). Kunyange kune vanhu vakambomira mberi kwemaviri maviri akapfuura HER2 inotarirwa nemishonga, kurapwa netrastuzumab emtansine (TDM1) yakagadzirisa hupenyu hwehupenyu huri nani pane kusarudzwa kwevecologist kune zvimwe zvirongwa zvinowanikwa (kusanganisira makemikari akawanda emishonga) muchimwe chidzidzo.
Kana kenza yakafambira mberi paHerceptin kana mukati memwedzi gumi nemaviri ekumisa chirwere ichi, T-DM1 (trastuzumab emtansine) ndiyo inosarudzwa nzira yechipiri.
Mutsara wechitatu wechishanu huchasiyana-siyana zvichienderana nehutano hwekare. Kune avo vasati vambobatwa neT-DM1, ichi ndicho chisarudzo. Perjeta inogonawo kushandiswa kune avo vasati vamugamuchira pamwe chete naHerceptin. Kune avo vakamborapwa ne Perjeta uye T-DM1 uye vachiri kufambira mberi, zvisarudzo zvinosanganisira kusanganiswa kweXeloda (capecitabine) naTykerb (lapatinib), hormonal therapy kune avo vane estrogen receptor positive tumor, uye mamwe maitiro emakemotherapy pamwe chete neHER2 chinangwa chemishonga.
Metastasis-Specific Treatment
Kazhinji kurapwa kwemasastases (kupararira) kwekenza yebonde kune chero nzvimbo yepaiti inowanzobatwa nemishonga inokonzerwa nehomoni, HER2 yakanaka inorapwa, kana chemotherapy. Izvi zvinogona kuvhiringidza kune vamwe vanhu. Sei kenza masero mumapapu, somuenzaniso, achibatwa nemishonga yehomoni?
Zvakakosha kucherechedza kuti kana kenza yemazamu inopararira kune dzimwe nhengo, dzakadai semapfupa, uropi, chiropa, uye mapapu, inokonzera kenza yemucheche inouraya inopararira munhengo idzodzo.
Mishonga inonzi "metastasis-specific" inogona kushandiswawo zvakare. Aya ndiwo marapirwo anonyatsotarisa nzvimbo yemasitosita, akadai semasitosita emapfupa. Chiropa neuropi metastases zvinowanzoonekwa kune vakadzi vane HER2 / neu positive kanzera yepamu kupfuura kune avo vari HER2 asina kunaka.
Bone Metastases
Bone metastases nekenza yemazamu inowanzozara, inowanikwa munharaunda inenge 70 kubva muzana yevanhu vane chirwere chemasastatic. Mukuwedzera kumagadziriro ehutano ehutano anotarisana nekenza yebonde pachayo, metastasis-chaiyo kurapwa kwemasitasase emapfupa inogona kuderedza marwadzo uyewo kuvandudza kupona, uye mapfupa emapfupa ane tsvina yakanaka kune dzimwe nzvimbo dzechirwere chetachiona. Chinyorwa ndechekuti zvinetso zvemasitasase emapfupa, zvakadai sekuputsika, zvinokosha zvakanyanya sekurapa kwekenza yemazamu kunogona kutungamirira kupfupa kurasikirwa.
Zvimwe zvinosanganisira:
- Mafupa anoshandura mabhesi anosanganisira mabhonphosphonates, akadai seZometa (zoledronic acid) anogona kuderedza zvinetso zvakadai sekuputsika uyewo ane simba rinopesana nemaronda. Xgeva (denosumab) imwe imwe sarudzo iyo inoratidzika seine kupesana nekenza zvinhu.
- Radiation therapy inogona kuderedza marwadzo uye inogona kuderedza ngozi ye
- Radiopharmaceuticals inogona kubatsira kune avo vane mazamu akawanda emasitema, sezvikamu zvemavara anoiswa kune imwe ikemikari inopindwa muropa uye inotakurwa kuva mapfupa kumativi ose emuviri.
Chiropa Metastases
Chiropa chinosangana nekenza yemazamu chikamu chechipiri chinonyanya kuwanikwa chemasastases uye chinoitika kakawanda pakati pevanhu vane HER2 maitiro akanaka. Radiation therapy inowanzoshandiswa pakuwedzera kune dzimwe mishonga dzekenza. Mimwe mishonga yakadai sekugadzira ingashandiswa.
Kana pane zvikamu zvishomanana zvemasastasis (oligometastases) kubviswa kushandiswa kana kuti stereotactic body radiotherapy inogona kusimbisa kupona. Chiropa chinosanganisa chiropa chinowanzokonzera ascites (kumimba kumimba) uye paracentesis (kubvisa mvura inenge mudumbu kuburikidza nesimbi yakarembera yakareba) inowanzodiwa kuderedza kusagadzikana. Itching inowanikwawo zvakanyanya nechiropa chechiropa uye kurapwa kwekuchenesa kunogona kuvandudza hupenyu hwehupenyu.
Brain Metastases
Kunyange zvazvo metastases kubva kenza yemazamu inowanzobatwa sechikamu chetachiona chetachiona chetachiona chepamuviri, hutachiona hwehupombwe hunogona kuunza dambudziko rakasiyana. Ropa-uropi hunopfigira ishongedzo yemasipirare yakasimba akadzivirira anovhara mishonga yakawanda, kusanganisira mazhinji chemotherapy mishonga, kubva pakuwana huropi. Ndinofara, mamwe madhiragi anokwanisa kuyambuka barr
A 2017 kudzokorora mabhuku akawanikwa kuti Herceptin (trastuzumab) inonyatsokurudzira kupona kune avo vane HER2 chirwere chepachifu chemahuro neuropi metastases. Trastuzumab emtansine (T-DM1) uye Perjeta (pertuzumab) vari kuvimbisa zvakare. Kusiyana neizvi, Tykerb (lapatinib) inoratidzika kunge isina zvishoma muhutano hwemashupusi (sehudziro dze 2017) uye ine purogiramu yakanyanyisa. Apo lapatinib inosanganiswa nekemotherapy, zvisinei, mhinduro yehupenyu iri nani.
Lung Metastases
Mastasisita ine mvere yakabva kune kenza yemazamu inonyanya kurapwa nehutano hukuru hwokurapa kenza yemazamu, yakadai semishonga inouraya, HER2 inotarisirwa zvinodhaka, uye chemotherapy, panzvimbo pemishonga ipi zvayo. Apo maitiro mashomanana chete aripo, kurapa izvi nekuvhiya kana SBRT kunogona kufungwa, asi zvidzidzo zvisati zvaratidza kuwedzerwa kwekuwedzera kwepabonde kubva pamutemo uyu.
Mamwe Masetasita Akare
Kanzera yepabonde inogona kupararira kune dzimwe nzvimbo dzakawanda dziri kure dzomuviri pamwe chete, kusanganisira ganda, musuru, mafuta, mawere, uye dzimwe nzvimbo. Kazhinji yenguva idzi zvipembenene zvakakura zvinorapwa nehuwandu hwehutachiona hweHER2 mutsara wakanaka, asi kana masastases ari oga aripo, zvisarudzo zvakadai sokuvhiya kana remishonga inonzi radiation zvingafungidzirwa.
Kutsungirira
Kurwisana nekenza yemasitatimendi yemazamu chinhu chakaoma pasinei nemhando kana majekitiki. Kana iwe wakambofanirwa kurapwa kutanga kwechirwere chirwere uye kenza yako yakadzokorora, nzira yehutano yekenza yemasitini inogona kunge inoshungurudza pakutanga, sezvo chinangwa chacho chinowanzoshandiswa sekurapa zvishoma sekugona kudzora chirwere, panzvimbo pekutambudza iwe zvichida aiva nekambani yekutanga kenza yepamu.
Izwi rokuti "rinotora musha" harina kumbobvira rakakodzera kupfuura pane zvakagadzirwa nekenza yakawanda. Kune vazhinji mapoka ekutsigira uye musha wekenza wepamukira inowanika, asi vanhu vakawanda vane kenza yepamusasa yevasasa inosarudza mapoka ayo anosanganisira zvikuru avo vane chirwere chekenza 4 chepabonde pane avo vanobatanidza vanhu vane chirwere chepabonde chekutanga.
Kana iri mudikanwa wako ari kurarama nechitsauko chekenza yepamu 4, tora nguva kuti uzive nezvinhu zvisingatauri kumunhu ane kenza yemukomana yemasast .
Shoko Rinobva
Metastatic HER2 kamu yakanaka yepamu inogona kurapwa nemishonga inouraya (kune avo vanovewo estrogen receptor positive) uye chemotherapy, asi sarudzo yekushandisa HER2 inotarisirwa nzira dzokurapa inowedzerazve mamwe maitiro mumamiriro ezvinhu aya.
HER2 matumbo akanaka anowanzopararira kuuropi uye nechiropa kupfuura HER2 matumbo asina kunaka. Kana izvi zvikaitika, zvose zvinorapwa uye metastasis zvakarapwa zvinogona kuonekwa. Nenzira yakanaka, uye kusiyana nemishonga yakawanda, Herceptin uye zvichida pertuzumab inoita seyayambuka chirwere chepfungwa chepfungwa kuti itarise zvakajeka izvi zvirwere.
> Sources:
> Dieras, V., Miles, D., Verma, S. et al. Trastuzumab Emtansine Kusiyana neCapecitabine Plus Lapatinib muVarwere Vakambotariswa HER2-Yakanaka Yakanyanya Kenza Yemukomana (EMILIA): Kuongorora Kunotsanangurwa Kwekupedzisira Kwokupona Mhinduro Kubva muRandomized, Open-Label, Phase 3 Kuedzwa. Lancet Oncology . 2017. 18 (6): 732-742.
> Krop, I., Kim, S., Martin, A. et al. Trastuzumab Emtansine Kurapa Kurapa Kwechiremba Kusarudzwa Nevarwere Vakatorwa Kare HER2-Yakanaka Metastatic Breast Cancer (TH3RESA): Zvigumisiro Zvokupedzisira Zvokupona Kubva MuRandomized Open-Label Phase 3 Muedzo. Lancet Oncology . 2017. 18 (6): 743-754.
> Laakmann, E., Muller, V., Schmidt, M. et al. Zvirongwa Zvokurapa Zvirongwa zveHER2-Chipo Chechirwere Chechirwere Chechiremba vane Brain Metastases Beyond Trastuzumab: Kuongorora Zvinyorwa. Breast Care . 2017. 12 (3): 168-171.