Ndezvipi zvipembenene zvingaitwa nachiremba wako?
Kufanana nemishonga ipi zvayo, kune chikwata uye chinopera. Icho chinoputika ndechekuti immunotherapy iri kushandiswa kuvandudza kufungidzira kwemamwe marudzi ekenza seyaiyo isina chechi duku chekenza yemapapu emapapu, melanoma, kenza yemusero wesero, kenza yemaroni, uye Hodgkin's lymphoma. Mune mamwe mazwi, vanhu vari kupiwa mukana wechipiri mukurarama kwenguva yakareba uye hupenyu hwakanaka-humwe chinhu chinoshandura chaizvoizvo chiso chekenza.
Ichokwadi kuti kubuda mu immunotherapy kunongotanga, uye iyi inzvimbo inofadza uye inofadza zvikuru pakutsvakurudza kwekenza uye kutarisira iye zvino.
Nezvo, sezvo vakawanda uye vakawanda vari kurapwa ne immunotherapy, kunyanya checkpoint inhibitors (ipilimumab, nivolumab, uye pembrolizumab), vanachiremba vachicherechedza zvinetso zvakasiyana-siyana zvingamuka nekuda kwekutora mishonga iyi mitsva.
Nhamba yeHotpoint Inhibitors
Kuti uchinzwisise migumisiro yakaipa kana kuti zvinosvibisa zve checkpoint inhibitors , zvakakosha kunzwisisa kuti rudzi urwu rwekudzivirira muviri runoshanda sei.
Muchidimbu, zviratidzo zvekudzivirira zvirwere zvinowanzoonekwa pamusoro pemasikirini emasero (anonzi T masero). Aya majekesi anotarisa anoshanda nenzira yakaoma yekujekesa nzira yekumisa masero eT munhu kuti arwise masero ane utano-chete masero, kunze kwemasero (semuenzaniso, masero anotapukirwa nehutachiwana).
Zvinosuruvarisa, masero ekenza anonyengedza pakuti vanoita uye vanotaura mavoko ekucherechedza mamolekemu, uye ichi ndicho chikonzero muviri wako usingarwisi chirwere chakaipa, sezvungada kufunga.
Zvisinei, masayendisiti akarwisa zvakare nekugadzira kurapwa kunodzivisa mazamu anoona nezvekenza masimbi mune tarisiro yokuti ikozvino muviri wechirwere chemuviri unozoziva kenza sevatorwa, kuunza kurwisa, uye kuisa pachena.
Toxicities of Checkpoint Inhibitors
Zvechokwadi, zvinetso zvinogona kusimuka kana muviri wevanhu uchinge uchinge uchinetseka uye unotanga kurwisa hutachiona, masero ane hutano kuwedzera kune masero emakenza akaipa.
Mune mamwe mazwi, kuputika kukuru, nhengo dzomumakumbo, uye zvirwere zve autoimmune zvinogona kuitika nekushandiswa kweiyo checkpoint inhibitors.
Kutaura zvazviri, kutsvakurudza kunoratidza kuti izvi zvinosvibisa, zvinonzi zvirwere zvinopinda mumuviri zvakashata, zvinoitika kusvika kuzana 85 muzana yevanhu mushure mekurapwa ne checkpoint inhibitor ipilimumab. Zvinowanzoitika kusvika ku70 muzana yevanhu mushure mekurapwa ne checkpoint inhibitors nivolumab kana pembrolizumab.
Senguva iyo, ipilimumab inhibits the immune checkpoint CTLA-4 (cytotoxic T- lymphocyte-linked protein 4) uye yakashandiswa kurapa maranoma .
Nivolumab uye pembrolizumab chinangwa PD-1 (rakarongwa chirongwa chekufa-1) uye yakashandiswa kurarisa mishonga yekenza, kenza yemusero wesero, kwete kamudiki kenza yemapapu emapapu, uye Hodgkin's lymphoma.
Kudzokera kune zvinosvibisa, kunyange zvakadaro, iyo inonyanya kurongeka maitiro ayo aya inhibitor "maitiro" zvisina kunaka "kurwisa" mumuviri ndeye ganda, maviri emimba, chiropa, uye endocrine systems.
Skin Toxicities
Dambudziko reganda ndiro rakajairika rinowanzosangana nemuviri wehutachiona hunosangana nekutora checkpoint inhibitor, uye vanoitawo kuitika kutanga kune mukurapa.
Mienzaniso yezvinetso zveganda zvinosanganisira kupisa, kutema, alopecia (kusuruvara kwebvudzi), uye vitiligo .
Muromo unotambudza semuromo wakaoma uye muromo mucositis (kana ulcers yakaumbwa mumuromo) inogonawo kuitika.
Kurapa kwehashti kazhinji kunosanganisira kushandisa sopicostosteroid cream. Kunyangwe kana kupisa kwakanyanya, chirwere chemukanwa corticosteroid dzimwe nguva chinodikanwa. Kutora antihistamine yakanyorwa seBenadryl (diphenhydramine) inogona kubatsira pakubata.
Kazhinji, kana kuputika kwakanyanya, zvichireva kuti inosvika 30 muzana yemuviri, munhu angada steroid inopiwa kuburikidza nemuviri (intravenously) inoteverwa ne taper ye oral steroids.
Zvakakoshawo kuziva kuti shungu dzakanyanya seStvens -Johnson syndrome dzisingawanzi kuziviswa kuvanhu vanotora checkpoint inhibitor.
Ichi ndicho chikonzero iwe kana kuti chiremba wako wekenza uchange achicherechedza iwe zvakanyatsonaka paunenge uchitora immunotherapy uye nokukurumidza iwe unoona dermatologist kana kukurumidza kwako kuchiita kunetseka (sekunge kuchiita blisters) kana kuti iwe usingagadzirwi nematanho akaoma yakafanana nekristicosteroid cream.
Gestrointestinal Tract Toxicities
Dhairrhea uye chirwere, chinokonzera marwadzo emimba uye dzimwe nguva ropa muzvigaro, zvinetso zviviri zvemukati zvinogona kuitika semugumisiro wekutora checkpoint inhibitor. Kana izvi zviitiko zvichiitika, zvinowanzoonekwa masvondo matanhatu kana gare gare mushure mokutanga immunotherapy.
Izvozvo zvakati, izvi zvinokanganisa zvinoratidzika sezvowakanyanya kune avo vanogamuchira CTLA-4 kudzivirira zvirwere (semuenzaniso, ipilimumab yepamusoro ye melanoma), kana zvichienzaniswa nevaya vanogamuchira PD-1 inhibitor (somuenzaniso, nivolumab yepamusoro squamous cell kwete duku kenza yemapapu yemapapu).
Kurapa kwehutachiona uye zvishoma kwekutanga kunosanganisira kuwandisa kwakakwana kwemvura, chirwere chinorwisa-diarrheal , pamwe pamwe nemishonga inorwisa-diarrheal yakafanana neImodium (loperamide). Asi kana diarrhea inoramba ichiwedzera kwemazuva maviri kana matatu, pasinei nemishonga isinganzwisisiki, kana kana chirwere ichi chiri chakanyanya kuoma (zvishoma kana kupfuura zvigadziridzo zvemuviri pamusi pane zvese zvinoitika), kuongorora kwakakwana kuchaitwa kuti iwedzere kuongorora marwere-akafanana kana hutachiona chinhu chinokonzera, kwete chirwere.
Kana utachiona huri kutaridzika, uye chikonzero chacho chinoratidzika sechirwere-chakakodzwa, corticosteroids inodiwa uye dzimwe nguva kunyange mishonga inosimba yakasimba iyo inodzivisa maitiro ezvirwere semasikirwo akaita se Remicade (infliximab) inodiwa.
Chimwe chezvinhu zvinotyisa zvinotyisa, zvisinei, zvisingaiti zvehutachiona izvo vanachiremba vanocherechedza ndezvekudzivirira kwepachivi (apo gomba rinoumba mumatumbo emukati kubva kuvhuvhuta kukuru).
Chiropa Toxicities
Checkpoint inhibitors inogona kukonzera kukwirira mukati mehupenyu hwechiropa, iyo inoratidza chiratidzo chechiropa chokuputika. Izvi zvinowanzoonekwa mwedzi miviri kusvika mitatu mushure mekutanga kurapwa.
Kazhinji, chiremba achacherechedza chiropa chako cheropa , kunyanya mushure mega imwe yero ye immunotherapy, uye kana ma enzymes akawedzerwa, basa rinozoitwa rinozoitwa kuti rione kana chinokonzera ichibatana ne immunotherapy kana chimwe chinhu (somuenzaniso, imwe mishonga kana utachiona hwehutachiona).
Kungofanana nezvimwe zvinokonzerwa nemigumisiro yechirwere chekuzvidzivirira pamuviri, kana chinokonzerwa chichienderana nehutachiona, corticosteroids icharairwa. Kana chiropa chekutyisa chiri chakanyanya, kurapwa ne immunotherapy kunogona kumira zvachose.
Endocrine System Toxicities
Zviitiko zvakashata zvakasangana nemushumo inogona kuitika mukati me endocrine system yemuviri, iyo inosanganisira chirwere chepituitary, chirwere chetachiona, uye glands zvinowedzera. Pavhareji, zviratidzo zvinowanikwa mumapfumbamwe masvondo mushure mokutanga kurapwa uye zvinogona kusanganisira:
- Kuneta
- Kushaya simba
- Nausea
- Kusanganiswa
- Headache
- Kufirwa kwechido
- Zviratidzo zvinetso
- Fever
Chimwe chezvinhu zvinowanzogadzirisa endocrine zvinopisa zvinokonzerwa ne hypothyroidism , iyo iyo apo munhu anoumba utachiona husingaiti.
Chirwere chetachiona chinopedza simba, chinonzi hyperthyroidism, chakave chakataurwawo. Zvose zviri zviviri zvinogona kutarisirwa ne-endocrinologist uye kuongororwa kuburikidza nekuongororwa kweropa, zvikurukuru chirosi inokurudzira hormone (TSH) yeropa rekuongorora. Hypothyroidism inoda kurapwa nehomoni inonzi thyroid, inonzi Synthroid (levothyroxine).
Mukuwedzera kune hypothyroidism, chimwe chinetso chinowanzoguma chekupedzisira chinogona kukura somugumisiro wekutora checkpoint inhibiting immunotherapy ndiyo hypophysitis, iyo kuputika kweplandishi gland-inonzi sa tenzi gland nokuti inodurura mahomoni mazhinji mumuviri.
Hypophysitis inogona kukonzera kuneta uye kuora musoro uye kuongorora ropa kunoratidzira huwandu hutachiona hwehomoni. Kufananidza miedzo kunogonawo kuratidza kuzvimba kwechigamba chepituitary. Kana akaonekwa nokukurumidza zvakakwana, high-dose corticosteroids inogona kugadzirisa kuputika pasi zvakakwana kudzivirira kudiwa kwemaawa akawanda kwenguva refu mishonga yemishonga.
Kana zvipembenene zvakanyanya, munhu angava nekuderera kwemhepo, kushaya mvura, uye zvinetso zve electrolyte zvakadai sepamusoro pepamasiyamu mazinga uye nemaitiro echepasi eropa muropa. Ichi ndicho chirwere chekurapa chinotarisirwa uye chinoda kuti munhu apinde muchipatara uye agamuchire corticosteroids.
Pakupedzisira, chirwere chechirwere cheshuga chinonzi diabetes hachina kumbobatanidzwa nekutora PD-1 inhibitor. Ichi ndicho chiremba vanachiremba vanowanzotarisa glucose (shuga muropa renyu) pavanotanga kurapa.
Rarer Toxicities
Imwe immunotherapy inogonawo kuita kuti kuputira mupapu, uye izvi zvinonzi pneumonitis, kunyange zvazvo isingawanzoitiki, kana ichienzaniswa nezvinoitwa zvakataurwa pamusoro apa. Izvi zvinokonzera kushungurudza kune vanhu vane kenza yemapapu yakakurumbira inotapira immunotherapy, sezvo mapapu avo akatove asina kukonzerwa nekenza. Zvinogona kukonzera zviratidzo zvakadai sekukanda kana matambudziko ekufema.
Kunyange zvazvo kazhinji kusinganzwisisiki kwakashata, pneumonitis inogona kuisa upenyu pangozi. Kana uchifungidzirwa, chiremba wako achabvisa zvimwe zvinokonzera mapapu kuvhiringidzika semapiritsi emapapu (anonzi pneumonia) kana kufambira mberi kwekenza. Chiremba achawanzogadzira CT scan yebhokisi kuti ibatsire pakuongorora.
Mushonga unowanzosanganisira kuvhara immunotherapy kwenguva yakatarwa apo munhu ari kutarisa pedyo nemapapu avo. Corticosteroids inowanzopiwa, uye mumatambudziko akaoma, immunosuppressant like Remicade (infliximab) inogona kudikanwa kana munhu asingaiti nani nesteroid.
Pakupedzisira, mamwe maitiro asingasviki anokonzerwa nemasikirwo akazvidzivirira ezvirwere akataurwa sehutano kana maziso eziso. Muchiitiko ichi, chiremba wako achakutumira kune imwe nyanzvi, nyanzvi yezvehutano kana ophthalmologist , kuitira chirwere chakakodzera uye chirongwa chekurapa.
Shoko Rinobva
Kana iwe kana munhu waunoda ari kutora checkpoint inhibitor, zvakanaka kuti uve nezivo pamusoro pezvinokonzera zvakasiyana-siyana zvinosangana nazvo, sezvo zvakasiyana kune avo vanobatana nemagariro echechi.
Mune mamwe mazwi, zviratidzo zvisinganzwisisiki uye zviratidzo zvemigumisiro iyi yakaipa ndeyanove inodikanwa kune vanachiremba vane kenzawo. Kunyange zvakadaro, usatye kubva kwavari. Panzvimbo pezvo, dzidza uye iwe wakangwarira, sezvo vakawanda vachagadzirisa kana vakaonekwa nokukurumidza.
> Sources:
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> Linardou H, Gogas H. Toxicity management of immunotherapy kune varwere vane metastatic melanoma. Ann Transl Med . 2016 Jul; 4 (14): 272.
> Micho JM et al. Zviitiko zvakashata zvakasangana nemushumo nehutachiona hunokonzera kudzivirirwa: kuongorora kukuru. Eur J Cancer . 2016 Feb; 54: 139-48.
> Posto M, Wolchok J. Toxicities yakabatana ne checkpoint inhibitor immunotherapy. Mu: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, Amin A. Immune checkpoint inhibitors mumakiriniki: chiitiko chekuchengetedzwa kwezvirwere zvehutachiona. Shandura Lung Cancer Res . 2015 Nha. 4 (5): 560-75.