Ikoko kune zvakawanda zvinotarisirwa nzira yekurapa zvinowanikwa
Mumakumi mashoma emakore apfuura, takadzidza kuti havasi vose vemazamu evanhu vemazamu akafanana. Mukuwedzera kumasiyana-siyana inogona kuonekwa pasi pe microscope, pane kusiyana pakati pekenza iyi pane imwe molecule. Mushure mokunge iwe uine biopsy kana chirwere iwe uchadzidza pamusoro pekuti kanhi yako yepamu iserogen receptor yakanaka kana progesterone receptor positive, pamwe neHER2 yako yehutano.
Kana iwe wakamboudzwa kuti kenza yako yepafu iHER2 yakanaka, zvinorevei? Ndezvipi zvirwere zvinoshanda zvakananga kune rudzi urwu rwekenza yepafu uye ndeapi mamwe marapirwo angashandiswa?
Kukurukura kweChirangarudzo Options
Vanhu vane HER2-positive mazamu echeperi angaporerwa nenzira yakafanana nevanhu vane HER2 nhengo dzisina kunaka mune dzimwe nzira. Somuenzaniso, kuvhiyiwa (zvichida lumpectomy kana mastectomy,) adjuvant chemotherapy, uye / kana hormonal therapy (kana chironda ichi chiri estrogen receptor positive) chingashandiswa.
Targeted therapies chaiyo yeHER2 mishonga yakakosha inoshandiswa uye yakasimudza mararamiro ehupenyu hweHER2-positive tumors. Nzira dzekurapa dzekutanga kwekutanga uye zvirwere zvemastasi zvinokurukurwa pasi apa.
Maitiro Akarongwa Namapano Anoshanda
Pakati pevamwe vanhu vatanhatu kana vatanhatu vane kenza yemazamu vachave nemamota ari HER2 / neu positive. Izvi zvinoreva kuti kenza yemukenza yemazamu ine kenza ine basa rinowedzera mumararamiro eHER2, izvo zvinoguma nekuwedzera kwehuwandu hweHER2 mapuroteni.
Aya mapurotini anoshandisa kuendesa kukura kwekenza yesero.
HER2 mazamu emapfupa akanaka anowanzova anonyanyisa, uye mumakore apfuura aive nemafungiro akaipa. Muna 1998 mishonga yekutanga yekutsvaga HER2 yakagamuchirwa. Iyi mishonga ndeye Herceptin (trastuzumab).
Kubvira panguva iyo imwe HER2 inotarirwa mishonga yakawanikwa.
Perjeta (pertuzumab) uye T-DM1 (trastuzumab emtansine) yakagamuchirwawo.
Muna 2017, mushonga weNerlynx (neratinib) wakabvumirwawo nevanhu vane mazera ekutanga eHER2-positive mazamu echechi achitevera kurapa naHercceptin. Apo neratinib (a tyrosine kinase inhibitor) yakawedzerwa kuongorori hutano hwekenza yemazamu mumusangano we2016, mhinduro dzakakwana dzakapfuura kune vanhu vaibatwa neHerceptin pamwe chete nehutano hwakanaka.
Tykerb (lapatinib) ndeimwe tyrosine kinase inhibitor inogona kushandiswa mushure mekurapwa naHerceptin kana mamwe maHER2 arapies.
Zvirwere Zvokutanga
Chirwere chekutanga-chetachiona cheHER2-positive kenza yepamu yakafanana neyeHER2-negative yekenza yemazamu, asi kazhinji inosanganisira kushandiswa kweHER2 zvinodhaka zvinodhaka zvakadai saHerceptin.
Zvimwe zvinosanganisira:
- Kuvhiya: Zvichida lumpectomy kana mastectomi inowanzokurudzirwa kubvisa tumarara. Kana chironda chacho chiri DCIS ( chigarire 0) kana kana chiine maitiro akanaka (maitiro ekuongorora maitiro kuti aone dambudziko rekudzoka), mamwe marapirwo angada kudiwa. Pamakumbo anenge ari makuru, uye kunyanya avo vane lymph nodes , adjuvant therapy inowanzokurudzirwa.
- Hormonal therapies: Kana chiremera chiriwo chestrogen receptor positive, hormonal remitambo inowanzokurudzirwa (inotevera chemotherapy mune avo vanozovawo nechikwata chemadhivant adjuvant). Kune vakadzi vanotungamirirwa naamai, chisarudzo chokutanga kazhinji tamoxifen, ne aromatase inhibitor yakarongedzwa kune vakadzi vari postmenopausal. Zvimwewo, kubvisa maawa ovarian, ovarian ablation, kana kazhinji, ovariectomy inogona kukurudzirwa kuti vakadzi ve premenopausal kuderedza eserogen mazinga uye kubvumira kushandiswa kwearomatase inhibitors.
- Chemotherapy: Zvichienderana nechikamu chekenza yemazamu, ukuru, ingave lymph node inobatanidzwa iripo, uye kuongorora mazita, chirongwa chemadhivant chemotherapy chinogona kukurudzirwa. Izvi zvinowanzotanga zvinenge mwedzi mushure mekunge lumpectomy kana mastectomy uye inopedzerwa kwemakore anenge mana kusvika matanhatu.
- HER2 inotarirwa mishonga: Sezvambotaurwa pamusoro apa, pane zvakawanda zvingasarudzwa zvekutarirwa kwemaHER2-positive mazamu emvere, kusanganisira Herceptin (trastuzumab), Perjeta (pertuzumab), uye T-DM1 (trastuzumab emtansine), nemimwe mishonga inoongororwa muchipatara miedzo. Kazhinji kazhinji, Herceptin inoshandiswa kutanga. Tykerb (lapatinib) inonzi tyrosine kinase inhibitor inoshanda yeHER2 matumbo akanaka. Nelynx (neratinib), imwe kinase inhibitor, yakanga ichangobva kugamuchirwa kuitira kurapwa kwekutanga-gwara reHER2-positive kenza yemazamu mushure mekurapwa naHerceptin.
- Radiation therapy: Kune vanhu vanosarudza lumpectomy, kurapwa kwemaawa kunowanzokurudzirwa mushure mekuvhiyiwa. Pamakumbo ane mana kana akawanda akawanda ane lymph nodes, chirwere chemaawa pashure pokunge mastectomy inowanzoonekwa. Tumha neyechitatu kusvika kune mitatu ine nhengo dzakasvibirira dzakanaka, uye zvakakosha kutaurirana neavo vezvechiremba oncologist uye mazairo oncologist pamusoro pezvinobvira zvinobatsira zvekurapa.
- Mishonga yemakiriniki: Kune dzakawanda zvipatara zvinowanzoenderera mberi zvichiratidza zvirongwa zvakasiyana-siyana zvekuvhiya, chemotherapy, uye remishonga yekurapa, uyewo kuenzanisa maitiro akasiyana-siyana ehurmoni uye HER2 anotarisirwa kurapwa. Kune ngano dzakawanda pamusoro pekuongororwa kwechiremba , asi dzimwe nguva chirwere chemakiriniki chinopa nzira yakanakisisa yekurapa. Zvakakosha kutaura nemumwe wako oncologist pamusoro pemakiriniki epiki angave akakodzera iwe.
- Bvudzi rinoshandiswa zvinodhaka: Munguva ichangopfuura, kuwedzerwa kwesafisphonate therapy kwave kuchionekwa pakutanga kwekenza yepabonde sezvo inogona kuderedza dambudziko remasasa magetsi mune ramangwana. Taura neo oncologist yako pamusoro peizvi.
Mishonga yeMatanho Akareba
Neyemastastatic (chigarire 4) kenza yemvere, zvirongwa zvehutano zvekudzivirira chirwere ichi kazhinji chinangwa chekurapa. Kuvhiya uye remishonga inonzi radiation inoonekwa semishonga yemunharaunda uye haigoni kushandiswa chete kunze kwezvinangwa (kuti kuderedza marwadzo uye / kana kudzivirira kuputika).
Kana chirwere chepachibereko cheHER2-positive chiri chekare chekare chepabonde chekare rekenza yemazamu, zvakakosha kuziva kuti HER2 chimiro (pamwe nemamiriro e-estrogen receptor) chinogona kuchinja. Chirevo chesaiti yemasitasisiti uye kudzokorora zvidzidzo zvekutambira zvinowanzokurudzirwa. Chirwere chakanga chiri pakutanga HER2 chingave chiri HER2 chakaipa pakudzoka uye zvakasiyana.
Chokutanga mishonga yekurapa yeHER2-positive kenza yemazamu inotarisana ichachengetedzwa pane izvi zvidzidzo zvekugamuchira. Kune avo vari HER2 akanaka, imwe yeHER2 inotarisirwa kurapwa inowanzoshandiswa. Kana chirwere chacho chiriwo chestrogen receptor positive, kana hormonal therapy, HER2 therapy, kana kuti zvose zvingafungidzirwa. Chemotherapy inogona kushandiswawo kwemwedzi inoverengeka.
Zvakakosha kucherechedza kuti chinangwa mukurapa kenza yepamuviri yemazamu inowanzosiyana yakadaro kune yekutanga kwekenza yepema, mune zvishoma sekurapa sezvinobvira kuitira kuti chirwere ichi chiwanzobvunzwa.
Kana chirwere chave chabatwa naHercceptin (trastuzumab) muchidimbu chechirongwa, mushure mekunge pasina nguva yekurapa (yakayerwa kubva kumagumo eti adjuvant trastuzumab) mushure memwedzi mitanhatu yakasarudzwa kwechipiri mutsara inowanzoitwa T-DM1 (ado -trastuzumab emtansine). Zvimwewo, kana chirwere chacho chave chave chabatwa naHerceptin muchirongwa chechirongwa, mushure mokunge pasina nguva yekurapwa kwemwedzi inopfuura mitanhatu Perjeta (pertuzumab) pamwe chete netrastuzumab uye taxane ingashandiswa.
Kune varwere vanopfuurira mushure metrastuzumab uye mutane mumamiriro ekusimudzira, T-DM1 ndiyo sarudzo yakasarudzwa. Kune varwere vakanga vasina kutarisirwa naHerceptin kare, kusanganiswa kwaHerceptin pamwe nePerjeta pamwe neatane kunofanira kushandiswa.
Kana kenza yakafambira mberi pasinei nemishonga iyi, kusanganiswa kweTykerb (lapatinib) uye Xeloda (capecitabine) inogona kuedzwa. Mimwe chemotherapi inotungamirirwa kana kuti inorapa zvirwere inogonawo kuedzwa.
HER2 kenza yakanaka yepamu inogona kupararira kune uropi uye chiropa kupfuura HER2 matumbo asina kunaka. Nenzira yakanaka, Herceptin, uye pamwe Perjeta inoita seyapfuura nepfungwa dzeropa reuropi uye kuderedza hukuru hwehupi hwemagetsi. Kune vanhu vane pfupa metastases, pfupa rinoshandiswa zvinodhaka zvakadai se-bisphosphonates haringangoderedza ngozi yeropa asi inogona kuwedzera kupona.
Kurapa Kunobatsira
Vanhu vazhinji vanobvunza nezvekugona kweimwe nzira dzokurapwa pavanenge vaonekwa kuti vane kenza yemazamu. Penguva ino, hapana maitiro "mamwe maitiro" akawanikwa akabudirira mukurapa kenza yemazamu. Pane kudaro, vamwe vanhu vakasarudza kurapwa uku kuregererwa kwehutano hwechirwere vakarasikirwa nemishonga inoratidzwa kuti inobudirira.
Asi zvakakosha kuti urege kukanda mwana kunze kwebhajiji. Pane hutano hutano hwakakosha hwekenza yakawanikwa kuti hubatsire vanhu kurarama nezviratidzo zvechirwere uye mishonga yekenza, kubva pakutya uye kuzvidya mwoyo kusvika pakuora mwoyo, kuparara kweuropathy , nekuwedzera. Mimwe yemishonga yakave yakadzidzwa zvakananga kuvakadzi vane kenza yemazamu inosanganisira yoga , kufungisisa , kuisa massage , uye kugadziriswa .
Prognosis
Pamberi peHER2 paine chinangwa cherapi, pakanga pasina hutano hwakananga hunowanika kune HER2 mishonga yakanaka, uye idzi dzaifungidzirwa kuti zvinodhaka zvekenza. Nekuuya kwechirwere chinotarisirwa, zvakadaro, izvi zvakachinja.
Chidzidzo che 2017 chakawana kuti vakadzi vane chirwere chetachiona cheHER2 chakanaka chepabonde chaive nekupfuura kwakanyanya kupfuura vakadzi vakanga vari HER2 zvisina kunaka apo kurapwa naHerceptin kwaishandiswa. Nhamba yepamusoro yekupukunyuka inowanzove yevakadzi vane katatu ine mvere yekenza yekenza.
Kuwana rubatsiro
Nenzira yakanaka, kuwedzerwa ruzivo nekubhadhara mari yekenza yemazamu kwave kukonzera kuwanda kwezvigadzirwa kubatsira vanhu kurarama nechirwere ichi. Masangano ekutsigira uye masangano ekutsigira anowanika kuvakadzi vane kenza yemazamu pamwe chete, uye kune avo vari kunyatsopikisana nekenza yemasita. Mharaunda yeIndaneti uye kunyange mapoka evanhu vevanhu vane HER2-positive kenza yepamu vakaungana pamwechete pavanotarisana nematambudziko avo akasiyana.
Kubatanidzwa mune zvemagariro evanhu kwakange kuri chinhu chekutsigira nekusimbisa kwevanhu vakawanda vane chirwere. Kana ukasarudza kuita izvi nenzira iyi, zvakadaro, tora nguva kuti udzidze kugovera rwendo rwako rwekenza pahutete zvakachengeteka.
Indaneti inzvimbo huru uye dzimwe nguva zvinogona kunge zvakaoma kuwana vanhu vari kutarisana nerwendo rwakadaro kune rako. Kuti ukwanise kushamwaridzana nevamwe vanogara, kana kurapa, kenza yemazamu, kushandisa hashtag #BCSM inobatsira zvikuru. BCSM inomirira kenza yepamusoro yehutano.
Shoko Rinobva
Munguva yakapfuura, kenza yeHER2-positive yakaonekwa sechirwere chinotyisa pasina mushonga chaiwo wawanikwa. Izvo zvose zvakashandurwa muna 1998 nekugamuchirwa kwekutanga HER2 inorapwa, Herceptin. Kubva panguva iyoyo, mamwe mishonga yakave yakabatanidzwa kusanganisira Perjeta, T-DM1, lapatinib, uye munguva ichangopfuura neratinib, nedzimwe mishonga iri kuongororwa mumakiriniki. HER2 inotarirwa mishonga inokwanisa kuderedza dambudziko rekudzoka pakutanga kwekutanga HER2-positive kenza yemazamu uye kuwedzera hupenyu hwehutachiwana muhutachiwana hweHER2-positive kanzvadzi yekamu.
Mukuwedzera kune HER2 zvakarongwa nemishonga, kurapwa kweHER2-positive kenza yemazamu inosanganisirawo kurapwa kweHER2 zvirwere zvisina kunaka zvakadai sokuvhiya, hormonal therapy (kana zvichibvira), chemotherapy, remishonga inonzi radiation, marapirwo akasiyana-siyana ekugadzirisa zvirwere, uye kukwanisa kwekurapa kwechiremba .
> Sources:
> Chan, A., Delaloge, S., Holmes, F. et al. Neratinib Mushure meTrastuzumab-Based Adjuvant Therapy muvarwere vane HER2-Positive Cancer Cancer (ExteNET): A Multicentre, Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial. Lancet Oncology . 17 (3): 367-77.
> Kast, K., Schoffer, O., Link, T. uye al. Trastuzumab uye Kuponeswa kwevarwere vane Metastatic Breast Cancer. Archives of Gynecology and Obstetrics . 2017. 296 (2): 303-312.
> Park, J., Liu, M., Yee, D. et al. Kugadzirisa Randomzation yeNeratinib muBrazil Early Breast Cancer. The New England Journal of Medicine . 2016. 375 (1): 11-22.