Hazvingave zvakanaka here kana vanachiremba vachigona kutarisa kenza yenyu, tarisa mishonga yakasiyana-siyana yakasiyana-siyana iri kubuda, uye kutsunga pamusoro pezvinhu zvipi zvingaita kuti zvibudirire?
Kunyange zvazvo incologist inogona, mune dzakawanda mamiriro ezvinhu, ine zvishandiso zvakanaka uye deta kuronga uye kuenzanisa mishonga yakasiyana-siyana, ichangobva kubuda mishonga dzimwe nguva inogona kuva yakaoma kufanotaura, kana pasina chiitiko chechipatara.
Kufambira mberi muzivo kunobva kuchirwere chekuchirapa, umo vatori vanobvumirana kupinda muchidzidzo nemishonga yekutsvakurudza iyo yakaratidza chivimbiso; asi, sezvo izwi rokuti 'muedzo' rinoreva, kune nguva dzose kusava nechokwadi nezvekuti zvakanaka sei mushonga unozoita uye ndiani achazobatsirwa zvikuru-ndiko kuti, mapepa emhando ipi uye zvikamu zvipi zvekenza.
Chii Chinonzi Cancer Immunotherapy?
Cancer immunotherapy inorapwa inosanganisira dzimwe nhengo dzomuviri wezvirwere zvekudzivirira zvirwere. Mumwe muenzaniso wekudzivirira muviri ndiyo kushandiswa kwemasango anonzi monoclonal anonzi rituximab uye obinutuzumab . Monoclonal antibodies masimba anogadzirwa nevanhu, kana maitiro ezvirwere zvekudzivirira muviri. Izvi zvinorwisa zvirwere zvinogona kurwisa chikamu chaicho chekenza yechirwere mune izvo zvinozivikanwa sechirwere chinotarisirwa .
Dzimwe mhando dzekenza immunotherapy dzinosanganisira immune checkpoint inhibitors , iyo inotora mabheki 'kubva mumuviri wechirwere chekuzvidzivirira kuti avabatsire kuziva nekurwisa masero emukenza.
Nyika yekenza immunotherapy haisi iyo inongogumira mienzaniso iri pamusoro apa, zvisinei, uye pfungwa itsva dzekushandisa muviri wako pomuviri wechirwere kuti urwe nemasero emukenza unoramba uchivandudzwa nekuedzwa.
Izvo Immunotherapy Inoshanda Kwose Kenza Here?
Munhu mumwe nomumwe akasiyana, uye kenza yemunhu wese yakasiyana; kwete munhu wose anopindura nenzira imwechete kune imwecheteyo immunotherapy.
Kushandisa zvakajeka, izvo zvisati zvamboitika, izvo vanhu vangave vangazoita kune immunotherapy zvingave zvakakosha kubva kune dzimwe nzira dzakasiyana. Kune murwere, iyo inogona kuchengetedza nguva inokosha, iyo inogona kushandura muchipatara kubatsirwa.
Mune mamwe mazwi, haungapedzi nguva yako kana zviitiko zvinokonzera njodzi kuedza chimwe chinhu chingave chisinganyanyi kuitika kana paine 'pfuti huru' kana kuti kurapa kunobudirira kunowanikwa. Asi munhu angaziva sei rudzi urwu rwezvinhu zvisati zvaitika? Imwe nhau inoratidzira nzira yekuti oncologists uye vatsvakurudzi vekenza vari kuita sei izvi zvinotanga nechinhu chinonzi neoantigens.
Neoantigens: Achilles Achiri Kuporesa Here?
Makero eC Cancer anogona kunyengera. Vanowanzova nehuwandu hwekuchinja mune mazamu avo, mamwe acho angafananidza nekukwanisa kwavo kuita zvinhu zvakaipa izvo zvisizvo, masero ane utano haagoni. Zvimwe zvekuchinja uku zvinokonzera kusiyana kwepanyama mukati kana kune kunze kwemasero emukenza anogona kuonekwa nemusununguko wemuviri. Izvi zvikamu zvemasero emukenza izvo zvirwere zvemuviri zvisingagoni kuziva sevatorwa vanonzi "neoantigens."
Neo, zvinoreva zvitsva, nokuti dzinomuka dzichibva kumasero edu, dzisina hutano nekenza , kusiyana nemasikirini anogara aripo masayendisiti anowanzotaura nezvezvirwere zvinopararira, somuenzaniso.
Nguva dzose antigens inogona kuwanika kune kunze kwebhakitiriya, kana masero ane utachiona, semuenzaniso. Kusiyana neizvi, neoantigens yakafanana nemiragi tsvuku inogona kuratidza maitiro ezvirwere zvemuviri izvo masero edu ega ari kusvibisa.
Neoantigens inotungamirira kushandiswa kwemasero machena eropa anozivikanwa seT-seli -mauto ezvirwere zvemuviri. Masoja aya T-masero anobva achifamba nemidziyo yeropa, yakafanana nemigwagwa yeCobblestone yekare yeRoma, kuti asvike panzvimbo yezviremera zvisingaregi masero, kupinda mukati mechirwere uye kubatsira kubvisa chizvarwa chemukati chemasero akaipa.
Saka, neoantigens imwe yeiyi dzekudzivirirwa kwezvirwere zvekuchengetedza kenza.
Izvozvo zvakati, kukunda hondo yacho kazhinji kunosanganisira immunotherapy chete, uye imwe nzira yakatsva-nyika yekutaura inowanzodiwa; immunotherapy inowanzoshandiswa pamwe chete ne cytotoxic chemotherapy uye / kana kuti mamwe emunotherpies, zvichienderana nekurwara uye murwere mumwe nomumwe .
Will Immunotherapy Ichandishandira?
Uyu mubvunzo unokosha mumazuva ano oncology, uye umwe uri kushanda nesimba. Kusvika pakuguma ikoko, maitiro maviri emakirini emukenza anogona kubatsira vanachiremba kuti vataure kuti ma immunotherapies anowanikwa sei achashanda: TMB neMSI.
Kunyorera mutsika mutoro, kana TMB , kunogona kufungidzirwa sehurukuro yezvose izvo zvinoshanduka mumagenene mumasero emukenza anenge aenda-awry-genes, somuenzaniso, ayo akashandiswa kupora zvinhu zvose zvinowanzoshandiswa nesero-asi iyo vane kuchinja kana kuchinja mamiriro ezvinhu emasero ekenza. TMB dzimwe nguva inowanzonziwo sekutakura mutengo mutengo kana kutenderera mutoro.
Mishonga inenge yakakwirira TMB inofungidzirwa kuva neoantigens yakawanda uye saka inogona kupindura zviri nani ku-immunotherapy. Makero eC Cancer anogona kuguma neTMB yakakwirira kuburikidza nekubudiswa kunobatanidzwa nekenza, kusanganisira fodya kana chiedza che UV. Imwe nzira ndeyokusagadzikana kwema microsatellite, kana kuti MSI , izwi remagetsi rinoreva chinetso nemitemo yemuviri yenyu yeDNA kugadzirisa-chinetso chinoguma nekuchinja kusina kuenzana nekudzokorora kweDNA gene sequence.
Imwe kambani inonzi Foundation Medicine iko zvino inopa kutanga kuongororwa, kuongororwa kuongororwa kweTMB sechikamu cheStateOne testay, iyo inogona kubatsira kufanotaura kuti munhu angapindura sei kune immunotherapy.
"Maitiro evanhu vanokanganisa ndiwo anowanzobatwa nekenza yose," anotsanangura kudaro Vincent Miller, MD, mukuru wezvehutano paState Medicine. "Mishonga ine nhamba yakanyanya yepamusoro yekuchinja-chinja inowanzoita kuti iite itsva, mapuroteni asina kuchena anonzi neoantigens. Mune masimba emuviri anoziva kuti maooantigens aya kune dzimwe nyika uye anoenderera mberi akangwarira, kutanga nhungamiro yakaoma yematanho ekurwisa tumarara. "
Izvo Zviratidzo Zvokudzivirira Zvirwere Inhibitor Zvindishandira Kwandiri Here?
Chirongwa chacho chinowedzera mune zvekuti mamwe kanzira yakagadzira nzira dzakanyanyisa dzekudzivirira zvirwere zvemuviri-kuburikidza nekuita mapuroteni anonyatsopedza mamwe maitiro ezvirwere zvemuviri wako. A biologic cloaking device , kana iwe uchida.
Kudzivirira kenza kuti irege kuzviputira nenzira iyi, mamwe mafungiro ezvirwere akagadzirirwa kuvhiringidza zvirwere izvi zvekudzivirira muviri. Aya immunotherapies, anonzi immune checkpoint inhibitors , anosanganisira avo vanonzi anti-PD1 uye anti-PDL1 antibodies . Uye, semamwe maitiro e-immunotherapy, kune uchapupu hunoratidza kuti hukuru hwakakosha hwevaooantigens mumasero ekenza hunobatanidza nekupindurwa kwakanaka kune immune checkpoint inhibitors.
Mhinduro yekuchechera inhibitor inopararira kubva inenge 20 muzana mumukenza wemapapu kusvika ku80 muHodgkin lymphoma. Chikonzero nei zvimwe zvipembenene zvichipindura kune chekuita inhibitors uye vamwe havasi pachena.
Zvakakosha Kufanotaura Kupinda Kwechipatara
Aya maitiro ekufananidzira uye kubudirira kwawo yaiva hurukuro yekukurukurirana pamusangano wegore rino weAmerican Society of Clinical Oncology, kana ASCO.
TMB yakaratidzwa kuti inofanotaura humwe huwandu hwekupindura uye nguva yakareba yekupindura kwekenza immunotherapies kune varwere vane kenza yemukaka, kenza yemapapu, melanoma nezvimwe zvinokonzera kanzira. Mukuwedzera kune TMB, FoundationOne inotarisa kusagadzikana kwema microsatellite, inomiririra kuedza imwechete kutungamirira matanho ekurapa kwezvinodiwa kurapwa, kliniki miedzo uye FDA-inogamuchirwa nekenza immunotherapies vachishandisa bhiopsy imwe chete.
"Cancer immunotherapies iri mberi kwekurapa kenza mutsva, uye nzira itsva, yehuwandu inoshandiswa inofanirwa kufanotaura zvipatara zvemugarire kune ichi chinokosha, asiwo inodhura, kirasi yezverapi," akadaro Dr. Miller.
"Kukwanisa kunyatsorongedza zviyero zvakasiyana-siyana panguva imwe chete, kusanganisira TMB uye MSI, inokosha zvakakosha kune munda wekenza immunotherapy, uye imwe yakasiyana neShealth Medicine," akadaro Thomas George, MD, GI mutungamiri wepurogiramu yezvecology, University of Florida . "Nheyo yeMishonga yekubatana kwemasangano epamusoro ekugadzirisa mapurisa uye yakanyatsoshandiswa-shanduko yekugadzirisa zvinhu kunondipa ruzivo rwezvinhu zvose zvakakosha zvema genomic biomarkers kuvarwere vangu panguva imwe chete, kubatsira kuchengetedza nguva dzose uye mhuka."
"Takakurudzirwa nezvakawanikwa pa ASCO, kusanganisira mikana yekuziva varwere vanokwanisa kubatsirwa ne checkpoint inhibitor immunotherapy," akadaro Dr. Miller. "Chinangwa chedu ndechokupa vanachiremba nevarwere huwandu hwakakwana hunoenderana, hune hutachiona hunozivikanwa, uye tinofara kupa mhinduro yedu yakasiyana yekufungidzira TMB uye MSI panguva imwechete uye nekururamisa kwakasiyana-siyana, inotsigirwa nehutano hwakanaka uye yakadzika mumashoko ekufananidzira kubva pasuzivo redu FoundationCORE. Ichi chinhu chisina imwe chizvarwa chinotevera chekuenzanisa chikwata chinopa. "
Kuzvimiririra kweS FoundationOne uye FoundationOne Heme assays, Foundation Medicine inopawo kuongororwa kwePP-1 neP-PD-L1 protein inotaura, kupa, pamwe chete neStartOne assays, chizere chakazara chekenza immunotherapy kuedza kwevecologists.
Shoko Rinobva
Kunyange zvazvo ichi chiri nzvimbo inovimbisa, sayenzi ichiri kukura uye kuedza kwakasiyana-siyana kuchiri kuongororwa uye kuvimbiswa. Zvose zvinoshandiswa pakurangarirwa kwechirongwa chekliniki kune chekuita inhibitor ndezvekupfupisa chete uye pane ikozvino hakuna maitiro aDAA anobvumirwa anokwanisa kufanotaura nenzira yakarurama mhinduro yekutarisa pfungwa inhibitors.
> Sources:
> Foundation Medicine inopa ruzivo rutsva pa ASCO 2016 kuratidza kuti FoundationOne inogona kubatsira kufanotaura kutarisana nekenza immunotherapy mumhando dzakasiyana-siyana dzekenza.
Ansell SM, Lesokhin AM, Borrello I, uye al. PD-1 Blockade naNivolumab mukudzorerwa kana kuti kugutsikana Hodgkin's Lymphoma. N Engl J Med. 2015; 372 (4): 311-319.
Pardoll DM. Kuvharwa kwezvirwere zvekudzivirira zvirwere mukenza immunotherapy. Nat Rev Cancer. 2012; 12 (4): 252-64.