Zomwe Muyenera Kudziwa Zokhudza Kuyesedwa Kwachibadwa Kwa Khansa Yam'mapapo

Zamkati

• Kodi kusintha kwa majini ndi chiyani?
• Kodi pali mitundu ingati ya NSCLC?
• Kodi ndiyenera kudziwa chiyani za kuyesa kwa majini?
• Kodi kusintha kumeneku kumakhudza bwanji chithandizo?
• EGFR
• Kufotokozera: EGFR T790M
• ALK / EML4-ALK
• Mankhwala ena

Khansara yaying'ono yamapapo yam'mapapo (NSCLC) ndi mawu oti mkhalidwe womwe umayambitsidwa ndimitundu yambiri m'mapapu. Kuyesedwa kwa kusintha kosiyanaku kumatha kukhudza zisankho zamankhwala ndi zotsatira zake.

Pitilizani kuwerenga kuti muphunzire za mitundu yosiyanasiyana ya NSCLC, komanso mayeso ndi chithandizo chomwe chilipo.

Kodi kusintha kwa majini ndi chiyani?

Kusintha kwa majini, atengera kubadwa kapena kutengera, kumathandizira pakukula kwa khansa. Zosintha zambiri zomwe zidachitika mu NSCLC zadziwika kale. Izi zathandiza ochita kafukufuku kupanga mankhwala omwe amalimbana ndi kusintha kwina.

Kudziwa kusintha komwe kumayendetsa khansa yanu kumatha kupatsa dokotala malingaliro a momwe khansara idzakhalire. Izi zitha kuthandiza kudziwa kuti ndi mankhwala ati omwe angakhale othandiza. Ikhozanso kuzindikira mankhwala amphamvu omwe sangathe kukuthandizani.

Ichi ndichifukwa chake kuyesa kwa majini pambuyo poti NSCLC yapezeka ndikofunikira kwambiri. Zimathandizira kusintha kwamankhwala anu.

Chiwerengero cha chithandizo cha NSCLC chikukulirakulirabe. Titha kuyembekeza kuwona kupita patsogolo kambiri pomwe ofufuza amapeza zambiri zakusintha kwamtundu wamtundu komwe kumapangitsa NSCLC kupita patsogolo.

Kodi pali mitundu ingati ya NSCLC?

Pali mitundu iwiri ikuluikulu ya khansa ya m'mapapo: khansa yaying'ono yamapapo yam'mapapo komanso khansa yaying'ono yamapapo yamapapo. Pafupifupi 80 mpaka 85 peresenti ya khansa yonse yam'mapapo ndi NSCLC, yomwe imatha kugawidwa m'magulu ang'onoang'ono awa:

• Adenocarcinoma
  imayamba m'maselo achichepere omwe amatulutsa ntchofu. Subtype iyi imapezeka mu
  mbali zakunja zam'mapapo. Zimakonda kuchitika nthawi zambiri mwa akazi kuposa amuna komanso
  mwa achinyamata. Imakhala khansa yomwe ikukula pang'onopang'ono, ndikupangitsa kuti ichuluke
  kupezeka koyambirira.
• Wopusa
  ma carcinomas yambani m'maselo athyathyathya omwe amayenda mkati mwamayendedwe apandege
  m'mapapu anu. Mtunduwu uyenera kuti uyambira pafupi ndi mseu waukulu wopita pakati
  wa m'mapapu.
• Zazikulu
  ma carcinomas imatha kuyamba paliponse ndipo imatha kukhala yankhanza.

Mitundu yochepa yodziwika bwino imaphatikizapo adenosquamous carcinoma ndi sarcomatoid carcinoma.

Mukadziwa mtundu wanji wa NSCLC womwe muli nawo, gawo lotsatira nthawi zambiri limakhala kuti mudziwe zosintha zomwe zingachitike.

Kodi ndiyenera kudziwa chiyani za kuyesa kwa majini?

Mukamayambitsa biopsy yanu yoyamba, wodwala wanu anali akuyang'ana kupezeka kwa khansa. Mitundu yofananira ya biopsy yanu itha kugwiritsidwa ntchito poyesa majini. Mayeso achibadwa amatha kuwunika pazosintha mazana.

Izi ndi zina mwazomwe zasintha kwambiri ku NSCLC:

• EGFR
  zosintha zimachitika pafupifupi 10 peresenti ya anthu omwe ali ndi NSCLC. Pafupifupi theka la anthu omwe ali ndi NSCLC omwe sanasutebe
  amapezeka kuti ali ndi kusintha kumeneku.
• Kufotokozera: EGFR T790M
  ndi kusiyana kwa mapuloteni a EGFR.
• KRAS
  masinthidwe amakhudzidwa pafupifupi 25% ya nthawiyo.
• ALK / EML4-ALK
  kusintha kumapezeka pafupifupi 5% mwa anthu omwe ali ndi NSCLC. Zimakonda
  imakhudza achichepere komanso osasuta, kapena osuta pang'ono omwe ali ndi adenocarcinoma.

Zosintha zochepa zodziwika bwino zokhudzana ndi NSCLC ndizo:

• WOKHULUPIRIRA
• HER2 (ERBB2)
• MEK
• MET
• Bwezeretsani
• ROS1

Kodi kusintha kumeneku kumakhudza bwanji chithandizo?

Pali mankhwala osiyanasiyana a NSCLC. Chifukwa si NSCLC yonse yomwe imafanana, chithandizo chikuyenera kuganiziridwa mosamala.

Kuyesedwa kwama molekyulu kumatha kukuwuzani ngati chotupacho chili ndi kusintha kwamasamba kapena mapuloteni. Njira zochiritsira zakonzedwa kuti zithetse mawonekedwe a chotupacho.

Izi ndi njira zina zochiritsira za NSCLC:

EGFR

EGFR inhibitors amaletsa chizindikirocho kuchokera ku mtundu wa EGFR womwe umalimbikitsa kukula. Izi zikuphatikiza:

• afatinib (Gilotrif)
• erlotinib (Tarceva) Chizindikiro
• Malangizo (Iressa)

Awa onse ndi mankhwala akumwa. Kwa NSCLC yotsogola, mankhwalawa amatha kugwiritsidwa ntchito paokha kapena ndi chemotherapy. Pamene chemotherapy sikugwira ntchito, mankhwalawa amatha kugwiritsidwabe ntchito ngakhale mulibe kusintha kwa EGFR.

Necitumumab (Portrazza) ndi choletsa china cha EGFR chomwe chimagwiritsidwa ntchito pa cell squamous cell NSCLC. Amapatsidwa kudzera mu kulowetsedwa kwa intravenous (IV) kuphatikiza ndi chemotherapy.

Kufotokozera: EGFR T790M

EGFR inhibitors amachepetsa zotupa, koma mankhwalawa amatha kusiya kugwira ntchito. Izi zikachitika, dokotala wanu amatha kuyitanitsa chotupa chowonjezera kuti awone ngati mtundu wa EGFR wapanga kusintha kwina kotchedwa T790M.

Mu 2017, US Food and Drug Administration (FDA) kupita ku osimertinib (Tagrisso). Mankhwalawa amathandizira NSCLC yapamwamba yokhudza kusintha kwa T790M. Mankhwalawa anapatsidwa chilolezo chofulumira mu 2015. Chithandizochi chikuwonetsedwa pomwe EGFR inhibitors sakugwira ntchito.

Osimertinib ndi mankhwala akumwa omwe amamwa kamodzi patsiku.

ALK / EML4-ALK

Mankhwala omwe amalimbana ndi mapuloteni achilendo a ALK ndi awa:

• alectinib (Alecensa)
• brigatinib (Alunbrig)
• cholembera (Zykadia)
• crizotinib (Xalkori)

Mankhwalawa amatha kugwiritsidwa ntchito m'malo mwa chemotherapy kapena chemotherapy atasiya kugwira ntchito.

Mankhwala ena

Njira zina zochiritsira ndi izi:

• BRAF: dabrafenib (Tafinlar)
• MEK: trametinib (Mekinist)
• ROS1: crizotinib (Xalkori)

Pakadali pano, palibe chithandizo chovomerezeka chovomerezeka pakusintha kwa KRAS, koma kafukufuku akupitilira.

Zotupa zimafunika kupanga mitsempha yatsopano kuti ipitilize kukula. Dokotala wanu akhoza kukupatsani mankhwala olepheretsa kukula kwa mitsempha yatsopano mu NSCLC, monga:

• bevacizumab (Avastin), yomwe itha kugwiritsidwa ntchito ndi kapena
  popanda chemotherapy
• ramucirumab (Cyramza), yomwe imatha kuphatikizidwa ndi
  chemotherapy ndipo amaperekedwa pambuyo poti mankhwala ena sakugwiranso ntchito

Mankhwala ena a NSCLC atha kukhala:

• opaleshoni
• chemotherapy
• cheza
• mankhwala ochepetsa ululu

Mayesero azachipatala ndi njira yoyesera chitetezo ndi kuyesayesa kwamankhwala oyeserera omwe sanalandiridwebe kuti agwiritsidwe ntchito. Lankhulani ndi dokotala wanu ngati mukufuna kudziwa zambiri zamayesero azachipatala a NSCLC.