Zomwe Muyenera Kudziwa Zokhudza Matenda a Immunotherapy Opambana a Melanoma

Zamkati

• Chidule
• Mitundu ya immunotherapy
• Zoletsa zoletsa
• Mankhwala a Cytokine
• Mankhwala a Oncolytic virus
• Kuchita bwino kwa immunotherapy
• Ipilimumab (Yervoy)
• Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
• Nivolumab + ipilimumab (Opdivo + Yervoy)
• Ziphuphu
• Talimogene laherparepvec (Wopanda nzeru)
• Zotsatira zoyipa za immunotherapy
• Mtengo wa immunotherapy
• Mayesero azachipatala
• Zosintha m'moyo
• Chiwonetsero

Chidule

Ngati muli ndi khansa yapakhungu ya khansa ya khansa ya pakhungu, dokotala wanu angakupatseni chithandizo chamankhwala. Chithandizo chamtundu woterechi chitha kuthandiza kulimbikitsa chitetezo cha mthupi lanu polimbana ndi khansa.

Mitundu ingapo ya mankhwala a immunotherapy ilipo yothandizira khansa ya khansa. Nthawi zambiri, mankhwalawa amaperekedwa kwa anthu omwe ali ndi gawo lachitatu kapena gawo lachinayi khansa ya khansa. Koma nthawi zina, dokotala akhoza kukupatsani mankhwala a immunotherapy kuti muchepetse khansa yapakhungu yaposachedwa.

Pemphani kuti mudziwe zambiri zamomwe immunotherapy ingathandizire pochiza matendawa.

Mitundu ya immunotherapy

Kuti mumvetsetse kuchuluka kwa ma immunotherapy, ndikofunikira kusiyanitsa mitundu yosiyanasiyana yomwe ikupezeka. Pali magulu atatu akuluakulu a immunotherapy omwe amagwiritsidwa ntchito pochiza khansa ya khansa:

• zoletsa kufufuzira
• mankhwala a cytokine
• oncolytic kachilombo mankhwala

Zoletsa zoletsa

Checkpoint inhibitors ndi mankhwala omwe angathandize chitetezo cha mthupi lanu kuzindikira ndikupha maselo a khansa ya khansa ya khansa.

Food and Drug Administration (FDA) yavomereza mitundu itatu ya zoletsa pochiza khansa yapakhungu:

• ipilimumab (Yervoy), yomwe imatchinga poyang'anira mapuloteni a CTL4-A
• pembrolizumab (Keytruda), yomwe imatchinga mapuloteni oyang'anira PD-1
• nivolumab (Opdivo), yomwe imatchinga PD-1

Dokotala wanu akhoza kukupatsani choletsa chimodzi kapena zingapo zowunikira ngati muli ndi gawo lachitatu kapena khansa ya 4 yomwe singachotsedwe ndi opaleshoni. Nthawi zina, amatha kupatsidwa zida zoletsera palimodzi ndi opaleshoni.

Mankhwala a Cytokine

Kuchiza ndi ma cytokines kumatha kuthandizira chitetezo chamthupi ndikulimbikitsa kuyankha kwake ku khansa.

A FDA avomereza mitundu itatu ya cytokines yothandizira khansa ya khansa:

• interferon alfa-2b (Intron A)
• pegylated interferon alfa-2b (Sylatron)
• interleukin-2 (aldesleukin, Proleukin)

Interferon alfa-2b kapena pegylated interferon alfa-2b imaperekedwa pambuyo poti khansa ya khansa yachotsedwa ndi opaleshoni. Izi zimatchedwa chithandizo chothandizira. Zingathandize kuchepetsa mwayi wobwerera khansa.

Proleukin amagwiritsidwa ntchito kwambiri pochiza khansa ya melanoma yomwe yafalikira.

Mankhwala a Oncolytic virus

Mavairasi a Oncolytic ndi ma virus omwe asinthidwa kuti apatsire ndikupha ma cell a khansa. Zitha kupanganso chitetezo chamthupi mwanu kuti chiwononge maselo a khansa mthupi lanu.

Talimogene laherparepvec (Imlygic) ndi kachilombo ka oncolytic komwe kaloledwa kuvomereza khansa ya khansa. Amadziwikanso kuti T-VEC.

Imlygic amalembedwa asanachite opareshoni. Izi zimatchedwa chithandizo cha neoadjuvant.

Kuchita bwino kwa immunotherapy

Immunotherapy itha kuthandiza kutalikitsa moyo mwa anthu ena omwe ali ndi siteji 3 kapena siteji 4 ya khansa ya khansa - kuphatikiza anthu ena omwe ali ndi khansa ya khansa yomwe singachotsedwe ndi opaleshoni.

Pamene khansa ya khansa siingathe kuchotsedwa opaleshoni, imadziwika kuti khansa ya khansa yosasunthika.

Ipilimumab (Yervoy)

Pamawonekedwe omwe adasindikizidwa mu 2015, ofufuza adalemba zotsatira za kafukufuku 12 wakale pa checkpoint inhibitor Yervoy. Adapeza kuti mwa anthu omwe ali ndi gawo lachitatu losavomerezeka la khansa ya melanoma, 22% ya odwala omwe adalandira Yervoy anali amoyo patatha zaka zitatu.

Komabe, kafukufuku wina wapeza phindu locheperako mwa anthu omwe amathandizidwa ndi mankhwalawa.

Ofufuza kuchokera ku kafukufuku wa EURO-VOYAGE atayang'ana zotsatira za chithandizo mwa anthu 1,043 omwe ali ndi khansa yapakhungu yapamtima, adapeza kuti 10.9% omwe adalandira Yervoy adakhala zaka zosachepera 3. Anthu asanu ndi atatu pa zana alionse omwe adalandira mankhwalawa adapulumuka kwa zaka 4 kapena kupitilira apo.

Pembrolizumab (Keytruda)

Kafukufuku akuwonetsa kuti chithandizo ndi Keytruda chokha chitha kupindulitsa anthu ena kuposa chithandizo ndi Yervoy yekha.

Mu, asayansi anayerekezera mankhwalawa mwa anthu omwe ali ndi gawo losazengereza 3 kapena siteji 4 ya khansa ya khansa. Adapeza kuti 55% ya omwe adalandira Keytruda adapulumuka kwa zaka zosachepera ziwiri. Poyerekeza, 43% ya omwe amathandizidwa ndi Yervoy adapulumuka zaka 2 kapena kupitilira apo.

Olemba kafukufuku waposachedwa akuti zaka zisanu zapakati pazopulumuka mwa anthu omwe ali ndi khansa yapakhungu yoopsa yomwe amathandizidwa ndi Keytruda anali 34%. Adapeza kuti anthu omwe adalandira mankhwalawa amakhala zaka pafupifupi ziwiri pafupifupi.

Nivolumab (Opdivo)

Kafukufuku apezanso kuti chithandizo ndi Opdivo chokha chitha kuwonjezera mwayi wopulumuka kuposa chithandizo ndi Yervoy yekha.

Ofufuzawa atayerekezera mankhwalawa ndi anthu omwe ali ndi gawo lachitatu losavomerezeka la melanoma, adapeza kuti anthu omwe adalandira Opdivo okha adapulumuka kwa zaka pafupifupi zitatu. Anthu omwe amathandizidwa ndi Yervoy okha adapulumuka kwa pafupifupi miyezi pafupifupi 20.

Kafukufuku omwewo adapeza kuti zaka 4 zomwe zidapulumuka zinali 46 peresenti mwa anthu omwe amathandizidwa ndi Opdivo okha, poyerekeza ndi 30% mwa anthu omwe amathandizidwa ndi Yervoy okha.

Nivolumab + ipilimumab (Opdivo + Yervoy)

Zina mwa zotsatira zabwino kwambiri zamankhwala kwa anthu omwe ali ndi khansa ya khansa yosasunthika yapezeka mwa odwala omwe amathandizidwa ndi Opdivo ndi Yervoy.

Pakafukufuku wowerengeka wofalitsidwa mu Journal of Clinical Oncology, asayansi apeza kuti zaka 3 zapulumuka pafupifupi 63% mwa odwala 94 omwe amathandizidwa ndi mankhwalawa. Odwala onse anali ndi gawo 3 kapena siteji 4 ya khansa ya khansa yomwe sinathe kuchotsedwa ndi opaleshoni.

Ngakhale ofufuza adalumikiza kuphatikiza kwa mankhwalawa ndikuwongolera kupulumuka kwa moyo, apezanso kuti zimayambitsa zovuta zoyipa pafupipafupi kuposa mankhwala okha.

Kafukufuku wokulirapo pamankhwala othandizira awa amafunika.

Ziphuphu

Kwa anthu ambiri omwe ali ndi khansa ya khansa, phindu lomwe angalandire ndi mankhwala a cytokine limawoneka ngati locheperako poyerekeza ndi omwe amatenga malo ochezera. Komabe, odwala ena omwe samvera bwino mankhwala ena atha kupindula ndi mankhwala a cytokine.

Mu 2010, ofufuza adafufuza kafukufuku wa interferon alfa-2b pochiza siteji yachiwiri kapena yachitatu ya khansa ya khansa. Olembawo adapeza kuti odwala omwe amalandira milingo yayikulu ya interferon alfa-2b atachitidwa opaleshoni anali ndi ziwopsezo zochepa zopulumuka popanda matenda, poyerekeza ndi omwe sanalandire mankhwalawa. Anapezanso kuti odwala omwe amalandila interferon alfa-2b atachitidwa opaleshoni anali ndi ziwerengero zochepa zopulumuka.

Kafukufuku wa pegylated interferon alfa-2b adapeza kuti m'maphunziro ena, anthu omwe ali ndi gawo 2 kapena gawo lachitatu la khansa ya khansa omwe adalandira mankhwalawa atachitidwa opaleshoni anali ndi ziwonetsero zambiri zopitilira kubwereza. Komabe, olembawo adapeza umboni wochepa wosintha kwamitundu yonse.

Malinga ndi kuwunikanso kwina, kafukufuku apeza kuti khansa ya khansa imayamba kupezeka pambuyo pothandizidwa ndi mankhwala a interleukin-2 mwa 4 mpaka 9 peresenti ya anthu omwe ali ndi khansa ya khansa yosalephera. Mwa anthu ena 7 mpaka 13 peresenti, kuchuluka kwa interleukin-2 kwawonetsedwa kuti kumachepetsa zotupa za khansa ya khansa.

Talimogene laherparepvec (Wopanda nzeru)

Kafukufuku woperekedwa pamsonkhano wa 2019 European Society for Medical Oncology akuwonetsa kuti kupatsa Imlygic musanachotse khansa ya khansa kumatha kuthandiza odwala ena kukhala ndi moyo wautali.

Kafukufukuyu anapeza kuti pakati pa anthu omwe ali ndi khansa ya khansa yapamtima yomwe idachitidwa opaleshoni yokha, 77.4% adapulumuka kwazaka ziwiri. Mwa omwe adachitidwa opareshoni kuphatikiza Imlygic, 88.9% adapulumuka kwa zaka zosachepera ziwiri.

Kafufuzidwe kafukufuku amafunika pazomwe zingachitike chifukwa cha mankhwalawa.

Zotsatira zoyipa za immunotherapy

Immunotherapy imatha kuyambitsa zovuta zina, zomwe zimasiyana kutengera mtundu wa mankhwala omwe mumalandira.

Mwachitsanzo, zovuta zomwe zingachitike ndi monga:

• kutopa
• malungo
• kuzizira
• nseru
• kusanza
• kutsegula m'mimba
• zotupa pakhungu

Izi ndi zina mwa zovuta zoyipa zomwe immunotherapy imatha kuyambitsa. Kuti mudziwe zambiri pazomwe zingayambitse mankhwala ena opatsirana pogonana, lankhulani ndi dokotala wanu.

Zotsatira zoyipa za immunotherapy nthawi zambiri zimakhala zochepa, koma nthawi zina zimakhala zoyipa.

Ngati mukuganiza kuti mwina mukukumana ndi zovuta, dokotala wanu adziwe nthawi yomweyo.

Mtengo wa immunotherapy

Mtengo wakuthumba wa immunotherapy umasiyanasiyana, kutengera gawo lalikulu pa:

• mtundu ndi mlingo wa immunotherapy womwe mumalandira
• ngati muli ndi inshuwaransi yazaumoyo kapena ayi
• ngati mukuyenera kulandira mapulogalamu othandizira odwala
• kaya mumalandira chithandizocho ngati gawo la kuyesa kwachipatala

Kuti mudziwe zambiri za mtengo wamankhwala omwe mungakonde, lankhulani ndi dokotala, wamankhwala, komanso wothandizira inshuwaransi.

Ngati mukuvutika kuti mupeze ndalama zothandizira, dziwitsani gulu lanu lazachipatala.

Angakulimbikitseni kusintha kwa dongosolo lanu la mankhwala. Kapenanso atha kudziwa za pulogalamu yothandizira yomwe ingakuthandizireni kulipirira zosowa zanu. Nthawi zina, atha kukulimbikitsani kuti mulowe nawo mayeso azachipatala omwe angakuthandizeni kuti mupeze mankhwalawa kwaulere mukamachita nawo kafukufuku.

Mayesero azachipatala

Kuphatikiza pa chithandizo chamankhwala omwe avomerezedwa kuchiza khansa ya khansa, asayansi pano akuphunzira njira zina zoyeserera za immunotherapy.

Ofufuza ena akupanga ndikuyesa mitundu yatsopano ya mankhwala a immunotherapy. Ena akuphunzira za chitetezo ndi kuphatikizika kwa mitundu ingapo ya immunotherapy. Ofufuza ena akuyesera kupeza njira zophunzirira odwala omwe angapindule nawo ndi mankhwala.

Ngati dokotala akuganiza kuti mungapindule mukalandira chithandizo chamankhwala kapena kuchita nawo kafukufuku wofufuza za immunotherapy, atha kukulimbikitsani kuti mulowe nawo kuchipatala.

Musanalembetse mayesero aliwonse, onetsetsani kuti mukumvetsetsa zabwino zomwe zingachitike komanso zoopsa zake.

Zosintha m'moyo

Pofuna kukuthandizani kuti mukhale ndi thanzi labwino komanso thanzi lanu mukamalandira chithandizo chamankhwala kapena matenda ena a khansa, dokotala akhoza kukulimbikitsani kuti musinthe zina ndi zina pamoyo wanu.

Mwachitsanzo, akhoza kukulimbikitsani kuti:

• sinthani zizolowezi zanu kuti mugone mokwanira
• sungani zakudya zanu kuti mupeze michere yambiri kapena zopatsa mphamvu
• sinthani zizolowezi zanu kuti muzichita masewera olimbitsa thupi, osakhoma msonkho kwambiri
• sambani m'manja ndikuchepetsa kupezeka kwanu kwa odwala kuti muchepetse chiopsezo chotenga matenda
• khalani ndi njira zopewera kupsinjika ndi kupumula

Nthawi zina, kusintha zizolowezi zanu zatsiku ndi tsiku kungakuthandizeni kuthana ndi zovuta zamankhwala. Mwachitsanzo, kupuma mokwanira kungakuthandizeni kuchepetsa kutopa. Kusintha kadyedwe kungakuthandizeni kuthana ndi mseru kapena kusowa kwa njala.

Ngati mukufuna thandizo kuti musinthe momwe mumakhalira kapena kuwongolera zoyipa zamankhwala, adokotala angakutumizireni kwa akatswiri kuti akuthandizeni. Mwachitsanzo, katswiri wa kadyedwe angakuthandizeni kusintha kadyedwe kanu.

Chiwonetsero

Maganizo anu ndi khansa ya khansa ya khansa ya khansa imadalira pazinthu zambiri, kuphatikizapo:

• thanzi lanu lonse
• siteji ya khansa yomwe muli nayo
• kukula, kuchuluka, ndi malo am'matumbo mwanu
• mtundu wa chithandizo chomwe mumalandira
• momwe thupi lanu limayankhira mankhwala

Dokotala wanu akhoza kukuthandizani kuti mudziwe zambiri za matenda anu komanso malingaliro anu kwanthawi yayitali. Angakuthandizeninso kumvetsetsa zosankha zanu zamankhwala, kuphatikizapo zomwe chithandizo chingakhale nacho kutalika ndi moyo wanu.