Arimidex, Femara, iyo Isbarbardhigga Aromasin iyo Saameynada Dhaawaca
Haddii aad dhammaysatay daaweynta asaasiga ah ee hore, hormoonka estrogen- kansarka naasaha ee jirrada, dhakhtarkaagu wuxuu u badan yahay inuu kugula taliyo daaweynta hormoonnada muddo 5 ilaa 10 sano ah. Doorashada daroogada waxay ku xiran tahay xaaladdaada menopausal, oo leh xayawaanka aromatase inta badan xulashada koowaad ee haweenka ragga ka dib iyo sidoo kale haweenka premenopausal oo ay weheliso daaweynta xakameynta ugxan-sidaha.
Waa maxay farqiga u dhexeeya Femara, Arimidex, iyo Aromasin, maxay yihiin dhibaatooyinka soo raaca ee aad filayso, iyo sidee ayay daawooyinkani uga duwan yihiin tamoxifen? Sidee ayay waxtar ugu yihiin inay ka hortagaan soo noqoshada kansarka naasaha?
Aromatase Inhibitors: Qeexitaan
Ka hortagga aromatase waa daawooyin joojiya soo saarida estrogen ee jirka. Marka sidaas la samaynayo, waxay yareeyaan halista kansarka naasaha (iyo kordhinta badbaadada) ee haweenka qaba kansarka naasaha hore ee hormoon-naqshadeeyaha ah ee hore iyo postmenopausal. Waxay sidoo kale hoos u dhigi karaan halista soo noqoshada dumarka qaarkood ee qaba kansarka naasaha ee premenopausal ka badan tamoxifen. Waxaa jira saddex daawo oo kala duwan oo ku saabsan daroogada.
Daaweynta ka hortagga aromatase waxaa la bilaabaa ka dib marka daaweynta asaasiga ah ee kansarka naasku ay dhammaato. Tani waxaa ka mid ah qaliinka kansarka naasaha iyo suurtogalka ah daaweynta kiimikada iyo / ama daaweynta shucaaca . Daaweyntu waxay socotaa 5 ilaa 10 sano iyada oo ay ku xiran tahay khatarta qofka ee soo noqnoqoshada iyo dulqaadashada saameynaha.
Hormoon Daaweynta Kansarka Naasaha
Kansarka naasaha ee ah oogada xajiinta ee estrogen ayaa asal ahaan lagu quudin karaa estrogen. Unugyada kansarka naasaha, sida unugyada naaska caadiga ah, waxay leeyihiin qabtayaasha estrogen dusha sare. Kansarka loo arko inay "positive" u tahay daaweeynta estrogen ama progesterone waa kuwan kuwa soo dhaweeyeyaasha estrogen ugu horreyn ka mas'uul ah koritaanka kansarka.
Doorka estrogen ee burooyinkaan waa in lagu xiro xayawaanka estrogen si loo kiciyo koritaanka iyo qaybinta unugyada.
Si loo yareeyo ama u joojiyo koritaanka unugyada kansarka naasaha, waxaan sidaas darteed u baahanahay hab lagu yareeyo estrogen ee jirka ama xannibaya qashinka loo yaqaan 'estrogen receptors' si markaas estrogen aan joogteyn karin.
Mechanisms of Hormonal Therapy: Tamoksifen iyo Aromatase Inhibitors
Ka hor inta aanad dhicin, ugxan-yari waa goobta ugu muhiimsan ee wax-soosaarka estrogen ee jirka. Tamoxifen daroogada ayaa ka shaqeynaya xayirista qanjidhada estrogen ee unugyada kansarka naasaha (iyo unugyada kale) sidaa daraadeed estrogen ma xirna karo. Tamoxifen waxay haysaa saameyn ka-hor-celinta qanjidhada qaybo ka mid ah jidhka sida naaska, laakiin saameynaha foosha-dheer ee dadka kale, sida lafaha (waxay yareyn kartaa lafaha luminta). Marka ugu horeysay ee la ansixiyo 1998, tamoxifen waxay ahayd aasaaska daaweynta hoormoonka ee hormoonnada kansarka naasaha muddo ka badan labaatameeyo sano.
Ka dib markii ay caado ka baxdo, ilaha ugu horreeya ee estrogen waa ka soo wareegidda isbedelka ah ee asrogens (hormoonada nooca lab ah ee laga helo unugyada baruurta) oo loo yaqaan 'estrogen'. Dareen-celintaas waxaa fududeynaya enzim oo loo yaqaano aromatase. Kaararka Aromatase waxay ka shaqeeyaan xannibaadda aromatase si aaney iyo kuwa loo celin karin estrogen ee jirka.
Tan iyo markii laga helo ilaha ugu horreeya ee estrogen ka hor intaan menopause ahayn ugxanuunada, ma aha isbedelka dhirta ee isrogens, aromatase xannibaadayaasha keligood ayaa waxtar u leh dumarka weli ku jira premenopausal (iyo haweeney weli waxay noqon kartaa menopausal xitaa haddii muddooyinkeeda ay ka tagto kiimoterapiyada).
Fahamka Aromatase Inhibitors: Arimidex, Femara, iyo Aromasin
Hadda waxaa jira saddex siyaabood oo aromatase kala duwan kuwaas oo loo ansixiyey yaraynta halista dib u soo noqoshada haweenka qaba marxaladda hore, hormoonka estrogen-kansarka naasaha. Kuwaas waxaa ka mid ah:
- Arimidex (aassozole)
- Femara (isrozole)
- Aromasin (tusaale ahaan)
Daawooyinkani waxay u muuqdaan inay si fiican u shaqeynayaan ka hortagga soo noqoshada laakiin waxay leeyihiin kala duwanaansho. Aromasin waa steroid, halka Arimidex iyo Femara aysan ahayn. Saddexda dawooyinka ee suntan ayaa sidoo kale u muuqda mid la mid ah.
Tamoxifen iyo Kansarka Naasaha
Waxaan leenahay xog aad u tiro badan waqtigan eegaya isticmaalka tamoxifen iyo halista kansarka naasaha . Guud ahaan, marka loo isticmaalo marxaladda hore, daawada estrogen-cilladaha wanaagsan, daawadu waxay yareysaa halista soo noqoshada qiyaastii boqolkiiba 50. Tamoxifen ayaa sidoo kale hoos u dhigaysa waxyeellada aad ku qaadi doonto buro kale oo ku jirta naaskaaga (haddii aad qabto lumpectomy) ama inaad kansar naas kale ku sameysid naaskaaga kale.
Aromatase Waxyeelayaasha iyo Kansarka Naasaha
Kaararka Aromatase waxay u muuqdaan inay yareeyaan khatarta soo noqoshada xitaa tamoxifen waxaana hadda loo tixgeliyaa daawooyinka ay doorbidaan haweenka postmenopausal ama kuwa horey u maraya iyo daaweynta xakameynta ugxan-sidaha.
Cusboonaysiiyay habraaca daaweynta hormoonka
Dumarka postmenopausal oo qaadaya aromatase inhibitor ah, tilmaamaha 2017 ayaa hadda kugula talinaya isticmaalka bosfonfonate Zometa (zoledronic acid) oo ay la socdaan aromatase inhibitor ah. Labada daawo ee isku jira ayaa isu muuqda si loo yareeyo khatarta kansarka naasaha ee ku faafta lafaha in ka badan kan ka hortagga aromatase oo keliya. Baro wax badan oo ku saabsan isticmaalka bisphosphonates ee kansarka naasaha hore .
Aromatase Inhibiters ee Haweenka Premenopausal ee Dumarka uurka leh
Su'aasha ah in haddii lagu daro daaweynta xakameynta ugxan-sidaha (iyadoo la adeegsanayo gonadotropins si ay caafimaad ahaan u keento cilladda) tamoxifen ayaa ah arrin ka mid ah doodda. Daraasad lagu daabacay Wargeyska New England Journal of Medicine ee 2015, si kastaba ha ahaatee, waxay u muuqataa inay muujinayso in haweenka uurka leh ee lagu daaweeyo daaweynta xakameynta ugxan-sidaha si ay u isticmaalaan aromatase inhibitor halkii ay ka heli lahaayeen tamoxifen waxay yeelan karaan heerar sii fiicnaanaya.
Daraasad kale oo lagu daabacay joornaal la mid ah 2014 ayaa lagu ogaaday in Aromasin (exemestane) ay la socoto daweynta xakameynta ugxansidaha si weyn u wanaajisay badbaadada marka la barbar dhigo tamoxifen iyo daaweynta xakameynta haweenka.
Maaddaama aromatase xannibaadayaashu ay saameyn weyn ku yeeshaan muruqyada lafdhabarta waxayna keeni karaan lafaha luminta, qaar badan oo ka mid ah dhakhaatiirtu waxay ku talinayaan in ay iska ilaaliyaan habkan haweenka premenopausal ee leh marxaladda 2aad iyo marxaladda 3 naasaha naaska, kuwaas oo u badan inay soo noqdaan.
Saameynnada daaweynta ee Aromatase Inhibitors
Sida daawo kasta, saameynada daawada iyo fal-celin xun ayaa laga yaabaa inay ku dhacdo dumarka qaarkood aromatase xannibaadayaasha.
Qaar ka mid ah saameynaha guud ee caadiga ah waa kuwa la xidhiidha dhimista estrogen ee jirka (calaamadaha menopausal) oo ay ku jiraan nambarada kuleylka ah, dhididka habeenkii, qallalka siilka, iyo dheecaanka hoosta haweenka. Inkasta oo calaamadahani ay noqon karaan caro, daraasadaha waxay soo jeedinayaan in kulayliyaha kuleylku yahay calaamad wanaagsan oo ku jirta haweenka qaba kansarka naasaha, iyo kuwa la kulma saameynaha daaweyntan waxay leeyihiin natiijooyin ka sii wanaagsan.
Wadne xanuun iyo murqo xanuun ayaa sidoo kale ah saameyn aad u daran oo ka yimaada xayawaanka aromatase. Waa jirro xanuun kuwaas oo ah mid ka mid ah sababaha ugu weyn ee dumarka joojiya daroogooyinkaas.
Mid ka mid ah dhibaatooyinka aadka u daran ee ku saabsan aromatase xannibaadayaasha waa lafo beelid, iyadoo isticmaalka daroogooyinkaasi ay horseed u noqon karto lafdhabarta iyo jabka. Dhakhtarrada badani waxay ku talinayaan in ay tijaabiyaan lafaha lafaha ka hor intaan bilaabin daawooyinkan asaasiga ah, iyo raacitaanka natiijooyinka baaritaanka bilawga ah.
Faa'iidada bosfosphonates (Zometa) si loogu daaweeyo aromatase inhibitor ah ayaa si weyn u yareeya khatartaas. Bisfosphonates ayaa marka hore loo ansixiyey daaweynta osteoporosis, waxaana Zometa lagu arkay in la yareeyo khatarta lafdhabarta iyo jabka muruqyada (iyo naafonimada oo inta badan la socota jajabka). Zometa ayaa markaa lagula taliyay dadka qaba kansarka caadiga ah, sababtoo ah waxay yareyn kartaa xanuunka lafaha iyo khatarta jabka ee la xiriira lafaha lafaha. Daraasado dheeraad ah waxay soo jeedinayaan in Zometa uu bedelo lafaha lafaha si ay unugyada kansarka naasku u "aanad u dhigi karin" si fudud. Isticmaalka bukaan-socodka, waxay u muuqataa inay yareyso fursadda ah in kansarka naasuhu ku faafo lafahooda.
Kaararka Aromatase sidoo kale waxay la xiriiraan khatarta sii kordheysa ee dhibaatooyinka wadnaha. Inkastoo tani run tahay, waxaa la ogaaday in cudurada wadnaha iyo nolosha ee khatarta ku ah sida wadnaha wadnaha iyo stroke aysan ahayn wax caadi ah haweenka qaata aromatase ka hortagayaasha kuwa aan u qaadan daawooyinkan. Xaaladaha wadnaha ee dhacaya inta badan daawooyinkaan waxaa ka mid ah xanuunada wadnaha ee wadnaha, dhibaatooyinka wadnaha wadnaha , iyo pericarditis (caabuqa xuubaha ku wareegsan wadnaha).
Haddii Waxyeelada Sideedu Samayso inaad Joojiso Daaweyntaada
Dhibaatooyinka soo noqnoqda ee xayawaanka aromatase, gaar ahaan jidhka xanuunka, waxay noqon kartaa mararka qaar. Nasiib daro, saameyntan soo socota waxay keenaysaa in haween badani ay joojiyaan daaweyntooda xilli hore oo ayna ka lumin ka hortagga soo noqoshada (iyo sii wanaajinta badbaadada) ay bixiyaan.
Haddii ay kugu dhacdo waxyeelo, la hadal dhakhtarkaaga kansarka. Inkasta oo badbaadada iyo sunta seddexda daroogada ee fasalkan ay isku mid yihiin, qiyaastii seddex meelood oo haween ah ayaa awood u leh in ay u dulqaataan daawo kala duwan fasalka.
Ka beddelidda Tamoxifen ilaa Aromatase Inhibitor
Dadka qaarkiis ee uurka leh iyo daaweynta tamoxifen waxaa laga yaabaa inay noqdaan daawada postmenopausal inta lagu jiro daaweynta. Tani waxay si gaar ah u tahay haweenka ku dhaca kansarka naasaha wakhtiga caadada. Maadaama kiimoteraabistu badanaa keento amenorrhea (maqnaasho la'aan), baaritaannada dhiigga ayaa laga yaabaa in loo baahdo in la sameeyo si loo go'aamiyo in aad dhab ahaantii ku dhalatay caado. Daraasaduhu waxay ogaadeen in badalida aromatase inhibitor ka dib 2 illaa 3 sano oo ah daaweynta tamoxifen daaweynta si ka fiican sidii loo sii waday tamoxifen.
Dheerka Daaweynta ee Kaadi-saareyaasha Aromatase
Inkastoo lagu taliyay in dadku ay sii wadaan tamoxifen ama aromatase inhibitor muddo 5 sano ah, xogta cusub waxay soo jeedinaysaa in qaadashada daawooyinkan 10 sanadood ay sii yareyso khatarta soo noqoshada. Waa mid si fiican u caansan in kansarka naasuhu uu soo noqnoqon karo sanado badan ama xitaa tobanaan sano kadib markii bukaanka koowaad la daaweeyo, khatartaasina waxay si gaar ah ugu badan tahay haweenka ku jira hindhicirrada 'estrogen-positive'. Ma naqaanno sababta kansarka naasaha uu soo laabanayo sanado badan ama tobanaan sano, laakiin waxaan ognahay inay taasi dhacdo marar badan.
Labadaba tamoxifen iyo aromatase labadaba waxay u muuqdaan inay sii wadayaan shaqadooda ka dib markii la joojiyo, inkastoo qaar ka mid ah cilmi-baarayaashu ay rumeysan yihiin in daaweynta hormoonnada sii wadidda lagu kordhin karo muddo ka badan 10 sano mustaqbalka. Taas waxay sheegtay, faa'iidooyinka suurtogalka ah ee loo baahan yahay in la miisaamo khatarta.
Qiimaha Aromatase ka hortagga
Si ka duwan tamoksifen oo ku dhawaad toban sano oo uu leeyahay qaabab guud, korriinka aromatase wuxuu noqon karaa qaali. Qorshayaasha caymiska badiyaa waxay daboolaan qayb ka mid ah kharashka, in kastoo ay bixin karaan caymis mid ka mid ah daawooyinka fasalka. Haddii ay kugu adkaato inaad ku qorto AI, hubi talooyinkan adigoo maareynaya kharashka daaweynta hoormoonka .
Ereyga
Cudurka aromatase wuxuu ka shaqeeyaa kahortagga soo saarida estrogen ee unugyada baruurta, ilaha ugu horreeya ee estrogen ee dumarka postmenopausal. Waxaan ognahay dhowr sano in tobaneeyo ah in tamoxifenku si weyn u yareeyn karto halista kansarka naasaha nambarka iyo tirooyinkan waxay u muuqdaan inay xitaa ka sii fiican yihiin xayawaanka aromatase.
Nasiib darro, iyo sida daawo kasta, saameynaha daawadu waa caan, jirkuna wuxuu noqon karaa midka ugu dhib badan. Haddii aad ku haysato kuwaan, la shaqee dhakhtarkaaga ku qaabilsan kansarka. Mararka qaar waa ay fiicantahay in aad u beddesho daroogada kale ee fasalkan. Daaweynta isdhexgalka oo ka duulaya masaajeynta ilaa figradaha ayaa sidoo kale caawin kara. Waxa kale oo muhiim ah in aad xasuusato sababta aad u qaadanayso daroogada. Dhibaatooyinka kale waxay noqon karaan wax dhib ah, laakiin waa la doorbidi karaa inay soo noqoto. Hadda oo la ogaaday in fesafosafonatka lagu taliyo aromatase xannibaadayaasha, walaaca ah in la yareeyo lafaha lafaha iyo osteoporosis ayaa laga yaabaa inay ka yartahay wax dhibaato ah marka hore.
Maskaxda ku hay in haweeney kasta ay ka duwan tahay mana jirto waqti "magic" ah oo ay tahay in qof waliba qaato daroogooyinkaas. Qof kasta, waxaa muhiim ah in la miisaamo faa'iidooyinka ka iman kara saameynta qibradaha leh iyo khataraha iman kara. Hubso inaad weydiiso su'aalo badan oo aad u noqotid u doodahaaga daryeelkaaga. Qofna kuma dhiirigelin in aad ku noolaato noloshaada oo bilaa kansar ah.
> Ilo:
> Francis, P., Regan, M., Fleming, G. et al. Kontoroolka Ovarian Adjusting ee Kansarka Naasaha ee Premenopausal. Wargeyska New England Journal of Medicine . 2015. 372 (5): 436-446.
> Hague, R., Shi, J., Schottinger, J. et al. Isticmaalka Cudurka Wadnaha Ka Dib Aromatase Inhibitor Ka Hortagga. JAMA Onkoloji . 2016. 2 (12): 1590.
> Pagani, O., Regan, M., Walley, B. iyo al. Cudurka Adjuvant ee Xakameynta Laga Yiraahdo Kansarka Naaska ee Premenopausal. Wargeyska New England Journal of Medicine . 2014. 371 (2): 107-118.
> Tjan- > Hejinen >, V., Hellemond, I., Peer, P. et al. Ka hortagga Aromatase La Xoojiyay Adjuvant Kadib Daaweynta Dheeriga ah ee Dhiig Aasaasiga ah (DATA): Tijaabin Gaaban, Wejiga 3aad. Lancet Oncology . 2017. 18 (11): 1502-1511.