Daaweynta Hormoonku badanaa waa tallaabada ugu horreysa ee lagu daaweynayo kansarka naasaha ee heer-kulka ah, ugu yaraan kuwa leh burooyinka leh oogada xayawaanka estrogen . Doorashada daawooyinka waxay ku xirnaan doontaa haddii aad tahay daawada premenopausal ama postmenopausal, iyo sidoo kale haddii kansarkaagu soo noqodo intaad isticmaaleysid mid ka mid ah daawooyinkan. (Haddii kansarkaagu uu soo noqnoqonayo isagoo qaadanaya mid ka mid ah daroogooyinkaas waxaa loo maleynayaa in kansarkaagu u badan yahay inuu u adkaysto daroogada.)
Doorka Estrogen
Daawada estrogen-kansarka naasaha ee wanaagsan, estrogen wuxuu u shaqeeyaa sida shidaalka, oo ku xiran hindhicirrada estrogen dusha sare ee unugyada kansarka iyo kicinta korriinka iyo kobaca kansarka. Tallaabadani ee estrogen ee unugyada kansarku waxay ku koobnaan kartaa siyaabo kala duwan; iyadoo hoos loo dhigayo qiyaasta estrogen ee jirka, ama haddii la xakameeyo receptors estrogen sidaas darteed estrogen ma awoodo inuu kiciyo koritaanka unugyada. Marka la barbardhigo dawooyinka kiimoteraabiga oo si toos ah u dila unugyada kansarka si toos ah (sida fudud), daaweynta hoormoonka waxay ku shaqeyneysaa "aasaasida" unugyada kansarka ee estrogen.
Ka hor inta aan la baarin, dhakhtarkaaga ayaa ah kuwa ugu weyn ee soo saaraha estrogen. Kadib markaad ka baxdo, ilka ugu weyn ee estrogen ee jirka ku jira ayaa ka yimid isbedelka forrogens ilaa estrogen. Isbedelkan waxaa lagu kiciyaa xayawaanka enzyme ee ku jira baruur iyo murqo. Kaararka Aromatase waa daawooyin joojiya aromatase si ay isugeyntan u socoto asrogensens ku dhacdo estrogens ma dhici karto, si wax ku ool ah u yareeya heerarka estrogen.
Daaweynta Hormoonku waxtar uma leh dadka qaba hindhisada hormoonada hormoonka ah ee hormoonada hormoonka ah iyo hormoonka hormoonada ee hormoonka ah ee progesterone.
Waxa kale oo muhiim ah in la ogaado in qaar ka mid ah burooyinka qanjirada 'estrogen-positive' ku jira ay sidoo kale yihiin HER 2 positive . Kantaroolka oo u fiican labadaba kuwan soo socda, daaweynta anti-estrogen-ka waxaa loo isticmaali karaa ama la isticmaali karaa daroogo oo wax ka qabta HER 2.
Daaweynta Premenopausal
Haddii aad uur leedahay, ugxan-sidahaagu weli waa ilaha ugu weyn ee estrogen, oo markaa shidaalka, kansarka naaska. Hadafka daaweynta haweenka premenopausal waxay hoos u dhigeysaa awooda hormoonka si loo kobciyo korodhka kansarka adoo hoos u dhigaya qiyaasta estrogen ee la heli karo (daaweynta xakameynta ugxanta) iyo faragelinta awoodda estrogen si loogu xidho qaboojiyeyaasha estrogen ee kansarka naasaha unugyada.
Daawooyinka sida tamoxifen waxaa loo yaqaannaa sida loo yaqaan 'citrus-hormoonka' hormoonka 'estrogen', oo u shaqeynaya unugyada kansarka sidaas daraadeed estrogen-ta jirku ku jiro jirka ma awoodo in uu isku xidho unugta oo muujiyo unugyada si ay u koraan.
Waxaa loo maleynayaa in carbuuniyeyaasha aromatase laga yaabo inay ka waxtar badan yihiin tamoxifen, laakiin kuwan lama isticmaali karo haweenka premenopausal sababtoo ah waxqabadka ugxan-yari. Si loo yareeyo estrogen soo saaro ugxan-yari, oo kuu oggolaato inaad isticmaasho aromatase inhibitor, dhakhtarkaaga kansarku wuxuu kugula talin karaa daaweynta xakameynta ugxan-sidaha.
Xakamaynta haweenka ayaa laga yaabaa in ay fuliso:
- Isticmaalka dawada Zoladex (goserelin) - Tani waa daawo la siiyay subag ahaan iyo joojinta soo saarida estrogen ee jirka, waxaana loo yaqaannaa gonadotropic sii deynaya hormoonada hormoonka. Dhakhtarku wuxuu soo saaraa estrogen isaga oo ka jawaabaya hormoon la yiraahdo gonadotropin kicinta hoormoonka qoynta qanjirka pituitary. Zoladex wuxuu hor istaagi karaa awooda gonadotropin kicinta hormoonka si loo kiciyo ugxan-yarta.
- Oophorectomy - Inta badan, haweenka qaarkood waxay doortaan in ay ka baxaan ugxan-yahannadooda (iyada oo loo marayo nidaam loo yaqaan oophorectomy) halkii ay isticmaali lahaayeen Zoladex. Qalliinkan waxaa loo sameeyaa si ka yar inta badan khatarta ugu weyn ee la xidhiidha qaliinka, laakiin dumarka qaarkood ayaa doorbidaya habkan, gaar ahaan kuwa leh saameeyn ku saabsan kansarka ugxan-sidaha iyo sidoo kale kansarka naasaha.
Qalabka oophorectomy badanaa waxaa loo sameeyaa habka laparoscopic oo badanaa waa qaliinka maalinta. Marka lafaroscopic oophorectomy, jeexitaan yar oo yar ayaa lagu sameeyaa caloosha, ugxan sidaha ugxan leh ayaa la saaraa qalabka gaarka ah.
Ka dib daaweynta xakameynta haweenka, haweenka premenopausal ayaa markaa kadib lagu daaweyn karaa daawooyinka sida dumarka postmenopausal ee hoosta lagala hadlay ama tamoxifen.
Daaweynta Postmenopausal
Ka dib markii caado ka baxda, ilaha ugu weyn ee estrogen ee jirka ka yimaadaa isbedelka isdhexgalka ee istrogenka iyo estrogen. Kansarka naasaha ee 'postmenopausal' waxaa laga yaabaa in lagu daaweeyo tamoxifen (si loo xakameeyo estrogen oo loo yaqaan 'estrogen peripherally' oo ka soo horjeeda unugyada kansarka) laakiin qaybta daawooyinka loo yaqaan 'aromatase inhibitors' waxay u muuqdaan kuwo wax ku ool ah oo leh waxyeelo yar.
Nadaafadayaasha aromatase ee jira waxaa ka mid ah:
- Arimidex (aassozole)
- Femara (isrozole)
- Aromasin (tusaale ahaan)
Ka hortagga aromatase waxaa loo isticmaali karaa kali ahaan, ama marka lagu daro daaweynta kemotherabi . Tusaale ahaan, isu-geynta Femara (letrozole) iyo Ibrans (palbociclib) iyo Aromasin (Exemestane) oo leh Afinitor (weligeed). Mar walba waxaa jira dheelitirnaan markaad ku dareyso daawo kale. Inkastoo isku dhafku uu waxtar badan yahay, waxaa sidoo kale jira korodhka saameynaha marka la isku daro wax ka badan hal daawo.
Waa muhiim in mar labaad la fiiriyo in ujeeddada daaweynta ay badanaaba ka duwan tahay kansarka naasaha ee aan caadiga ahayn marka loo eego kansarka naasaha hore. Hadafka hore ee kansarka naasaha, himiladu waa daaweyn, falsafaduna waa inay "soo qaadaan qoryaha waaweyn" si ay ugu suurta gasho cudurka. Falsafada leh kansarka naasaha naas-nuujinta, ee ka soo horjeeda, badanaa waa in la xakameeyo kobaca kansarka leh qiyaasta ugu yar ee daaweynta suurtogalka ah, in la keydsado daawooyinka kale waqti marka daawooyinka ugu horreeya aanay shaqaynin.
Daaweynta Hormoonnada kale ee kale
Marka laga reebo tamoxifen iyo aromatase inhibireyaasha, waxaa jira dhowr daawooyin hoormoon oo kale oo la xidhiidha kansarka naasaha ee jirka. Haddii kansarka naaska uu sii korayo ama ku faafo daawooyinka kor ku xusan waxaa badanaa loo tixgeliyaa daawooyinkaas. Kansarka naasaha ee jimicsiga ayaa marwalba adkaynaya daawooyinkan waqti ka dib. Marka tani dhacdo, xulashooyinka waxaa ka mid ah:
- Faslodex (fulvestrant) -Wax ahaan dumarka postmenopausal ee hormaraya kansarkooda ku jira tamoxifen ama aromatase inhibitor, ikhtiyaarku waxay isticmaalaysaa dawada Faslodex. Faslodex hadda waa daawada kaliya ee loo ogolaaday kansarka naasaha qaybta loo yaqaan 'SERD's-selective decrose downregulators'.
Daawadani waxaa loo yaqaan "antiestogen" macnaheeduna wuxuu saameyn ku yeeshay estrogen on daaweeynta estrogen-unugyada kansarka naasaha laakiin hab kale oo ka duwan tamoksifen (waa ficil-celiyaha xajinta ee estrogen.) Faslodex waxaa loo isticmaali karaa kali ama Ibrans (palbociclib), daawo kiimiko ah, oo la siiyo cirbad.
Daawooyinka aan Caadir ahayn
Waxaa jira daaweyno kale oo hormoonno ah oo loo isticmaalo si aan caadi ahayn laakiin mararka qaarkood waxaa loo tixraacaa daaweynta 3aad ama 4aad. Kuwaas waxaa ka mid ah:
- Fareston (Toremifene) - Fareston waa daawo la mid ah tamoxifen iyo sidoo kale waxay tixgelineysaa wakiilka qalliinka xayawaanka ee estrogen mararka qaarkood loo tixgeliyo dumarka postmenopausal leh daaweeynta estrogen-kansarka naasaha ee wanaagsan, gaar ahaan dumarka aan haysanin enzim oo beddesha foomka firfircoon ee tamoxifen jirka.
- Progestins - Megace (megestrol) waa nooc dabedheer oo progesterone ah oo mararka qaar loo isticmaalo dadka qaba daawada estrogen-kansarka naasaha oo u adkeysanaya tamoxifen. Waxaa badanaa la isticmaalay marar badan kahor intaan la qaadan daawooyinka cusub.
- Hormooyinka Astaamaha Galmada ee Xanuunka - Hormoonnada sida estrogen iyo androgens looma isticmaali karo kansarka naasaha, laakiin mararka qaarkood waxaa la isticmaali karaa marka daaweyn kale oo hormoon ah ay ku fashilmeen.
Daaweynta Ragga
Ragga qaba kansarka naasaha naas-nuujinta ee hormoonnada maqaarka ayaa badanaa lagu daaweeyaa tamoxifen.
Waxyaabaha kale ee saameynaya
Tamoxifen
Tamoxifen waxay leedahay shaqooyin kala duwan, labaduba waxay la jaanqaadayaan saameynta ay ku leedahay estrogen qaybo ka mid ah jidhka oo ka hortagaya kuwa kale. Calaamadaha ugu caansan waxaa ka mid ah dareemo kulul iyo jir xanuun taas oo lagu soo koobay '' gabar 'gabow gabdhaha' 'inkastoo jiradaas jiran ay badanaa ka khafiifsan yihiin kuwa aromatase ka hortagga.
Dhibaatooyinka halista ah waxaa ka mid ah khatarta kordhaysa ee dhiig-xinjirowga ku dhaca lugaha (guntinta dhiig-gardarrada) ee, haddii aan la daaweynin, waxay awood u leedahay inay jebiso bilaashka iyo socdaalka sambabada (sanbabada sambabada.) Waqti-waqti, tamoxifen ayaa sidoo kale keeni karta dhiig-raacidda iyadoo kor u kaca yar ee horumarinta kansarka ilmo-galeenka.
Dumarka qaarkiis (iyo ragga) qaadashada tamoxifen waxaa laga yaabaa in ay sii xumaato calaamaddooda (tusaale ahaan, kordhinta maqaarka maqaarka ama kordhinta lafaha ee lafaha lafaha) dhawr maalmood gudahood markii la bilaabayo dawada.
Haddii aad yeelatid calaamadahaas, waxay caadi ahaan ku xallin doonaan afar illaa lix toddobaad gudahooda, inkastoo mararka qaarkood daaweyntu u baahan tahay in la joojiyo. Xidigga lacagta ah haddii aad leedahay ficil-celintan waxay tahay in jawaab celinta ficilka loo arko calaamad muujinaysa in daaweyntu ay shaqaynayso ayna noqon doonto mid waxtar leh. Zoladex waxay sidoo kale keeni kartaa fal-celin feker ah oo la mid ah.
Ogsoonow Tamoxifen in ay sababi karto baaritaanno unugyo aan caadi ahayn, dhiig-yaraan, iyo qolofta hoose ee hooseeya waxayna la xiriirtaa khatarta sii kordheysa ee kansarka endometrial. Kala hadal dhakhtarkaaga haddii doorashadani adiga kuu fiican tahay.
Ka hortagga aromatase (AI's)
Ciladda AI waxay sidoo kale keeni kartaa jir xanuun, iyada oo ku dhawaad 40 boqolkiiba dadka oo dareema murqaha iyo murqaha wadnaha. Lafaha lumidu waa wax saameyn ah, dhakhtarkaagu wuxuu u ekaan doonaa daloolka lafta si uu kuugu eego lafdhabarta, labadaba bilawga daaweynta iyo marmarka qaarkood. Jabka ayaa dhici kara sababtoo ah luminta lafta, xitaa iyada oo aan lafdhabarta lafaha. Cudurka AI ayaa sidoo kale kordhin kara khatarta cudurka wadnaha.
Faslodex
Faslodex badiyaa waa mid si cadaalad ah u dulqaadan karta, iyadoo leh saameynaha ugu badan ee daaweyntu ay noqdaan dhaliilo kulul iyo heerarka sare ee baaritaanka shaqada beerka.
Zoladex (goserelin)
Mid ka mid ah waxyeelada ugu badan ee daawadani waxay dhab ahaantii saameyn ku yeelataa. Hadafka daaweynta waa in la joojiyo ugxan-yari, si kale haddii loo dhigo, joojiyo ugxan-yari in ay sii daayaan estrogen. Tani waxay sameyneysaa asbuuciin caafimaad ahaan loo soocay oo sidaas awgeed, calaamadaha caadiga ah ee menopause sida qalabka kuleylka iyo qallalka siilka waa caadi.
Sida tamoxifen, dadka qaarkiis waxaa laga yaabaa inay yeeshaan fal-celin ficil-celin marka ugu horeysa ee bilawda daawada, tusaale ahaan, kororka lafaha lafaha ee kuwa leh lafaha lafaha.
Oophorectomy
Dhibaatooyinka asaasiga ah ee la xidhiidha ka-saarida ugxan-yarta ayaa ah, sida daaweynta xakameynta hormoonnada caafimaadka, calaamadaha caadiga ah ee ku dhaca caadadaada sida menopause-ka sida qalabka kuleylka iyo qallalka siilka. Waxa kale oo jira waxyeelo iyo halis la xidhiidha qaliinka. Qalabka oophorectomy hadda waxaa lagu sameyn karaa qalliin yar oo qallalan (laparscopy) iyada oo loo marayo dhowr maqaar oo yar oo maqaarka ah waxaana caadi ahaan loo sameeyaa habka qalliinka maalintaas ah.
Faslodex (fulvestrantrant)
Maadaama ay tani tahay daawo anti-estrogen ah, calaamadaha badankood waxay la mid yihiin kuwa la helay miyir-qabad, sida tamoxifen iyo xayawaanka aromatase. Qiyaas ahaan saddex meelood oo dadka ka mid ah ayaa ku dhacda lallabo khafiif ah, laakiin haddii kale, daawadani badiyaa waa loo dulqaataa.
> Ilo:
> Bulshada Mareykanka ee Oncology. Cancer.Net. Hormonal Therapies for Cancastative Breast Cancer. La sii daayo 05/066. https://www.cancer.net/research-and-advocacy/asco-care-and-streat-recommendations-patients/hormonal-therapy-metastatic-breast-cancer
> Martin, M., Lopez-Tarruella, S., iyo Y. Gilarranz. Daaweynta Endocrine ee Daaweynta Hormoon-Naeef Hor leh Kansarka Naasaha. Naaska . 2016. (Epub ka hor daabac).