Daaweynta xiisaha leh ee dadka qaba kansarka sambabada sare
Inkasta oo kiimoterapigu bartilmaameed unugyada sida unugyada kansarka ee si dhakhso ah u qaybsanaya jirka, immunotherapy ayaa bartilmaameedsanaysa nidaamka difaaca jirka, oo kicinaysa inay aqoonsato oo ay weeraraan unugyada kansarka oo keligood ah. Si kale haddii loo dhigo, immunotherapy waxay u ogolaaneysaa qof inuu isticmaalo qalabkiisa ugu wanaagsan (caafimaadkooda difaaca jirka) si loola dagaallamo kansarka.
Dadka qaba kansarka sambabada unugyada yaryar ee unugyada yaryar (NSCLC), warka wanaagsan wuxuu yahay in talobixinada cusub ee immunotherapy ay joogeen oo ay sii wadaan inay horumariyaan saynisyahannada.
Dabeecadahan, dabcan, ma daaweeyaan kansarka sambabada sare, laakiin waxay kugu caawin karaan adiga ama qofka aad jeceshahay inaad dareento fiicnaan oo xataa waqti dheer ku noolaato.
Shuruudaha Kansarka Sambabka
Ka hor inta aanad ku dhicin talaalka immunotherapy-ka ee loo isticmaalo daaweynta NSCLC-da, waa muhiim in la qeexo dhowr ereyo oo la xiriira kansarka sanbabada.
Waa maxay Kansarka Sambabka Unugyada yar-yar (NSCLC)?
Waxaa jira laba nooc oo ah kansarka sanbabada : kansarka sambabada unugyada yaryar iyo kansarka sambabka unugyada yaryar, oo leh unug yar oo aan caadi ahayn. Dhab ahaantii, qiyaastii 80 ilaa 85 boqolkiiba kansarka sanbabadu waa kansarrada unugyada unugyada yaryar.
Markaad maqasho ereyga "kansarka sanbabada" loo isticmaalo, qofku wuxuu caadi ahaan ku tilmaamaa kansarka sanbabada unugyada yaryar, inkastoo tani mar walba run tahay.
Maxay Tahay Kansarka Kansarka Sambabka Unugyada yar-yar (NSCLC)?
Kansarka qanjidhada unugyada yar-yar, unugyada kansarka (kansarka) ayaa si dhakhso ah u koraaya oo aan la xakameynin si ay u sameeyaan buro gudaha unugta sanbabada. Marka kansarku sii kordho, waxay bilaabi kartaa inuu ku faafo qanjirada nudaha, iyo sidoo kale meelo fog oo jidhka ka mid ah sida maskaxda, lafaha, beerka, ama sambab kale.
Iyadoo lagu saleynayo tiro tijaabo ah (tusaale ahaan, dheecaan ka qaadista bukaanka iyo tijaabada sawirada sida CT scan), marxaladda NSCLC ayaa go'aamisa. NSCLC-ga horumarka guud ahaan wuxuu loola jeedaa marxaladda IIIb ama marxaladda IV-ga , taas oo macnaheedu yahay in kansarku ku faafay qanjidhada qaarkood iyo / ama meelaha fog (tan waxaa lagu magacaabaa metastasis ).
Maxay Tilmaamayaasha Nidaamka Immune System?
Si loo fahmo talaalka immunotherapy, waxaa muhiim ah in la fahmo fikradda ah habka difaaca jirka ee loo yaqaan 'immunotherapies'.
Kantaroolka habka difaaca ayaa caadi ahaan ku yaala unugyada difaaca jirka ee qofka, waxayna ka hortagaan nidaamka difaaca jirka in ay weeraraan unugyada caafimaad qaba, caadi ah, kaliya shisheeye, unugyo aan caadi ahayn (sida unugyada cudurka qaba).
Kansarka waa xummad, sababtoo ah hal dariiqo oo looga hortago in lagu weeraro nidaamka difaaca jirka waa iyada oo la samaynayo oo lagu muujinayo borotiinada baaritaanka. Hase yeeshee, kansarka maqaarka ayaa shaqaynaya si loo xakameeyo baaritaanadaas si uu jidhku dhab ahaan u aqoonsado kansarku sida ajnabigaa oo uu u soo weeraro.
Immunotherapy for Cancer Cancer: PD-1 Antibody
Mid ka mid ah unugyada asaasiga ah ee difaaca jirka ee loogu talagalay in lagu barto NSCLC immunotherapies waa dhimashada barnaamijka 1-da (PD-1), oo ah gabbaad caadi ah oo ku yaala unugyada T-da laakiin waxaa la samayn karaa oo lagu caddeeyn karaa unugyada kansarka sanbabada.
Caadi ahaan, koontaroolka difaaca ayaa ku xiran barta shabakada sambabada, sidaas darteed habka difaaca jidhku wuxuu ka hortagayaa la dagaallanka kansarka. Laakiin daroogooyinka joojiya PD-1, habka difaaca jidhku wuxuu ka jawaabi karaa oo wuxuu weeraraa unugyada kansarka.
Hadda waxaa jira laba daroogo oo ah PD-1 antibodies (ama PD-1 checkpoint checkers), waxayna yihiin FDA-ansixin lagu daaweynayo NSCLC-ta horumarsan.
Labadaba daawooyinkaan waxaa loo siiyaa sida infusions (iyada oo loo marinayo xididada) labadii ilaa saddex toddobaadba. Labadan daroogo waa:
- Nivolumab
- Pembrolizumab
Warbixinta Nivolumab
Sida nambolumab PD-1, nivolumab waxaa lagu baranayey dhowr maroodi oo ay ku jiraan dadka qaba NSCLC. Tusaale ahaan, hal mar 2015 wajiga III ee daraasadda New England Journal of Medicine marka la barbar dhigo daaweynta nivolumab iyo daaweynta daawada qiyaasta daawada ee dadka ay kor u qaadeen NSCLC horey u soo marey ama ka dib markii ay qabteen nidaam platinum-kiimiko ah. Natiijooyinka ayaa shaaca ka qaaday in kuwa helay nivolumab ay ka badbaaday muddo ka badan kuwa helay helitaanka daawada - Dhexdhexaad dhexdhexaad ah oo ah 9.2 bilood oo koox nivolumab ah iyo 6 bilood oo ka mid ah kooxda daaweynta.
Dhinaca kale, Taxotere (docetaxel) waa daaweyn kiimiko ah oo caadi ahaan loo siiyay dadka horay loo daweeyey ee NSCLC, sidaa daraadeed daraasaddan ayaa la barbardhigay habka difaaca jirka ee loo yaqaan 'chemotherapy'.
Marka laga soo tago gargaarka badbaadada, nivolumab guud ahaan wuxuu u arkey inay ka badbaado badan daraasaddan daraasaddan - taas oo ah mid wanaagsan, sababtoo ah arrin aad u weyn oo la xiriirta difaaca jirka ayaa ah in nidaamka difaaca jirka uu weeraro maaha oo keliya unugyada kansarka laakiin sidoo kale xubnaha caafimaadka qaba.
Mid ka mid ah dhibaatooyinka ugu xun ee takhaatiirtu ka walwalayaan daaweynta kansarka waa pneumonitis, taas oo ah marka daroogadu keento infakshanka sambabada (ma aha caabuq, oo aad ku aragto pneumonia). Dhakhaatiirtu waxay si gaar ah uga walaacaan cudurka pneumonitis sababtoo ah waxay saameysaa shaqada sanbabada, taas oo horayba uga sii dartay kansarka sanbabada. Daraasaddan, pneumonitis waxay ku dhacdey nogolumab si aan caadi ahayn waxayna ahayd mid aad u hooseeysa markii uu dhacay.
Taasi waxay tidhi, waxyeellooyinka xun (oo aan ka ahayn pneumonitis) waxay ku xiran yihiin nivolumab oo dhakhaatiirtu u daawanayaan:
- Dhibaatooyinka maqaarka (tusaale, finan iyo cuncun)
- Dhibaatooyinka dheefshiidka (tusaale, shuban)
- Imtixaanka dhiigga ee aan caadi ahayn ee noolaanshaha
- Dhibaatooyinka qanjidhada
- Dareen-celinta la xidhiidha faleebka
Dulmarka Pembrolizumab
Pembrolizumab waa FDA oo loo ogolaaday in lagu daweeyo NSCLC-da sareeya ee dadka aan haysan kansar sambabeed ah oo ka mid ah kansarka sanbabada (oo ah isbedel EGFR ama loo yaqaan ALK ) oo ugu yaraan badh ka mid ah unugyada burooyinkooda ayaa kufilan PD-L1. PD-L1 waa borotiinka sida caadiga ah ugu xidhan PD-1 on T unugyada, isaga oo ka hortagaya inay weeraraan unugyada kansarka.
Pembrolizumab ayaa sidoo kale loo ogolaaday in lagu daaweeyo NSCLC ( sambabada adenocarcinoma ) oo ay wehliyaan daaweynta kiimikada, iyadoon loo eegin in unugyada burooyinka curyaaminta PD-L1.
Daraasaddan 2016-ka ee lagu magacaabo " New England Journal of Medicine" , dadka qaba laf-dhabarka NSCLC iyo PD-L1 ugu yaraan 50 boqolkiiba unugyada burooyinkooda ayaa waxay soo mareen nolol aad u dheer oo aan sii dheereyn (10.3 bilood ilaa 6 bilood) oo leh saameyn xun badbaado) marka loo eego dadka ka soo jeeda qalliinka kiimiko ee ku salaysan daawada platinum .
Gaar ahaan, badbaado la'aanta bilaashka ah ayaa lagu qeexay wakhtigii bukaanada loo kala soocay si loo helo daweynta maskaxda ama daweynta kemotherabi, ama dhibicda cudurkoodu kor u kaco.
Daraasaddan, saameyn xun ayaa lagu arkay 27 boqolkiiba kuwa qaada dawooyinka dhalmada ee kudhaca buundada (pergolizumab) ilaa 53 boqolkiiba kuwa qaata kemotherabi.
Guud ahaan, dhibaatooyinka ugu caansan ee ku dhaca kuwa daaweynta ku jira ee daweynta pembrolizumab waxay ahaayeen:
- Shuban
- Daal
- Qandho
Pneumonitis wuxuu ku dhacaa kooxda hor-timaadda ee pembrolizumab oo ka sarreysa kooxda ka soo horjeeda chemotherapy (5.8 boqolkiiba marka loo eego 0.7 boqolkiiba).
Immunotherapy loogu talagalay kansarka sanbabada: PD-L1 Antibody
Atezolizumab waa daawada FDA ee la ansixiyey si loogu daaweeyo dadka qaba NSCLC oo sii kordhaya oo xanuunkoodu sii wado xitaa inta lagu jiro ama ka dib marka ay galaan kiimiko ah oo kiimiko ah .
Atezolizumab wax yar way ka duwan tahay nivolumab ama pembrolizumab in uu yahay antibody PD-L1. Si kale haddii loo dhigo, waxa si gaar ah loogu talagalay PD-L1, oo ah borotiinka sida caadiga ah ku xira PD-1 (oo ah qolka T-cells), ka hortagaya inay weeraraan unugyada kansarka. Sida daroogada kale ee kale, ayaa loo yaqaan 'atezolizumab'.
Daraasad sannadkii 2017 ee Lancet, dadka qaatay jimicsiga hore ee platinum-ka ee loogu talagalay NSCLC-ka sareeya ayaa loo kala saaray si loo helo dhadheerisumab ama docsaxel.
Qaar ka mid ah natiijooyinka la ogaaday ayaa muujiyay in tirada guud ee badbaadada ay hagaagtay dadka ay qaateen qadatada loo yaqaan 'atezolizumab' iyo docetaxel, iyadoon loo eegin in unugyada burooyinka ama unugyada difaaca gudaha gudaha bukaanka ay u fiicnaadeen PD-L1 (dhexdhexaad ah 13.8 bilood oo loo yaqaan 'atezolizumab iyo 9.6 bilood' ).
Waxaa intaa dheer, saameyn xun oo daaweyn ah oo la xidhiidha daaweynta loo arko ayaa lagu arkay wax ka yar kooxda loo yaqaan 'atezolizumab', marka la barbardhigo kooxda cilmi-baarista (15% boqolkiiba 43%).
Taasi waxay tidhi, dhibaatooyinka ugu caansan ee dadka qaata atezolizumab waxay ahaayeen:
- Daal
- Lalabbo
- Cunto xumada
- Tabaruce
Pneumonitis ayaa ku dhacay boqolkiiba 1.6 bukaannada ku jira kooxda loo yaqaan 'atezolizumab', taas oo ah mid hooseeya, iyo in ka yar 1 boqolkiiba mid daran (fasalka 3 ama 4) pneumonitis.
Immunotherapies on Horizon
Waxaa muhiim ah in la xusuusto in ay jiraan kantarool baaritaano badan oo kale oo la horumariyo. Furaha lagu ogaanayo doorkooda daaweynta adiga ama qofka aad jeceshahay kansarka sanbabada sifiican ayaa lagu qeexay sida wanaagsan ee daawooyinkani u sameeyaan jaangooyooyinka wajiga III.
Tusaale ahaan, hal talaal oo difaac ah oo lagu magacaabo ipilimumab ayaa lagu ogaadey in ay sii dheeraanayso noolaanshaha dadka qaba melanoma metastatic . Daroogadaasi waxay bartilmaameed u tahay cytotoxic T-lymphocyte antigen 4 (CTLA-4), kaas oo ah kan ugu horreeya ee nidaamka T unku ku shaqeeyo nidaamka difaaca. Ipilimumab waxaa lagu barayaa sida daaweyn loogu talagalay NSCLC-da oo sii-daba-dheer iyada oo la isu-tago kiimoteraabiga.
Ereyga
Waa wax aan la rumaysan karin in kansarrada qaarkood (sida kansarka sanbabada) aysan si dhakhso ah u korin oo aan loo koontarooli karin, laakiin dhab ahaantii way caatoobaan ama khiyaaneeyaan, si ay u hadlaan, nidaamka difaaca ee qofka, habka difaaca jirka.
Taasi waxay tidhi, khubarada kansarka ayaa hadda haysta gacanta sare oo leh helitaanka immunotherapies - dhacdo isbeddel ah oo sii wadi doona beddelaadda habka aan u daaweyno kansarka mustaqbalka.
Ugu dambeyntii, go'aaminta sida loo daweeyo kansarka sanbabada waa nidaam adag oo taxadar ah, marmarka qaarkood, daawooyin badan ma aha had iyo jeer jawaabta saxda ah. Fadlan hubso inaad kala hadasho rabitaankaaga, cabsida, iyo walwalka qoyskaaga iyo dhakhtarkaaga.
> Ilo:
> Bulshada Mareykanka ee Kansarka. (2017). Immunotherapy loogu talagalay Kansarka Sambabka Unugyada aan-yareyn.
> Gettinger S. (Juun 2017). Immunotherapy oo ah kansarka sanbabada unugyada yaryar ee unugyada yaryar ee unugyada difaaca jirka. In: UpToDate, Jett JR, Lilenbaum RC, Schild SE (Eds), UpToDate, Waltham, MA.
> Reck M et al. Pembrolizumab oo ka soo horjeeda kiimotaroojinta loogu talagalay PD-L1 Kansarka Cudurka Sambabka-yar-yar-yar. N Engl J Med . 2016 Nov 10; 375 (19): 1823-33.
> Rittmeyer A et al. Atezolizumab ka soo horjeeda docsaxel ee bukaanada qaba kansarka sanbabada aan hore loo daweyn (OAK): marxaladda 3, cad-furan, tijaabin badan oo kala duwan oo la xaddiday. Lancet . 2017 Jan 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. Nivolumab ee NSCLC: caddaynta ugu dambaysa iyo suurta galnimada caafimaad. Ther Adv Med Oncol . 2015 Mar; 7 (2): 85-96.