Daaweynta Targeted waa daaweyn cusub oo loogu talagalay kansarka naasaha kaas oo laga yaabo in loo isticmaalo kali ahaan ama marka lagu daro daaweynta kale. Si ka duwan sida kiimikada dabiiciga ah ee soo jiidata unugyada degdega ah ee koraya, daawooyinka la beegsado si toos ah ayaa si toos ah loogu bartilmaameedsanayaa unugyada kansarka ama jidadka calaamadaynta kuwaas oo gacan ka geysanaya koritaanka unugyada kansarka. Sababtan awgeed, daawooyinka badankood waxaa laga yaabaa inay yeeshaan waxyeelo ka yar daaweynta kemotherabi.
Daawooyinka la bartilmaameedsaday waxaa loogu talagalay dadka qaba daawada estrogen-kansarka naasaha , HER 2 kansarka naasaha , iyo sidoo kale xitaa saddex laab kansarka naasaha.
Daawooyinkani waxay si fiican u shaqeyn karaan mararka qaarkood, laakiin sida daawooyinka kale ee loo isticmaalo daaweynta kansarka naasaha ee aan caadiga ahayn, iska caabinta caadiyan waxay sii korodhaa waqtiga. Qaar ka mid ah daawooyinkaan ayaa loo isticmaalaa marxaladda hore iyo kansarka naasaha ee caadiga ah, halka qaar kalena loo isticmaalo dadka qaba kansarka naasaha ee caadiga ah.
HER2 Kansarka Laga Hayo
Sida hore loo qoray, qiyaastii 25 boqolkiiba kansarka naasaha, hiddaha loo yaqaan 'epidermal growth receptor 2' (ama HER 2 / neu) waxay dhalisay sharaxaad dheeraad ah ee HER 2 protein (receptors) oo ku yaal dusha sare ee unugyada kansarka naasaha.
Si la mid ah, si la mid ah, habka ay qabaan qabtayaasha estrogen ayaa masuul ka ah inay tilmaamaan unugyada kansarka si ay u koraan oo u badiyaan, HER 2 reseptors waxay keeni kartaa koritaanka iyo kordhinta HER 2 kansarrada raajada.
Daawooyinka soo farageliya kuwan soo dhaweeyayaashu waxay saameeyaan calaamadaha unugyada kansarku, xaddidaan koritaankooda.
Daawooyinka lagu beegsanayo HER 2 waxaa ka mid ah:
- Herceptin (trastuzumab) - Herceptin waxaa la siiyaa IV inta badan hal mar toddobaadkii ama mar saddexdii usbuucba mar. Dhibaatooyinka waxaa ka mid ah qandho iyo qarqaryo hore. Qalitaanka wadnaha wuxuu ku dhici karaa seddex illaa shan boqolkiiba dadka la daweeyay daroogada, laakiin ka duwan wadnaha oo aan la xiriirin daawooyinka kemotherabi sida Adriamycin (doxorubicin), wadnaha qalalaasuhu wuxuu noqon karaa mid laga beddeli karo marka daaweynta la joojiyo. Dhibaatooyinka kale ee ka yimaada Herceptin ayaa badanaa wanaajiya waqti ka dib.
- Kadcyla (ado-trastuzumab) - Kaydcyla waa daawo ay ka mid yihiin Herceptin iyo daawo aad u xoogan oo loo yaqaan 'emtansine'. Qaybta Herceptin ee daroogadu waxay ku xidhan tahay HER 2 unugyada kansarka oo hagaagsan, laakiin halkii ay si fudud uga horjoogsan lahayd maqaar-celiyaha si looga hortago hormoonnada koritaanka ee ka soo xirma, waxay bixisaa "mushahar" - dawada kemotherabi- xaqqa unugyada kansarka.
Herceptin waxay u oggolaanaysaa daweynta kiimiko in ay galaan unugyada kansarka, halkaas oo emtansine la sii daayo. Inkastoo wakiilka kemotherabi uu badanaa la siiyaa unugyada kansarka, waxaa sidoo kale jira nuugista guud ee daroogada wareegga wareegga.
Sababtaa daraadeed, daroogada ayaa laga yaabaa inay leedahay saameyno daaweyn oo loo yaqaan 'chemotherapy' oo ay ka mid yihiin xakameynta lafta lafa-beelka iyo neuropathy peripheral. Kaydycla waxay noqon kartaa mid wax ku ool ah xitaa dadkoo ah qofkasta oo Herceptin uu ahaa mid aan waxtar lahayn. - Perjeta (Pertuzumab) - Perjeta waxay ahayd FDA oo la ogolaaday kansarka naasaha ee sanadka 2013-ka iyo daraasaduhu waxay heleen kor u kaca heerka noolaanshaha ee haweenka qaba kansarka naasaha ee caadiga ah (HER 2 positive) oo lagu daaweeyo daawada. Waxaa loo isticmaali karaa kali ahaan ama la socota Herceptin ama chemotherapy.
- Tykerb (lapatinib) - Tykerb waxay sidoo kale weeraraan HER 2 unugyada kansarka naasaha ee muuqda, laakiin qaab kale oo ka duwan Herceptin. Tykerb, oo aan ka duwanayn Herceptin maaha antibio, waxaa loo isticmaali karaa kali ahaan, ama la socota Herceptin ama kemotherabi. Saameynaha ugu caansan waxaa ka mid ah finan kaas oo u muuqda finan (laakiin looma daaweyn sida finanka) iyo shuban.
Saameynta daawooyinkaan
Herceptin, Kaydcyla, iyo Perjeta waxay leeyihiin qaabab la mid ah tallaabooyinka iyo sidan, waxyeelo isku mid ah. Mid ka mid ah waxyeelada soo socota ee daawooyinkaan waa wadnaha oo dhaawac ah. Dhakhtarkaaga ilkaha ayaa kugula talin kara baaritaanka baaritaanka wadnahaaga ka hor intaanad bilaabin daawooyinkan wuxuuna kuu sheegi doonaa calaamadaha muujinaya in aad wacayso.
Kansarka Cudurka Estrogen Kacsan
Dumarka qaba hindhistarka hormoon-kansarka naasaha ee wanaagsan, daaweynta la beegsanayo ayaa sidoo kale la heli karaa. Daawooyinkaan waxaa loo isticmaalaa dumarka ka soo baxa 'postmenopausal' (ama kuwa horey u marin kara daaweynta xaamilada ugxan-sidaha ah) si ay u sameeyaan daaweynta hormoonnada ee waxtar leh.
Daroogooyinka waxaa ka mid ah:
- Ibrans (palbociclib ) - Daawadani waxay xakamaysaa enzymes oo loo yaqaan kinaz-dependence kinases (CDK4 iyo CDK6) waxaana loo isticmaalaa ka dib markii loo yaqaan 'estrogen reseptor-kansarka naas-nuujinta' ee haweenka postmenopausal waxay u adkaysataa daaweynta hoormoonka. Waxaa laga yaabaa in loo isticmaalo daawada aromatase sida Femara (letrozole) ama leh daroogada anti-estrogen Faslodex (fulvestrant.)
- Afinitor (weligeed) - Daroogadani waxay xayiraan borotiin ku jirta jidhka oo loo yaqaan mTOR. Cunniheerka waxaa badanaa loo isticmaalaa daawada xajiinta estrogen iyo HER 2 buro xun oo ah ka dib marka ay noqoto mid u adkaysata aromatase inhibitor sida Aromatase (exemastine).
Kansarka Kansarka Naasaha ee Saddexaad
Iskuulada hormoonka ah ee hormoonada hormoonka ah, hormoonka hormoonada hormoonka ah, HER 2 negative (kansarka naasaha saddexaad ee negatif) ayaa noqon kara mid adag oo lagu daaweyn karo, sida daaweynta hormoonnada iyo HER 2 daaweyntu badanaaba waxtar ma leh. Iyadoo loo isticmaalo si aan caadi ahayn waqtigaan, daaweynta loogu talagalay Avastin waxaa loo tixgelin karaa dadka qaarkood.
- Avastin (bevacizumab) - Taasina kuma badna isticmaalka daaweynta kansarka naasaha, sababtoo ah mararka qaarkood dhiig-baxa oo culus. Waxaa loo kala saaraa sidii angiogenesis inhibitor ah. Ereyga "angiogenesis" micnaheedu waa "dhiig cusub" waxaana loola jeedaa xididdada dhiigga ee cusub oo u baahan in la sameeyo si loogu oggolaado kansarrada inay koraan.
Kaararka Angiogenesis wuxuu shaqeeyaa kahortaga kansarrada soo koraya kaankarada dhiigga cusub, iyo asal ahaan "gaajo" kansarka.
> Ilo:
> DeVita, Vincent, iyo al. Kansarka: Mabaadi'da iyo Tababbarka Onkoloji. Kansarka Naaska. Wolters Kluwer, 2016.
> Liedtke, C., iyo H. Kolberg. Daaweynta Nidaamka Nidaamka Kacsanaanta / Kansarka Naas-nuujinta - Calaamadaha Xaadirka ah iyo Natiijooyinka mustaqbalka. Daryeelka naaska . 2016. 11 (4): 275-281.