EML4-ALK a Ciwon Cutar Kwayar Wuta da Matsayi na Crizotinib
Idan likitanka ya gaya maka cewa kana da wani ALK da ke dauke da cutar ko kuma ALK-tabbatacce na ciwon huhu, za ka ji kamar kana cikin ƙasar da ke magana da harshen waje ba tare da mai fassara ba. Mene ne ainihin ALK, yadda tsarin gyaran ALK ya yi amfani da ita, kuma ta yaya mutane ke fama da ciwon daji na ALK-tabbatacce?
Ma'anar Kisa na ALK
An gyara ALK wani nau'i ne a cikin kwayar da zai iya faruwa a cikin kwayoyin cutar kanjamau irin su kwayoyin cutar kanjamau.
A matsayin nazari mai sauri, kwayoyin su ne sassan chromosomes a cikin DNA wanda ya sanya lambobi irin su launin ido da launin gashi. Sannan kuma su ne tsarin da ya tsara ga sunadarai da ke tafiyar da matakan da ke kula da jikinmu yana tafiya lafiya-ko sa kwayoyin su raba su da girma.
Ciwon kankara sune kwayoyin halitta wadanda suka shafe yawan maye gurbin mutun-canje-canje a cikin kwayoyin-a cikin tsarin zama kwayoyin cutar kanjamau. Kamar mutane, kowane ciwon daji yana da bambanci kuma yana ɗauke da canje-canje daban-daban da canje-canjen kwayoyin halitta. Wadannan sunadaran kwayoyin suna juya code don sunadaran da ke da mawuyaci kuma suna aikata ayyuka mara kyau - irin su tayar da ci gaban ciwon daji.
An gano shi a shekarar 2007, maye gurbin ALK shine maye gurbi a cikin wani nau'in da ake kira ALK (lymphoma kinase anaplastic.) Domin ya zama mafi daidai, wannan maye gurbi ne ainihin ƙarfafawar jiki - fuska da kwayoyin biyu da aka sani da ALK da EML4 (echinoderm microtubule-related protein kamar 4.) Wannan nau'in mahaukaci (jigon fusion) a biyun yana juya ga wani nau'in gina jiki wanda ake kira tyrosine kinase (akwai nau'in tyrosine kinases.)
Cincin jini shine asaliki (sunadarai) wanda ke aiki a matsayin manzannin sinadarai, aika da sigina zuwa cibiyar ci gaban kwayoyin halitta wanda ya gaya wa tantanin halitta ya raba da ninka. A sauƙaƙe, tyrosine kinase "koɗa" ko kuma ya bayyana ci gaban ciwon daji (maye gurbin irin su mahaifa EML4-ALK fuska ne da ake kira "gurbin direbobi.")
Sashin farin ciki na wannan binciken shine cewa yanzu ana iya maganin wasu cututtuka tare da magungunan tyrosine kinase, magungunan da ke toshe tyrosine kinase (a cikin wannan yanayin furotin EML4-ALK) da kuma hana ci gaban ciwon daji ta hanyar hanawa sakonnin da ke fada wa tantanin halitta don raba. Ta hanyar yin amfani da saurin "kashewa" ta hanyar ciwon daji, waɗannan magunguna sun inganta rayuwar wasu mutanen da ke ciwon ciwon daji wanda ke da maye gurbin ALK.
Wasu mutane sun saba da wani maye gurbin da aka samu a wasu mutane da ciwon daji na ƙananan ƙwayoyin cutar, wanda ake kira ragowar EGFR . Wannan maye gurbi yana haifar da samuwar sunadarai na tyrosine kinase mahaukaci, da kuma mai maganin EGFR tyrosine kinase Tarceva (erlotinib) ya ba da rayuwar mutane da yawa tare da ciwon huhu na huhu wanda yake da kyamarar kyama saboda wannan maye.
Wadannan kalmomi suna magana game da muhimmancin maye gurbin a cikin kwayoyin cutar kanjamau:
Mene ne Ciwon Cutar Kwayar lafiya na ALK?
ALK daji na kwakwalwa na gaske yana nufin mutanen da ke fama da ciwon huhu a cikin kwayar cutar da gwagwarmayar gwagwarmayar mutuncin ALK (EML4-ALK fusion gene.) Wannan maye gurbi yana cikin kashi uku zuwa biyar bisa dari na mutanen da ke fama da cutar kanjamau . Wannan yana iya zama kamar ƙarami kaɗan a kallon farko, amma la'akari da yawan mutanen da aka gano da cutar ciwon huhu a kowace shekara a Amurka (kimanin 200,000 a shekara ta 2017), wannan adadin yana da yawa.
Shin ALK Shin Shirye-shiryen Sake Gani ne kawai a Cutar Cancer?
Wannan jinsin ta EML4-ALK kuma ana samuwa a wasu mutane da neuroblastoma da anaplastic manyan cell lymphoma .
Bayyana Abun Mutuwa a Mutum da Ciwon Cutar
Abu mai mahimmanci da mahimmanci a lura shi ne cewa haɗin EML4-ALK ba tare da maye gurbi ba ne kamar maye gurbin BRCA1 da BRCA2 a wasu mutanen da ke fama da ciwon nono (da kuma sauran cututtuka). Mutanen da ke fama da ciwo na huhu ba su da kyau ga EML4 -BAI ba a haife jinsi ba tare da kwayoyin da ke da wannan maye kuma ba su gaji wani hali don samun wannan maye daga iyayensu ba. Maimakon haka, wannan maye gurbi ne da ke tasowa a cikin wasu kwayoyin cutar ciwon daji kamar wani ɓangare na ci gaban ciwon daji.
Sanin asali
An maye gurbin ALK ne ta hanyar labarun kwayoyin cutar samfurin. Yana da mahimmanci a cikin wannan gwajin cewa an samar da kayan jiki mai kyau daga kogin kwayar halitta ko ƙwayar cutar kanjamau. Masu bincike kuma suna kallon hanyoyi don tantance idan an maye gurbin ALK kafin a gwada gwajin kwayoyin halitta, ko kuma zai iya maye gurbin gwajin kwayoyin. Wasu abubuwa da ke nuna cewa maye gurbin ALK zai iya kasancewa sun haɗa da:
- Bloodwork - gwajin da ake kira CEA (carcinoembryonic antigen) tana nuna rashin jin dadi ga mutane tare da maye gurbin ALK.
- Radiology - A cikin nazarin daya, ciwon sukari tabbatacce ga ALK ya zama cikakke kuma basu da wani abu da ake kira bayyanar gilashin ƙasa. Ya bambanta, kashi 50 cikin dari na wadanda ba tare da maye gurbi suna da nazarin ilimin rediyo tare da siffar gilashin ƙasa.
A wannan lokaci, duk da haka, labarun kwayoyin (gwajin kwayoyin) ya kasance mafi gwaji mafi kyau kuma shine daidaitattun kulawa.
Wanene zai iya samun Sakamakon ALK?
Hanyoyin maye gurbin da ke cikin ƙwayar cutar huhu sun bambanta dangane da irin ciwon daji na huhu . Hakanan jinsin EML4-ALK sun kasance mafi yawanci a cikin mutane tare da irin ƙwayoyin cutar ciwon huhu na ƙananan ƙwayoyin cuta da ake kira huhu adenocarcinoma . Wancan ya ce, a lokuta masu wuya, an gano ALK a cikin mutane da kwayar cutar kwayar cutar kwayar cutar ta jiki (wani nau'i na marasa ciwon mahaifa) da ƙwayar ciwon huhu na kananan ƙwayoyin cuta .
Akwai kuma wasu mutanen da suka fi dacewa su sami ALK fusion gene. Wannan ya hada da marasa lafiya marasa lafiya, mutanen da ba su taɓa shan taba (ko ƙananan kyafaffen taba), mata, da wadanda ke da 'yan kabilar Asia . A cikin binciken da aka yi kwanan nan, an gano cewa marasa lafiya fiye da shekaru 40 suna gwadawa ga haɗin EML4-ALK kimanin kashi 50 cikin dari (kwatankwacin kashi 3 zuwa 5 bisa dari na mutanen da ke da tarin ciwon huhu.)
Wa ya kamata a jarraba shi ga wani ALK Mutuwa (Saukewa)?
Ƙungiyoyi da yawa sunyi aiki tare don tsara jagororin wanda za'a gwada su don maye gurbin ALK. Wannan yarjejeniya shi ne cewa dukkanin marasa lafiya tare da ciwon maganin adenocarcinoma ya kamata a jarraba su don maye gurbin ALK da kuma EGFR, ba tare da jinsi ba, tarihin shan taba, wasu matsaloli, da kuma tsere.
Ɗaya daga cikin iyakance shi ne cewa wasu ciwace-ciwacen daji suna da wuraren da suka zama daban-daban na ciwon huhu na huhu. Alal misali, nama a wani ɓangare na biopsy na iya zama kamar adenocarcinoma da nama a wani ɓangare na samfurin biopsy na iya zama kamar ƙwayar cutar ciwon mahaifa.
Akwai wasu ƙwayoyin likita zasu iya yin waɗannan sharuɗɗa. Alal misali, za'a iya gwada gwadawa ga wanda bai taba shan taba ba, ko da yake irin cutar kanjamau ba su zama adenocarcinoma ba. Wadannan jagororin zasu iya canzawa yayin da ƙarin koyayi game da waɗannan maye gurbi, kuma an gano sauran maye gurbin kuma an biyo bayan jiyya.
Ta yaya ake kula da Ciwon Cutar Kwayar Cutar Kwayar lafiya ta ALK?
Ko da yake an sake gano magungunan ALK a cikin cutar ciwon huhu a 2007, wata rigakafi (yanzu hudu) ga mutanen da suke da wannan maye gurbi (kuma suna da ciwon daji na ƙwayar cuta) sun riga sun yarda da FDA. Wannan amincewa ta FDA - kamar shekaru 4 bayan ganowa na farfadowa - yana da ban sha'awa cikin maganin ciwon daji na ciwon daji wanda ba su kara yawan rayuwa ba a cikin shekarun da suka wuce.
Bari mu fara da magana game da magani na farko da aka amince, sa'an nan kuma ambaci karin magunguna waɗanda aka amince da su yanzu ga waɗanda ke tare da ALK
Ta yaya yake aiki ? Magunguna - Xalkori (crizotinib) wani mai hanawa ne na tyrosine kinase. A wannan yanayin, Xalkori ya ɗauka ga mai karɓar maganin tyrosine kinase a kan jikin kwayar cutar ciwon huhu a cikin mahaifa kuma ya hana ingancin ALK mahaukaci. Hanyar da ta fi sauƙi don fahimtar wannan shine tunani game da mai karɓar maganin tyrosine kinase a matsayin kulle, da kuma ciwon tyrosine kinase (wanda aka halicce shi ta hanyar mahaukaci) a matsayin maɓalli. Mutane tare da maye gurbin ALK suna da mahimmanci maɓallin. Lokacin da maɓallin ke "sanyawa," ana aika sigina zuwa cibiyar ci gaba don samun rabuwar jiki tare da tsayawa ba. Magunguna irin su aikin Xalkori ta hanyar kulle keyhole - irin su ne idan kun cika keyhole a ƙofarku ta hanyar da kankare. Tun da maɓallin (abin gina jiki mai gina jiki) ba zai iya shigar da kulle (ɗaure tare da mai karɓar ba,) sigina don tantanin tantanin halitta don rabuwa da girma ba ta kai ga tashar sarrafawa da rarraba radiyo (ci gaba da tsangwama) an dakatar.
Yaya kyau yake aiki? Nazarin sun gano cewa maganin tare da Xalkori zai haifar da rayuwa mai ci gaba da sauƙi tsakanin watanni 7 zuwa 10. Akwai kimanin kashi 50 zuwa 60% zuwa ga miyagun ƙwayoyi. Wannan bazai yi ban mamaki ba, musamman ma idan aka kwatanta da jiyya ga wasu cututtuka, amma ya lura cewa mutanen da ke cikin wannan binciken sun riga sun karbi kuma sun kasa cin nasarar rigakafin kwayar cutar da kuma saran da aka sa ran za su iya cigaba da yin gyaran maganin gargajiya ne kawai da kashi 10% ci gaba-free rayuwa na kimanin 3 watanni.
Ko da yake sakon amsawa tare da Xalkori ya fi kyau tare da kwararrun chemotherapy, binciken bai gano cewa Xalkori yana ƙaruwa ba. Duk da yake yayin da rayuwa ta kasance muhimmiyar, rayuwar rayuwa ma mahimmanci ne. Tsayar da cigaba da ciwon daji zai iya rage alamun da ke da alaka da ciwon daji, kuma a gaskiya, marasa lafiya da Xalkori tare da ƙwayar cututtuka da suka danganci ciwon huhu na huhu (ƙananan gajeren numfashi , zafi na zuciya, da kuma gajiya). Kuma bai tabbata ba ko wannan binciken ya yi daidai ba. Rayuwar rayuwa tun lokacin da aka yarda da mutane a cikin wannan binciken don su "wucewa" kuma suyi amfani da sauran maganin idan alamun su ya ci gaba. Mutane da yawa sun dakatar da ilimin chemotherapy kuma suka canza zuwa crizotinib fiye da sauran hanya a kusa.
Tun da aka yarda da Xalkori, an riga an yarda da wasu magunguna don maganin cutar ta hanyar cutar ta ALK. Wadannan sun haɗa da:
- Zykadia (ceritinib)
- Alectinib (alencensa)
Bugu da ƙari, sabon magani don magance cutar kanjamau ALK-tabbatacce, Alunbrig (brigatnib) ya amince da ranar 28 ga Afrilu, 2017.
A halin yanzu an ɗauka cewa mai amfani na lantarki yana ba da cigaba da cigaba da rayuwa fiye da crizotinib (tsawon watanni 25.7 da 10.4) kuma yana da ƙasa kaɗan. Wannan ya ce, yana da muhimmanci a yi magana da likitan ku game da wane irin wadannan kwayoyi zasuyi aiki mafi kyau a gare ku.
Yana da mahimmanci a tuna cewa magoya bayan tyrosine kinase ba maganin cutar kanjamau ba ne , amma wani abu da zai iya yaduwa da ciwon sukari a matsayin likita don ciwon sukari zai iya sarrafa cutar amma bai warkar da shi ba. Ana fatan cewa a nan gaba, ciwon huhu na huhu, aƙalla wasu iri tare da wasu maye gurbin, za'a iya bi da su kamar sauran cututtuka irin na ciwon sukari.
Resistance
Abin takaici, ko da yake fiye da rabin mutane sun amsa da kyau ga magani, juriya kusan sau da yawa yana tasowa lokaci kuma miyagun ƙwayoyi ya rasa tasiri. Ga mutanen da suka ci gaba da juriya, akwai sauran zažužžukan. An baiwa Electinib izini a 2013 don mutanen da ke dauke da kwayar cutar kanjamau mai kyau na ALK zuwa crizotinib. A watan Maris na 2014 wani magani - Zykadia (ceritinib) - An ba da magani ta hanyar FDA. Sakamakon farkon amsawa zuwa Zykadia sun kasance kama da waɗanda suke tare da Xalkori. Bugu da ƙari - mutane da yawa waɗanda suka yi tsayayya da Xalkori sun amsa wa Zykada. Ana amfani da sababbin magunguna a gwaje-gwaje na asibiti ga mutanen da suka ci gaba da juriya, kuma wasu masu bincike sunyi fatan cewa a nan gaba marasa lafiya za a iya magance su a cikin wani yanayi na yau da kullum tare da wadannan kwayoyi kamar yadda juriya ta tasowa.
Bugu da ƙari, ƙwayoyin tumatir sukan canja (inganta sababbin maye gurbin) a tsawon lokaci. Wani lokaci maganin da ke sa ran wani maye gurbuwa (kamar EGFR) zai iya aiki ko da yake ƙwayar ƙari bai fara da kyau ga maye gurbin EGFR ba. Muna fatan cewa a nan gaba za mu iya magance ciwon huhu na huhu - a kalla wannan sassauci - kamar yadda muke bi da sauran cututtuka na kullum.
Wanne Drug ne Mafi Girma?
Gwaje-gwajewar gwaji a halin yanzu suna ƙoƙarin koyo game da wanene daga cikin magungunan nan hudu da ke samuwa a yanzu suna aiki mafi kyau. Akwai wasu shaidu cewa sababbin magungunan (duka tare da gyaran ALK tare da wasu maye gurbin) zai iya iya magance ƙwaƙwalwar ƙwayar cuta ga kwakwalwa. Saboda ciwon kwakwalwa na kwakwalwar jini, jerin sutura masu sutura da aka sanya su da yawa wanda ya hana magunguna da yawa (ciki har da chemotherapy da maganin kwantar da hankali) daga shiga cikin kwakwalwa, yawancin kwayoyi da muke da shi yanzu don magance ciwon huhu na huhu ba tasiri ne akan kwakwalwa ba. metastases. Ga wadanda ke da ƙananan ƙwayoyin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwararru, sakonni na kwakwalwa ta yanar gizo (SBRT) ko igiya na cyber ya ba da wani zaɓi don bi da waɗannan, duk da haka akasin haka, a nan gaba, za mu sami magunguna wanda zai iya magance wadannan mahimmanci.
Tsanani game da Vitamin E Ƙari
Kullum muna damu da mutane game da daukar duk wani kari yayin da suke shan maganin ciwon daji ba tare da fara magana da likitan su ba, kuma wannan yana da mahimmanci tare da crizotinib (da kuma yiwuwar wasu hanyoyin magance cutar). A shekara ta 2018 aka gano cewa wani ɓangaren bitamin E wanda ake kira a-tocopherol zai iya taimakawa sosai wajen maganin crizotinib. Vitamin E (ko a kalla wannan bangaren) duka biyu sun haɓaka aikin crizotinib, kuma sun hana mutuwa ta mutuwa ta hanyar ciwon ciwon ƙwayar cuta saboda crizotinib. Ya bayyana a gaskiya ne kawai ga a-tocopherol, kuma ba wani nau'in bitamin E ba kamar y-tocopherol. Wannan ya ce, yawancin cibiyoyin bitamin E da wasu karin kayan bitamin wanda ya ƙunshi bitamin E sau da yawa suna da-tocopherol a matsayin jagora mai mahimmanci.
Hanyoyi na gefe na Jiyya
Kamar dai yadda yawancin jiyya na ciwon daji, magunguna kamar Xalkori suna da tasiri. Abin godiya da yawa daga cikin wadannan sun fi damuwa fiye da abin da mutane ke fuskanta a lokuta na gargajiya. Mafi yawan bayyanar cututtuka da mutane ke fuskanta akan Xalkori sun hada da matsalolin gani, cututtuka, tashin zuciya, rashin ƙarfi na numfashi, da gwajin aikin hanta mahaukaci. Wani sakamako mai tsanani amma mai tsanani wanda aka lura shine ci gaba da cututtuka na ƙwayar cuta wanda zai iya zama m.
Future
Gasar fuska ta ALK tana daya daga cikin maye gurbin da ke cikin kwayar cutar ciwon huhu. Ana fatan cewa idan waɗannan sun fi fahimta, sababbin magunguna za su zama samuwa wanda ba kawai zai magance juriya ba sai dai wasu matsaloli (maye gurbin direbobi) a cikin kwayoyin cutar kanjamau. Game da crizotinib, an yi tunanin cewa miyagun ƙwayoyi na iya taimakawa wasu mutanen da ba su da ALK fusion din amma suna da wasu magungunan tyrosine kinase mahaukaci (kamar gyaran ROS1 ).
Final Comments
Domin a yi amfani da magunguna don magance maye gurbin irin su ALK, dole ne a gwada mutanen da ke fama da ciwon huhu na huhu don maye gurbin. Yayinda sharuɗɗa na ba da shawara ga gwaji ga kowa da kowa tare da ci gaba da adenocarcinoma da kuma amfani da wannan fasaha yana karuwa, har yanzu akwai mutane da yawa waɗanda basu taɓa yin gwajin ba.
Akwai wasu dalilai na wannan. Ɗaya shine cewa wannan wuri ne mai saurin canzawa, kuma babu likita na iya zama a saman kowane sabon binciken. Tambayi tambayoyi. Yi ɗan bincike kadan (ko samun aboki ko ƙaunataccen bincike kan ƙwayar ka.) Ka yi la'akari da samun ra'ayi na biyu a cibiyar ciwon daji wanda ke ganin babban ɓangaren marasa lafiya na huhu.
- Yadda za a zabi Cibiyar Nazarin Ciwon Cutar Kyau
- Matakai na farko Lokacin da aka saba gano ku tare da ciwon huhu
- Yadda za a nemi shawara game da kanka da Ciwon daji
Wani damuwa shine kudin. Sabbin sababbin magunguna da ke kawo ciwo a cikin kwayoyin cutar Kanada sau da yawa sukan zo tare da farashin farashi. Amma akwai zaɓuɓɓuka akwai. Ga wadanda basu da asibiti, akwai gwamnati da kuma shirye-shirye na sirri wanda zasu taimaka. Ga wadanda suke tare da inshora, shirye-shiryen taimako na kyauta zai iya taimakawa wajen rage farashin. A wasu lokuta, mai sana'a na miyagun ƙwayoyi zai iya samar da magunguna a rage farashin. Kuma mahimmanci, a matsayin mai shiga tsakani a gwajin gwaji , magungunan magunguna, da kuma ofisoshin ofisoshin, ana ba da kyauta kyauta.
A matsayi na ƙarshe, komai komai da kayi koya daga ƙungiyar likita, babu wani abu kamar sauraro daga mutanen da suka kasance a can kuma sun karbi jiyya da za ka samu. Bincika kungiyoyin tallafi ga mutanen da ke fama da ciwon huhu da mahaifa kuma ku tambayi idan wani ya sami maye gurbin ALK. Wasu kungiyoyi irin su LUNGevity suna da sabis na daidaitawa (LUNGevity LifeLine) wanda zasu iya wasa da ku tare da wani wanda ke fama da ciwon huhu na huhu wanda yana da irin wannan tsari da mataki na tumo.
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