Ka'idodin mu na yaudara ne na gaskiya - suna riƙe da kwayoyin halitta na jikinmu a karkashin iko; suna yakin basirar ƙwayoyin cuta, kuma sun samu nasarar kawar da mafi yawan cututtuka a lokacin da suke da matsala. Muhimmiyoyin binciken da aka samu a fagen rigakafi a cikin shekaru 20 da suka wuce sun haifar da sabon cigaba a hanyoyin kwantar da hankula wanda ke inganta ingantaccen tsarin aiki.
Juyin Halittar Immunotherapy
Kafin yin nazari akan hanyoyin rigakafin rigakafi don ciwon gurguwar ƙwayar cutar, lura cewa akwai wasu kuskuren da yawa da kuma yadda aka tabbatar da nasara a hanya don samun ciwon immunotherapy. Alal misali, FDA ta amince da interleukin 2 don melanoma shekaru 20 da suka wuce. Duk da cewa kawai kashi 10 cikin dari na mayar da martani da kuma mummunan cututtuka, interleukin 2 ya ba da kyakkyawar bege a lokacin da melanoma mai cin gashin kai ya kasance marar tabbas kuma ba a iya ba da shi ba. Magungunan ƙwayoyi ne ƙananan amma ƙarfafawa mai ƙarfafawa na gaba, mafi inganci, farfadowa.
A halin yanzu muna jin labarin rawanin da aka yi a cikin magunoma. Alal misali, kwanan nan, kafofin watsa labarun sun gaya mana cewa, za mu shirya wa Shugaba Jimmy Carter-ƙarshensa, wanda ya yi magunoma ya shiga cikin kwakwalwa. Sa'an nan kuma wata alama ce mai ban mamaki-wani sabon maganin rigakafin rigakafin rigakafi - ya sa shi ba shi da ciwo. Fake news? Ba komai ba. Ginin immunotherapy na zamani zai iya juyo cikin rashin jin daɗi zuwa cikin gafara.
Yaya aka samu ci gaba mai zurfi? An sami zurfin fahimtar fahimtarmu game da aikin da ake ciki a cikin tsarin. A cikin sauƙi, yanzu mun sani cewa tsarin rigakafi yana da manyan abubuwa uku:
- Kwayoyin tsarin, wanda ake kira TRegs, suna ci gaba da aiki na tsarin rigakafi daga barin fita daga cikin iko.
- Kwayoyin T-K sun kai hari kan kwayoyin cutar kanjamau kuma suka kashe su.
- Kwayoyin Dendritic suna aiki ne kamar kwayoyin halitta, ganowa da kuma gano ciwon daji sannan kuma suyi jagorancin tsarin na rigakafi don haka ya san wanene sel zasu hallaka. Kwayoyin Dendritic, bayan sun gano ciwon daji, suna shiryar da kwayoyin kisa akan "gida a" da kuma magance ciwon daji.
Shawarar ga Ciwon ƙwayar Ciwon Tsari
Ciwon ƙwayar cutar ciwon sankara ne dan takarar dan takara a cikin jam'iyyun adawa lokacin da FDA ta amince da shi a shekarar 2010. An amince da FDA bisa sakamakon sakamakon bazuwar, sau biyu, makafi, gwajin gwaji wanda ya nuna cewa Provenge inganta rayuwar rai maza da ciwon gurguntacciyar rigakafi da kashi 22.5 bisa dari.
Rahoton yana aiki ne ta hanyoyi masu ban sha'awa da ke inganta aikin dindritic cell. Kamar yadda muka gani a baya, kwayoyin dendritic sune "bloodhounds" na tsarin rigakafin, wanda zai iya yaduwa da kuma gano kwayoyin cututtuka. Shirin Provenge yana dogara ne akan hakar jini tare da leukapheresis don cire kwayoyin dendritic. Ana sarrafa wadannan kwayoyin a cikin layi, yana ba su damar gane acid prosthat acid phosphatase (PAP) -a siffar kwayoyin halitta da aka samo a kan jikin kwayoyin cutar kanjamau. Da zarar an kunna, ana amfani da kwayoyin dendritic zuwa cikin jinin jini inda zasu zuga kwayoyin T masu kisa don ganewa da kuma kai farmaki ga kwayoyin cututtuka, tun da an ba su damar gano fasalin fasalin PAP da kuma amfani dashi azaman manufa.
Ana iya ɗaukar hukunci a matsayin mafi mahimmanci a maganin ciwon maganin ciwon daji saboda dindritic sel an cire su daga jinin kowane mai haƙuri, an inganta su a dakin gwaje-gwaje don magance ciwon daji na prostate, sa'an nan kuma mayar da su a cikin wannan haƙuri. Abin farin ciki kamar yadda wannan fasahar ya ji yana iya zama mamakin jin cewa likitoci da marasa lafiya sunyi jin dadi sosai ga ra'ayin yin amfani da Provenge. Wannan tunanin da ya shafi yin amfani da Provenge ya kasance ba tsammani a lokacin da Provenge ya fara samuwa a kasuwa, ya ba da sanannun yawan hanyoyin magance matsalolin maganin cutar kamar su Graviola, namun kaza, pau de arco, da kuma Essiac.
Don me yasa akwai jinkirin yin amfani da FDA yarda da irin tsarin farfadowa?
Critics
Masu faɗakarwa sun nuna cewa Provenge yana da tsada kuma cewa yawancin mai karɓa yana rayuwa ne kawai a wata uku ko hudu. Duk da haka, a cikin ainihin duniya na ciwon daji (ba a duniya na gwaji gwaji), wannan ba daidai ba ne zato. Maza maza da ke shiga gwaje-gwaje na asibiti ba wakiltar marasa lafiyar masu ciwon karuwanci ba ne wadanda ke yarda da hanyoyin kwantar da hankalin FDA. Yawanci, mutanen da ke fuskantar gwaji na asibiti suna da ciwo mai yawa. Wannan kuwa shi ne saboda marasa lafiya suna jinkirta shiga gwaji na asibiti har sai bayan tsararrun maganin kasa.
Sabili da haka, rayuwar mutane a gwajin gwagwarmaya ta zama ɗan gajeren gajere, ba tare da la'akari da nau'in magani da ake gudanarwa ba. Duk da haka, duk wani maganin da aka tabbatar da tsawon rai a karkashin waɗannan yanayi mara kyau ya zama dole. Wannan shine dalilin da ya sa magunguna da ke nuna tsira daga rayuwa sun sami amincewar FDA. Ma'anar ita ce, magani zai nuna mafi kyau sakamakon idan aka yi amfani da su a wani mataki na baya.
Jiyya a Yanayin Bambanci
Shafin da Provenge ke da babbar tasiri idan an yi amfani da ita don maganin cutar ta prostate a wani mataki na farko an bincike shi ta hanyar sake nazarin bayanan asali wanda ya jagoranci FDA ta amince da shi. Sakamakon sake dubawa ya nuna cewa mutanen da ke fama da cutar ta farko sun kasance sun fi girma a kan rayuwa. A gaskiya ma, adadin yawan rayuwa ya ci gaba da girma a lokacin da aka fara gabatar da Provenge.
A cikin wannan reanalysis, ƙungiyoyi hudu na maza, waɗanda aka tsara ta hanyar PSA daban-daban a farkon farautar Provenge, an kiyasta su: maza da PSA da ke ƙasa da 22, maza da PSA tsakanin 22 da 50, maza da PSA tsakanin 50 da 134, da maza tare da PSA fiye da 134.
Teburin da ke ƙasa ya taƙaita rayuwar mutanen da aka yi da Provenge, idan aka kwatanta da mutanen da aka bi da su tare da placebo, wanda aka raba ta hanyar PSA a farkon Shari'ar. Yawancin bambancin rayuwa (a cikin watanni) tsakanin Provenge da placebo an jera a karshe.
Level PSA | ≤ 22 | 22-50 | 50-134 | > 134 |
|---|---|---|---|---|
Yawan marasa lafiya | 128 | 128 | 128 | 128 |
Sakamakon fansa | 41.3 | 27.1 | 20.4 | 18.4 |
Pla cebo | 28.3 | 20.1 | 15.0 | 15.6 |
Bambancin Rayuwa | 13.0 | 7.1 | 5.4 | 2.8 |
Kamar yadda teburin ya kwatanta, an samu ci gaba ga dukan yankunan da ake bi da laifi a kan waɗanda aka yi wa mazauninsu. Duk da haka, yawan ci gaba na rayuwa ya fi girma a cikin maza da suka fara Shari'ar lokacin da PSA ta kasance mafi ƙasƙanci. Maza da suka fara Shari'ar a lokacin da PSA ke da shekaru 22 ya rayu watanni 13 da maza fiye da maza a irin wannan mataki da aka sanya su. Maza a matakai na ci gaba sosai, tare da matakin PSA sama da 134, kawai sun rayu wasu 'yan watanni fiye da maza da suka sami placebo.
Aikace-aikacen
Ma'aikata sun yi tambaya game da ingancin Shari'a don wani dalili. Yawancin nau'ikan tasirin ciwon kwari, kamar maganin hormonal da chemotherapy, haifar da raguwa a matakin PSA. Amma tare da Provenge, wannan yawanci ba haka bane. Saboda haka, mutane suna mamakin, ta yaya za a iya shawo kan rayuwa?
Sun manta da cewa tasirin maganin ƙwayar cutar ta prostate, irin su chemotherapy da damuwa na hormon, yana ci gaba da ci gaba da aikace-aikace. Da zarar an dakatar da magani sai maganin maganin anticancer ya dakatar da ciwon daji ya ci gaba.
Tsarin na rigakafi, a gefe guda, da zarar an kunna, yana da ci gaba mai gudana. Sabili da haka, koda Shari'ar yana haifar da jinkirin cigaba a ci gaba na ci gaba, tun lokacin da ake ci gaba da ci gaba yana da tasiri mai yawa akan sauran saurayin rayuwa. Kuma mafi tsawon mutum yana rayuwa, mafi girman girman amfanin.
Cutar Cancer Metastases
Bisa ga bayanan da aka gabatar a cikin teburin da ke sama, ɗaya ya yi mahimmanci cewa ya kamata a fara gabatar da laifin nan gaba a cikin wani mutum da aka gano da ciwo mai karfin ciwon sankara . Abin baƙin ciki, kamfanonin inshora sunyi amfani da maganin ƙwararrun mutane bayan da maza suka inganta juriya (Lupron) da ciwon daji. Tunda a mafi yawan lokuta juriya na hormone ya faru a gaban lokuttuka, maza da suka dawo da cutar ciwon gurgu da ke kula da PSA tare da Lupron ya kamata su kasance a kan ido don tashi daga PSA. An tabbatar da juriya a matsayin tashi a PSA yayin da yake kan Lupron ko kowane likitancin Lupron.
A farkon nuni da cewa PSA fara tashi, maza ya kamata su fara bincike mai karfi ga metastases. A halin yanzu, labaran PET shine hanya mafi kyau don gano metastases yayin da PSA har yanzu yana cikin ƙananan layi, ya ce ƙarƙashin biyu. Akwai nau'i daban-daban iri-iri na PET don la'akari ta yin amfani da su: Harshen F18, Axumin, C11 acetate, C11 choline, ko PSMA Gallium68. Idan wadannan saurin sun kasa gane cutar ta farko a farkon su, za'a sake maimaita su a kowane watanni shida har sai an gano cutar ta hanyar ƙaddamarwa, bayan haka sai a fara samo asali.
Wani Irin Immunotherapy
A cikin shekaru 30 da suka wuce, yawancin kokarin da ake yi na rigakafi sun kasa. Mun fara koyi cewa wadannan lalacewa sune saboda yawancin aikin da aka tsara na tsarin tsarin rigakafi. Duk lokacin da jiki ya haifar da wani sabon aikin da ba shi da wata matsala, aikin da kansa ya motsa tsarin da ya dace don shafe ƙirar ba ta da amsa. Wannan shine don hana ci gaban cututtukan cututtuka masu lalacewa irin su lupus, arthritis na rheumatoid, ko siklerosis masu yawa.
Yanzu masu bincike sun koyi cewa kwayoyin cutar kanjamau sunyi amfani da wannan tsari na tsarin rigakafin ta hanyar masana'antu ta hanyar maye gurbin hormones. Wadannan hormones sun lalata tsarin rigakafi don barci, saboda haka yasa kwayoyin cututtuka su kara girma ta wurin ajiye tarin T a kullun. Kwayoyin tsarin, kwayoyin Treg, suna "sace" kuma an yi amfani dashi don garkuwa don rage aikin aikin anticancer na rigakafi. Wannan rashin yiwuwar tsarin rigakafi don magance ciwon daji ba saboda rashin karfi ba ne; Maimakon haka, yana da rinjaye daga maye gurbin ƙarin aiki da aka samar da kwayoyin cutar ciwon daji. Tare da wannan sabon fahimtar, an tsara wasu magungunan ƙwayoyi masu mahimmanci domin su biya wannan matsala.
Yervoy magani ne, wanda FDA ta amince don magance melanoma. Ayyukan Yervoy ta hanyar hana CTLA-4, mai sauya "canzawa" a kan farfajiyoyin Treg. Lokacin da wannan canji ya kasance "a kan," an ƙaddamar da aikin ƙaddara kuma an kawar da tsarin na rigakafi. Lokacin da Yervoy ya sauya CTLA-4 "a kashe," an hana aikin hanawa na jikin Treg kuma an inganta tasirin tasiri akan tsarin aiki.
Binciken farko na kimanta Yervoy a cikin maza da ke fama da cutar ta prostate ya nuna alƙawarin, musamman idan an hade shi da radiation (duba ƙasa). Duk da haka, ƙididdigar da aka yi kwanan nan sun nuna cewa wata magungunan ƙwayoyin da ake kira Keytruda na iya aiki mafi kyau.
Keytruda ya kaddamar da wani tsarin canzawa mai suna PD-1. Binciken farko a marasa lafiya na prostate sun nuna cewa Keytruda zai iya haifar da sakamako mafi girma fiye da Yervoy, kuma zai haifar da ƙananan tasiri a cikin taya. Idan an tabbatar da wannan binciken na farko tare da Keytruda, hade tare da Keytruda da Provenge na iya zama hanya mai kyau don kara inganta aikin maganin anticancer na tsarin rigakafi.
Ƙafin Farko
Radiation, wanda aka ba da umurni a kan ƙwayar metastatic wanda aka samo shi ta hanyar binciken, wata hanya ce ta iya motsa tsarin ta hanyar rigakafi ta hanyar da ake kira sakamako na Abscopal. Lokacin da katako na radiation ya rushe Kwayoyin tumatir, kwayoyin tsarin tsarinmu na kusa da mummunan ciwo kuma cire cirewar tarkacewar salula. Sakamakon sakamako na karshe ya ƙunshi ƙwayoyin rigakafi da farko da gano kwayoyin ƙwayar ƙwayar ƙwayoyin tumatir akan ƙwayoyin ciwon sukari da ke mutuwa sannan sa'annan sa'annan ya fara gano ciwon daji a wasu sassa na jiki ta yin amfani da irin kwayoyin kwayoyin cutar kamar cibiyoyin.
Akwai hanyoyi masu kyau ga radiation-induced immune far:
- Lokacin da aka gudanar da hankali kuma da fasaha babu ainihin tasiri.
- Dukkanin inshora ya rufe nau'in kulawa.
- Rashin wutar lantarki yana da iko sosai don kawar da kututtukan da aka yi niyya.
- Yana da saukin haɗuwa da radiyo tare da Provenge, Keytruda ko duka biyu.
Kalma Daga
Saninmu game da maganin rigakafi na ciwon gurguwar ƙwayar cuta yana ci gaba da sauri amma har yanzu yana cikin jariri. Duk da haka, yana da ban sha'awa don gane cewa muna da abubuwa da yawa masu tasiri a cikinmu. Kalubalen da ke ci gaba shine koyo yadda za a iya amfani da waɗannan kayan aikin da kyau, ko dai ta kansu ko a hade da juna. Ka kasance tare da likitanka game da tsarin zaɓin immunotherapy don sanin idan sun dace maka.
> Sources:
> Higano, Celestia S. "Sipuleucel-T: Tsarin Kwayoyin Lafiyar Na'urar Aiki na Autologous don Tsarin Ciwon Magungunan ƙwayar Cutar Gubar Ciki." A Ciwon Drug Management of Ciwon Tsari , shafi na 321-328. Springer New York, 2010.
> Kantoff, Philip W., Celestia S. Higano, Neal D. Shore, E. Roy Berger, Eric J. Small, David F. Penson, Charles H. Redfern et al. "Sipuleucel-T immunotherapy don ciwon ciwon gurguwar karuwanci." New England Journal of Medicine 363, babu. 5 (2010): 411-422.
> Lipson, Evan J., Patrick M. Forde, Hans-Joerg Hammers, Leisha A. Emens, Janis M. Taube, da Suzanne L. Topalian. "Antagonists na PD-1 da PD-L1 a maganin ciwon daji." A cikin Seminars a kan ilimin halitta , kundi. 42, babu. 4, shafi na 587-600. WB Saunders, 2015.
> Silvestri, Ida, Susanna Cattarino, Sabrina Giantulli, Cristina Nazzari, Giulia Collalti, da Alessandro Sciarra. "A hangen zaman gaba na immunotherapy don ciwon daji na prostate." Cancers 8, ba. 7 (2016): 64.