Jarabawa mai ban sha'awa ga wadanda ke fama da ciwon huhu na huhu
Duk da yake chemotherapy yana kama da kwayoyin halitta kamar ciwon daji wanda ke hanzari cikin jiki, immunotherapy yana ci gaba da tsarin kwayoyin cutar mutum, yana karfafa shi don ganewa da kaiwa kan kwayoyin cutar kanjamau a kansa. A wasu kalmomi, immunotherapy yana ba da damar mutum ya yi amfani da kayan aikinsa na musamman (lafiyarsu) don magance ciwon daji.
Ga mutanen da ke ciwon ciwon ciwon huhu na kananan kwayoyin cutar (NSCLC), bisharar ita ce, matasan immunotherapies sun kasance kuma masu ci gaba da ci gaba da bunkasa su.
Wadannan hanyoyin kwantar da hankali, ba shakka, ba su warke ciwon huhu ba, amma zasu iya taimaka maka ko ƙaunatacciyarka ya fi kyau kuma har ma ya rayu tsawon lokaci.
Lung Cancer Terms
Kafin yin amfani da immunotherapies da ake amfani dasu don kula da NSCLC mai zurfi, yana da muhimmanci a ayyana wasu kalmomi da suka shafi ciwon daji na huhu.
Mene Ne Ciwon Kwayar Wutar Kwayoyin Kwayoyin Cutar Kasa (NSCLC)?
Akwai magunguna biyu na ciwon huhu : ƙwayar ciwon huhu da ƙananan ciwon ƙwayoyin ƙwayoyin cuta, ba tare da ƙananan tantanin halitta ba. A gaskiya ma, kimanin kashi 80 zuwa 85 na kwayar cutar huhu ne marasa ciwon ƙwayar cutar kwayar cutar.
Lokacin da kake ji kalmar "ciwon huhu na huhu" da ake amfani dashi, mutum yakan saba da ciwon daji na ƙananan ƙwayoyin cutar, ko da yake wannan ba gaskiya ba ne.
Mene Ne Ciwon Kwayar Ciwon Kwayoyin Tsuntsar Ƙwayar Kwayar Kwayoyin Kwayoyin Cikin Kwayoyin Ciki (NSCLC)
A cikin ƙananan ƙwayoyin cutar ciwon huhu, ƙwayar cuta (ciwon daji) kwayoyin halitta suna girma da sauri kuma ba a iya ganewa ba don samar da ƙwayar cuta a cikin jikin kwayar huhu. Yayin da ciwon daji ke tsiro, zai iya fara yadawa zuwa ƙwayoyin lymph, da kuma wuraren da ke cikin jiki kamar kwakwalwa, kasusuwa, hanta, ko sauran ƙwayar.
Bisa ga yawan gwaje-gwaje (alal misali, kwayar cutar ta kwayar cutar da ƙwaƙwalwar hoto kamar CT scan), mataki na NSCLC ya ƙayyade. NSCLC mai mahimmanci gaba ɗaya yana nufin mataki na III ko mataki na IV , wanda ke nufin ciwon daji ya yada zuwa wasu takunkumi na lymph da / ko zuwa shafuka masu nisa (wannan ake kira metastasis ).
Menene Kayan Kayan Gidajen Kayan Gida?
Domin fahimtar immunotherapy, yana da mahimmanci a fahimci abin da ba a kula da su ba, kamar yadda wadannan kwayoyin da kwayoyin cutar kanjamau suke cike da cutar.
Kwanan nan ba a gano jigilar tsarin kula da tsarin suturar jikin mutum ba, kuma suna hana tsarin rigakafin mutum daga tayar da kwayoyin lafiya, Kwayoyin jiki kawai, kawai kasashen waje, ƙananan kwayoyin halitta (kamar kamuwa da kwayar cutar).
Ciwon daji yana da ƙyama, duk da haka, saboda hanyar daya da ta guje wa tsarin ta'addanci ta kai hari shi ne ta hanyar yinwa da bayyana wadannan sunadarai masu bincike. Amma ciwon daji na immunotherapies yayi aiki don toshe wadannan sharuɗɗa don ganin jiki ya gane ciwon daji kamar yadda ya zama na waje kuma ya kai farmaki akan shi.
Immunotherapy for Ciwon Daji: PD-1 Antibody
Ɗaya daga cikin mahimman tsarin bincike na rigakafi da NSCLC ya kaddamar da shi shine shirin kisa 1 (PD-1), mai karɓa wanda ke kasancewa akan sel T amma ana iya yin shi kuma ya bayyana ta kwayoyin cutar kanjamau.
Yawancin lokaci, wannan mahimmin dubawa ta ɗaure ne a shafin yanar gizo na ciwon huhu, don haka tsarin rigakafin yana hana yaduwar ciwon daji. Amma tare da kwayoyi da toshe PD-1, tsarin na rigakafi zai iya amsawa kuma ya kai hari kan kwayoyin cutar kanjamau.
Akwai magungunan kwayoyi guda biyu da suka hada da kwayoyin PD-1 (ko PD-1 masu zanga-zangar dubawa), kuma su ne FDA-sun yarda don magance NSCLC ci gaba.
Duk waɗannan kwayoyi suna ba da su a matsayin infusions (ta hanyoyi) kowane mako biyu zuwa uku. Wadannan kwayoyi biyu sune:
- Nivolumab
- Pembrolizumab
Binciken Nivolumab
A matsayin PD-1 antibody, nivolumab an yi nazari a cikin dama gwaji a cikin mutane tare da NSCLC ci gaba. Alal misali, wani bincike na zamani na zamani na 2015 na New England Journal of Medicine idan aka kwatanta da magani tare da maganin jiyya da magani tare da docetaxel a cikin mutanen da NSCLC masu ci gaba suka ci gaba a lokacin ko bayan sun amince da tsarin tsarin chemotherapy na platinum. Sakamakon ya nuna cewa wadanda suka karbi nivolumab sun rayu fiye da wadanda suka karbi docetaxel-rayayyen kwakwalwa na watanni 9.2 a cikin rukuni na nivolumab tare da watanni 6 a cikin ƙungiyar docetaxel.
Kamar yadda yake da shi, Taxotere (docetaxel) wani maganin rigakafi ne da aka ba wa mutane tare da NSCLC da aka ci gaba da ci gaba, don haka wannan binciken yana kwatanta wani littafi na immunotherapy zuwa halin kula da lafiyar chemotherapy na yanzu.
Bugu da ƙari, amfani da rayuwa, an yi la'akari da cewa nivolumab ne mafi aminci fiye da docetaxel a cikin wannan binciken-abin da yake mai kyau, saboda babban damuwa da immunotherapies ita ce tsarin rigakafi na mutum zai kai hari ba kawai kwayoyin cutar kanjamau ba amma gabobin lafiya.
Daya daga cikin manyan cututtuka da likitoci suke damu da maganin ciwon daji shine pneumonitis, wanda shine lokacin da miyagun ƙwayoyi ke haifar da kumburi na huhu (ba kamuwa da cuta ba, wanda kuke gani da ciwon huhu). Doctors sun damu sosai game da pneumonitis saboda yana rinjayar aikin huhu, wanda ya riga ya ragu a cikin ciwon huhu na huhu. A cikin wannan binciken, pneumonitis ya faru sau da yawa a cikin rukuni na nivolumab kuma yana da mummunan rauni lokacin da ya faru.
Wannan ya ce, wasu cututtukan cututtukan (wanin pneumonitis) da alaka da nivolumab cewa likitoci suna kallo don sun hada da:
- Matsarar fata (misali, rash da itching)
- Matsalar narkewa (misali, zawo)
- Abubuwa masu guba suna rayuwa a cikin gwajin jini
- Matsalar Thyroid
- Jiko-halayen halayen
Bayani na Pembrolizumab
Pembrolizumab shine FDA ta amince da kula da NSCLC mai ci gaba a cikin mutanen da ba su da wani cututtukan kwayoyin cutar ciwon daji ( maye gurbin EGFR ko ALK translocation ) kuma wanda akalla rabi jikinsu suna da kyau ga PD-L1. PD-L1 shine sunadaran da ke danganta zuwa PD-1 a jikin T, yana hana su daga kaiwa kwayoyin cutar kanjamau.
Har ila yau, an yarda Pembrolizumab ya bi da NSCLC wanda ba shi da kyau sosai ( adenocarcinoma ) tare da chemotherapy, ba tare da yaduwar kwayoyin tumo ba domin PD-L1.
A cikin binciken shekarar 2016 a cikin New England Journal of Medicine , mutanen da suka samu ci gaba da NSCLC da PD-L1 a kan akalla kashi 50 cikin kwayoyin jikinsu sun sami cigaba da rayuwa mai ci gaba (10.3 watanni zuwa watanni 6) tare da rashin rinjaye ( mafi aminci) fiye da mutanen da ke fama da maganin maganin maganin ƙwayar maganin platinum na gargajiya.
Musamman, rayuwa ta ci gaba ba ta kasancewa a lokacin da marasa lafiya suka bazu don karɓar pembrolizumab ko chemotherapy, ko dai ma'anar da cutar ta ci gaba ko mutuwar ta faru.
A cikin wannan binciken, an samu mummunar tasiri a cikin kashi 27 cikin dari na wadanda ke karbar pembrolizumab zuwa kashi 53 cikin dari na wadanda ke karbar ilimin chemotherapy.
Bisa ga al'amuran, sakamakon da yafi rinjaye a cikin wadanda ke fama da pembrolizumab shine:
- Diarrhea
- Wulo
- Fever
Kwayar cuta ya faru a cikin ƙungiyar pembrolizumab a matakin da ya fi girma fiye da ƙungiyar chemotherapy (kashi 5.8 bisa kashi 0.7).
Immunotherapy for Ciwon daji na huhu: PD-L1 Antibody
Atezolizumab wani magani ne na FDA don magance mutane tare da NSCLC mai cike da cutar wanda cutar ta ci gaba da tsananta ko a lokacin ko bayan sun ɗauki maganin maganin chemotherapy .
Atezolizumab ya bambanta da nivolumab ko pembrolizumab a cikin cewa yana da wani PD-L1 antibody. A wasu kalmomi, musamman ya sa ran PD-L1, furotin da ke danganta ga PD-1 (mai karɓa a kan kwayoyin T), yana hana su daga kayar da kwayoyin cutar kanjamau. Kamar sauran magunguna guda biyu, ana ba da atezolizumab a matsayin jiko.
A cikin nazarin 2017 a Lancet, mutanen da suka samu kafin maganin ƙwayar maganin platinum don NSCLC masu ci gaba sun kasance bazuwar don samun ko dai atezolizumab ko docetaxel.
Wasu sakamako masu ban mamaki sun nuna cewa an sami ingantaccen rayuwa a cikin mutanen da suka karbi atezolizumab da docetaxel, koda kuwa kwayoyin tumatir ko kwayoyin da ke fama da kwayar cutar sun kasance tabbatacce ga PD-L1 (tsakiyar watanni 13.8 da atezolizumab da watanni 9.6 tare da docetaxel ).
Bugu da ƙari, ana ganin cututtukan da suka shafi mummunar cututtuka a cikin kungiyar atezolizumab, idan aka kwatanta da ƙungiyar docetaxel (kashi 15 cikin dari zuwa kashi 43).
Wannan ya ce, abubuwan da ke faruwa a cikin mutanen da suke karɓar atezolizumab sune:
- Wulo
- Jiɗa
- Rage ci
- Rashin rauni
Kwayar cuta ya faru a cikin kashi 1.6 cikin 100 na marasa lafiya a cikin ƙungiyar atezolizumab, wanda yake da ƙasa, kuma ƙasa da kashi 1 cikin 100 na da tsanani (sa 3 ko 4) pneumonitis.
Immunotherapies a kan Horizon
Yana da mahimmanci a lura cewa akwai wasu maƙallacin magunguna masu yawa wadanda aka tsara. Mahimmanci don ƙaddamar da rawar da suke takawa wajen magance ku ko ciwon daji na ciwon ciwon huhu da ke ƙaunataccen wanda aka bayyana ta hanyar yadda wadannan kwayoyi ke yi a cikin binciken na III.
Alal misali, an riga an gano rigakafin rigakafi a cikin bututun da ake kira ipilimumab don tsawanta rayuwa a cikin mutane tare da melanoma . Wannan miyagun ƙwayoyi yana nufin T-lymphocyte antigen 4 na cytotoxic (CTLA-4), wanda shine mai sarrafawa na farko na yadda kwayoyin T ke aiki a cikin tsarin rigakafi. Ana nazarin Ipilimumab a matsayin magani don NSCLC mai ci gaba a hade da chemotherapy.
Kalma Daga
Babu shakka cewa wasu cututtuka (kamar cutar ciwon huhu) ba kawai girma cikin hanzari ba kuma ba a iya fahimta ba, amma zai iya ɓacewa ko ƙira, don yin magana, tsarin kare lafiyar mutum, tsarin su na rigakafi.
Wancan ya ce, masana masu fama da ciwon daji yanzu suna da hannu tare da gano magungunan immunotherapies-wani sabon juyin juya hali wanda zai ci gaba da canza yadda muke maganin ciwon daji a nan gaba.
A ƙarshe, ƙayyade yadda za a bi da ciwon huhu na huhu shine tsari ne mai rikitarwa da kuma biyan haraji, kuma wani lokaci, karin magani ba koyaushe ne amsar amsar ba. Da fatan a tabbata ka tattauna batutuwanka, tsoro, da damuwa da iyalinka da likita.
> Sources:
> Cibiyar Ciwon Ƙwayar Yammacin Amirka. (2017). Immunotherapy ga marasa ƙananan ƙwayar cutar ciwon ƙwayar cuta.
> Farawa S. (Yuni 2017). Immunotherapy na ƙananan ciwon huhu na kwayar cutar da ciwon daji ba tare da yaduwa ba. A cikin: UpToDate, Jett JR, Lilenbaum RC, Schild SE (Eds), UpToDate, Waltham, MA.
> Reck M et al. Pembrolizumab dangane da ilimin chemotherapy don PD-L1 Kwararren ƙwayar cutar ƙwayar ƙwayar ƙwayar cuta mai ƙwayar cuta. N Engl J Med . 2016 Nov 10; 375 (19): 1823-33.
> Rittmeyer A et al. Atezolizumab versus docetaxel a cikin marasa lafiya da ciwo da ciwon huhu na ƙananan ƙwayoyin cuta (OAK) da aka biyo baya: wani lokaci 3, bude-lakabi, jarrabawar gwaji mai sauƙi. Lancet . 2017 Janairu 21; 389 (10066): 255-65.
> Sundar R, Cho BC, Brahmer JR, Soo RA. Nivolumab a cikin NSCLC: shaidun da suka gabata da kuma asibiti. Ther Adv Mad Oncol . 2015 Mar; 7 (2): 85-96.