Sabbin hanyoyin kwantar da hankulan suna fitowa ne a madaidaicin gaggawa ga marasa lafiya da ciwon jini , ko rashin lafiyar jini , irin su cutar sankarar bargo , lymphoma, da myeloma .
Za'a iya ganin ci gaba da jiyya a ƙasa a matsayin matakan ƙananan, maimakon gagarumar ƙuƙwalwa; duk da haka, wadannan maganin zai iya ba da kariya ta rayuwa wanda zai iya zama ma'ana ga wadanda aka shafa.
A wasu lokuta, hanyoyin kwantar da hankali zai iya ci gaba da kasancewa da bege na bege-wanda za'a iya biyan magani kamar maganin suturar kasusuwa - amma kafin wannan, bazai kasance wani zaɓi ba.
Dole ne a yi la'akari da samun ci gaba a rayuwa tare da illa da kuma maye gurbi; A cikin wadannan yanayi, marasa lafiya suna so su zauna tare da su (ingancin rayuwa), kuma idan dai zasu iya (tsira).
Kwanan nan hanyoyin kwantar da hankalin
Drug | Ciwon Nazarin | Amfanin kwatantawa |
Inotuzumab zogamicin (Besponsa) | Rushewa ko ragowar B-cell ALL |
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Lenalidomide (Revlimid) | Newly bincikar asali myeloma |
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Daunorubicin da cytarabine liposome don allura (Vyxeos) | Sabuwar magungunan likitanci na AML (t-AML) AML tare da canje-canje na myelodysplasia (AML-MRC) |
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1. Inotuzumab Ozogamicin (Besponsa) don Ciwon sankarar barkewar Lymphocytic
Kimanin mutane 5,970 na cutar cutar sankarar lymphocytic mai tsanani (ALL) an yi tsammani a Amurka a shekara ta 2017, tare da kimanin 1,440 mutuwar a wannan shekara, in ji Amurka Cibiyar Cancer Society. Duk da cigaba a cikin shekarun da suka gabata a wajen maganin cututtuka daban-daban na jini, zane-zane ga marasa lafiya tare da ALL sun kasance marasa talauci.
Allogeneic ƙaddara-cell dashi ( kasusuwan karuwa daga mai bayarwa) yayi alkawarin, yiwuwar, magani ga tsofaffi da ALL. Duk da haka, akwai matsalolin da za a shawo kan su: low rates of complete remission with current chemotherapy tsarin. Tsarin shinge mai saukowa yana buƙatar cewa mutum ya sami cikakkiyar tsaguwa daga cutar, kuma rashin alheri, wannan yana nufin cewa ƙananan matasan da suka sake koma baya ko kuma marasa lafiya na B-cell ALL (cutar da ta dawo, duk da magani) zai iya samun dashi.
Sabili da haka, masu ci gaba da maganin ƙwayoyi suna neman sababbin kayan aiki don magance waɗannan kwayoyin cutar. Kashe Kwayoyin da ke da alamar da aka kira CD22 na iya zama ɗaya daga cikin kayan aiki, a yanayin da ya dace. CD22 shine kwayoyin da wasu kwayoyin halitta suke yi a cikin jiki kuma sun sanya su a cikin tantanin halitta, kamar su tags, a waje na tantanin halitta, a cikin tantanin halitta. A cikin marasa lafiya tare da B-cell ALL, ƙwayoyin kwayoyin halitta suna da wannan kwayar CD22 a cikin kimanin kashi 90 na lokuta - kuma waɗannan suna da kyau sosai a cikin kasuwancin maganin ciwon daji.
Inotuzumab ozogamicin (Besponsa) ita ce anti-CD22 monoclonal antibody da aka haɗe zuwa calicheamicin, wani wakili wanda zai iya kashe kullun da aka yi niyya.
Inotuzumab ozogamicin ana kiransa mai haɗuwa saboda yana da wani antibody da aka haɗe shi zuwa, ko kuma haɗuwa tare da, wani wakili wanda zai iya kashe kwayoyi. Ƙungiyar antibody na neman sel da ke da alamar CD22, kuma sashin ƙungiyar ya rushe cell din da aka yi niyya.
FDA ta amince da inotuzumab ozogamicin bisa tushen shaida daga jarrabawar gwaji inda masu bincike suka bincikar lafiyar lafiyar miyagun ƙwayoyi da kuma inganci idan aka kwatanta da wata mahimman tsari na chemotherapy. Wannan gwaji ya haɗa da marasa lafiya 326 wadanda suka sake komawa ko kuma sunyi watsi da B-cell ALL kuma waɗanda suka karbi daya ko biyu kafin maganin.
A cewar FDA, daga cikin mutane 218 da aka kwatanta da marasa lafiya, kashi 35.8 cikin dari wanda ya karbi inotuzumab ozogamicin ya sami cikakkiyar amsa, ga watanni 8.0; na marasa lafiya da suka karbi maganin rigakafi, kawai kashi 17.4 cikin dari ne kawai suka samu cikakkiyar amsawa, don watanni 4.9 na tsakiya.
Ta haka ne, inotuzumab ozogamicin wani muhimmin mahimmancin zaɓin magani ne don sake komawa ko ƙyama B-cell ALL.
Sakamakon kullun da ke tattare da inotuzumab ozogamicin sun haɗa da ƙananan matakan plalets (thrombocytopenia), ƙananan matakan wasu kwayoyin jinin (neutropenia, leukopenia), kamuwa da cuta, ƙananan matakan jini (anemia), gajiya, zubar da jini mai tsanani (zazzafan jini), zazzaɓi ( pyrexia), tashin zuciya, ciwon kai, ƙananan ƙwayoyin jinin jini tare da zazzaɓi (furotinen furotin), hasara na hanta (transaminases da / ko gamma-glutamyltransferase ƙãra), zafi na ciki, da kuma manyan bilirubin cikin jini (hyperbilirubinemia). Don ƙarin bayanan tsaro, duba cikakken bayanan bayanin.
2. Lenalidomide (Revlimid) Bayan Gyara a Multiple Myeloma
Tsare-gyaren gyare-gyare tare da lenalidomide wanda ya samo asali na kwayoyin hematopoietic (sashi na kasuwa ta hanyar bada kyauta) rage yawan mace-mace da kashi 25 cikin dari idan aka kwatanta da placebo ko lura tsakanin marasa lafiya da sababbin myeloma da aka gano, bisa ga sakamakon binciken bincike na meta-bincike.
McCarthy da abokan aiki sun bincikar bayanan marasa lafiya daga gwaje-gwaje na asibitoci guda uku daga Amurka, Faransa da Italiya. Wannan binciken ya hada da marasa lafiya da sababbin myeloma da aka samu wanda aka karɓa daga bishiyoyi wanda aka ba da kyauta (autologous) kashi biyu sannan kuma an kai 1,208 daga cikinsu tare da lenalidomide bayan haka, yayin da marasa lafiya 603 suka karbi wuri ko kuma ana lura da su, ko kuma aka kula.
Magunguna da aka yi da lenalidomide sun inganta rayuwa, ba tare da ci gaba da cutar ba, idan aka kwatanta da wadanda suka sami wuribo ko kallo (52.8 watanni da watanni 23.5). Kusan mutane 490 suka mutu. An sami gagarumar amfanar rayuwa a cikin ƙungiyar lanalidomide.
Mafi yawan yawan marasa lafiya a cikin ƙungiyar lanalidomide sun sami maganin rashin lafiya na farko na biyu da kuma mummunan ƙwayar cuta ta farko; Duk da haka, yawan ci gaba, mace-mace saboda duk abin da ya haifar, ko mace-mace saboda sakamakon myeloma duka sun fi girma a cikin wuri / dubawa.
3. Kayan shafawa-Haɗuwa da ilimin cututtukan kwayar cuta don cutar cutar sankarar myeloid mai tsanani
AML yana ci gaba da ciwon daji wanda ke farawa a cikin kasusuwan kasusuwa kuma yana da sauri ya sa yawan kwayoyin jini a cikin jini. Kimanin mutane 21,380 za a bincikar su tare da AML a wannan shekara, kuma kusan marasa lafiya 10,590 tare da AML zasu mutu daga cutar.
Vyxeos wani hade-hade ne da kwayoyin cutar shan magani daunorubicin da cytarabine wadanda zasu iya taimaka wa marasa lafiya su rayu fiye da idan sun sami magunguna guda biyu. FDA ta amince da Vyxeos don kula da tsofaffi da nau'i biyu na muraye sankarar myeloid m (AML):
- Sabuwar binciken likitancin AML (t-AML), da kuma
- AML tare da canje-canje na myelodysplasia (AML-MRC).
T-AML yana faruwa ne a matsayin maganin chemotherapy ko radiation a kimanin kashi 8 zuwa 10 na dukan marasa lafiya bi da bi don ciwon daji. A matsakaici, yana faruwa a cikin shekaru biyar bayan jiyya. AML-MRC wani nau'i ne na AML wanda ke hade da samun tarihin wasu cututtuka na jini da sauran maɓallin maɓalli a cikin kwayoyin cutar sankarar bargo. Dukansu marasa lafiya tare da t-AML da waɗanda ke tare da AML-MRC suna da raƙataccen rai.
A gwajin gwaji, marasa lafiya 309 da sababbin magunguna t-AML ko AML-MRC waɗanda aka bazu don samun Vyxeos ko kuma sunyi jiyya na daunorubicin da cytarabine, marasa lafiya da suka karbi Vyxeos sun rayu fiye da marasa lafiya waɗanda suka sami magunguna daban daban na daunorubicin da cytarabine (tsakani overall rayuwa 9.56 watanni vs. 5.95 watanni).
Abubuwan da suka shafi yawan jini sun hada da abubuwan jini (ciwon jini), zazzabi da ƙananan ƙwayar jini (furotin neutral), rash, kumburi na kyallen takarda (edema), tashin zuciya, ƙonewar mucous membranes (mucositis), da sauran cututtuka masu illa ciki har da matsalolin gastrointestinal , cututtuka masu tsanani da haukacin zuciya (arrhythmia).
> Sources:
> FDA News Release. FDA ta amince da sabon magani ga tsofaffi tare da sake komawa ko cutar kyakken jini ta lymphoblastic. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm572131.htm.
> FDA News Release. FDA ta amince da maganin farko ga wasu nau'i-nau'i-nau'i mai tsanani myeloid cutar sankarar bargo. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm569883.htm.
> FDA ta amince da sabon amfani da Lenalidomide a Multiple Myeloma. https://www.cancer.gov/news-events/cancer-currents-blog/2017/fda-lenalidomide-myeloma-maintenance.