R-EPOCH, wanda ake kira EPOCH-R, wani hade ne da ake amfani da shi don magance wasu bala'i, musamman ma wasu irin mummunan lymphoma ba Hodgkin .
Dokar miyagun ƙwayoyi ta ƙunshi wadannan jami'ai:
- R = Rituximab
- E = Etoposide phosphate
- P = Prednisone
- O = Vincristine sulfate (Oncovin)
- C = Cyclophosphamide
- H = Doxorubicin hydrochloride (Hydroxydaunorubicin)
R-EPOCH vs. R-CHOP
Idan kun riga kun san R-CHOP , tsarin da aka saba amfani dashi don lymphoma ba na Hodgkin, to, zaku iya tunanin R-EPOCH a matsayin "scrambled" version na R-CHOP tare da wasu bambance-bambance kaɗan.
Rubuce-gwaje-gwaje ya bambanta da R-CHOP ba kawai a cikin adadin etoposide ba, amma har ma a ba da izini na kayan aikin ilimin chemotherapy da kuma allurai ga jiki.
A cikin R-EPOCH, ana amfani da chemotherapies a wurare masu yawa a cikin tsawon lokaci-kwana hudu. Wannan ya bambanta da R-CHOP na gargajiya, inda a kowane juyayi, ana fito da CHOP gaba ɗaya, a cikin tsarin da ake kira bolus-type.
Mene ne DA-R-EPOCH?
DA-R-EPOCH, wanda ake kira DA-EPOCH-R, ya bayyana wani tsarin da aka gyara da gyaran kafa, da mahimmanci, vincristine, cyclophosphamide, doxorubicin (da rituximab). A cikin wannan bambance-bambancen tsarin, an gyara matakan chemotherapies don kokarin ƙoƙarin ƙarfafa inganci.
An kafa tsarin shirin DA-EPOCH a Cibiyar Cancer ta Kasa (NCI) bisa ga tsammanin cewa ingantawa da zabin miyagun ƙwayoyi, jigilar miyagun ƙwayoyi, da kuma bayyanar miyagun ƙwayoyi game da kwayoyin cutar ciwon daji zai haifar da kyakkyawan sakamako fiye da tsarin CHOP a marasa lafiya tare da m wadanda ba Hodgkin lymphoma.
An kafa tsarin jigilar jigilar haɗin gwargwadon 96, inda aka gudanar DA-EPOCH kowane kwana 21.
Dose gyara zuwa doxorubicin, etoposide, kuma cyclophosphamide an yi su ne bisa ƙididdiga mafi ƙasƙanci (cikakken neutrophil count nadir) a cikin sake zagayowar baya.
Binciken kan R-EPOCH don DLBCL Subsets
An hada rukunin lymphomas zuwa manyan sassa biyu: lymphoma Hodgkin (HL) da lymphoma non Hodgkin (NHL). Kaddamar da babban lymphoma na B-cell (DLBCL) shi ne NHL mai yawancin B-cell, wanda yake wakiltar kashi 30 zuwa 35 cikin dari kuma yana shawo kan marasa lafiya a duk shekaru daban-daban.
Ƙungiyar Lafiya ta Duniya (WHO) ta ware DLBCL a cikin manyan sassa hudu. Mafi yawancin rukunin-DLBCL ba'a kayyadewa-za'a iya raba su cikin ƙananan subtypes guda uku bisa ga asalin tantanin halitta, ciki har da cibiyar B-cell-like (GCB), B-cell (BBC) mai aiki da kuma B-cell lymphoma (PMBL).
A wasu kalmomi, lokacin da kake duban matakin kwayoyin, DLBCL wata ƙungiyar lymphomas ne daban daban da kuma daban-daban na DLBCL na iya samun gwaji daban-daban tare da magani . Bugu da ƙari, an kwatanta nau'in lymphoma mai tsanani da ake kira "double hit" lymphoma. DHL yana da ƙayyadaddun ƙwayoyin cuta waɗanda zasu iya rinjayar sakamakon. Yin amfani da duk waɗannan bayanan game da DLBCL na iya canzawa jiyya, amma wannan a halin yanzu yana da wani yanki da ba'a damu ba da batun batun bincike na ci gaba.
A wani lokaci, akwai bege cewa sakamakon da aka gyara R-EPOCH zai zama mafi girma ga R-CHOP kullum ga marasa lafiya da DLBCL. Ko da yake wannan har yanzu yana iya zama gaskiya a cikin takardun da aka zaba, ba ze zama shari'ar ba, akalla bisa shaidun da ke ciki.
Binciken masu halartar 524 idan aka kwatanta da inganci na R-CHOP da DA-R-EPOCH ya dace a magance marasa lafiya DLBCL, musamman a cikin GCB da ABC subtypes. An sanya masu halartar su karbi ko R- CHOP ko DA-EPOCH-R, kuma a cikin shekaru biyar da suka wuce, sakamakon rayuwa ya kasance daidai tsakanin kungiyoyi. DA-EPOCH ya nuna yawan ciwon haɗari, amma an sa ran hakan ne bisa girman girman karfi.
Duk da haka, masu bincike sunyi sauri don nuna cewa ana buƙatar ƙarin nazari don sanin sakamakon tasirin da ke kan takaddama na marasa lafiya da DLBCL.
DLBCL Tare da Magana mai Girma-67
Ki-67 shine alamar da aka yi amfani da shi a cikin wasu cututtuka kamar yadda aka haɓakawa-wato, alama ce ta ci gaban kwayoyin halitta game da rarrabawar sel. Tumatir da karuwa mai yawa ana sa ran za su sami babban ra'ayi na Ki-67.
An tsara tsarin tsarin jarrabawa a bangare bisa la'akari da cewa karawar ƙwaƙwalwar miyagun ƙwayoyi na iya haifar da ingancin antitumor mafi kyau fiye da tsarin bolus, kamar CHOP.
A cikin binciken da aka rigaya, an ƙaddara cewa marasa lafiya DLBCL tare da babban labaran Ki-67 sun sami amfaninsu daga iyakacin R-CHOP. Saboda haka, binciken da Huang da abokan aiki suka yi sunyi bincike ne ko R-EPOCH ya fi girma ga R-CHOP a cikin marasa lafiya DLBCL da ba a ba da izini ba.
Huang da abokan aiki sun gudanar da R-EPOCH a matsayin tsari na farko a cikin marasa lafiya na DLBCL tare da maganganu masu girma na Ki-67 kuma idan aka kwatanta tasirin maganin R-EPOCH da R-CHOP farfadowa a cikin wannan rukuni ta hanyar amfani da kwamiti guda biyu. Sakamakon su ya nuna cewa marasa lafiya da aka bi da tsarin R-EPOCH sun nuna mafi rayuwa fiye da waɗanda suke gudanar da tsarin R-CHOP, kuma sun kira don kara nazarin karatu don tabbatar da binciken da kuma gano masu yiwuwar nazarin kwayoyin halitta don amfani da su tare da R-EPOCH farfesa .
Biyu Hit Lymphoma
Siffofin lymphomas guda biyu, ko DHLs, asusu na kashi biyar zuwa 10 na DLBCL lokuta, kuma mafiya rinjaye za a iya sanya su a matsayi na cibiyar tsakiya na germinal kuma su bayyana genes BCL-2 (BCL-2 + / MYC +). Ƙananan ragowar DHLs sun bayyana BCL-6 (BCL-6 + / MYC +) ko kuma nuna duka BCL-2 da BCL-6 kuma an kira su lymphomas guda uku (BCL-2 + / BCL-6 + / MYC +).
Marasa lafiya tare da DHLs sau da yawa suna da nauyin haɓaka mara kyau, matsayi na IPI, da kuma shigar da kasusuwan kasusuwa ko tsarin kulawa na tsakiya. Tsarin tsarin mafi kyau ga DHLs ba'a sani ba; Duk da haka, marasa lafiya da suka karbi tsarin R-CHOP suna da matsala maras kyau, tare da yanayin rayuwa fiye da watanni 12.
A cikin nazari na sake dubawa, ci gaba da ci gaba da cigaba da cigaba da ingantaccen tsarin rayuwa, ya hada da DA-EPOCH-R, idan aka kwatanta da R-CHOP. Dokar DA-EPOCH-R ta haifar da ƙarin ƙimar da ya fi dacewa da tsaftacewa fiye da sauran tsarin tsabta.
Lymphoma Primary Primary Mediastyle (PMBL)
PMBL wani sashi na DLBCL wanda ke wakiltar kashi 10 cikin dari na lokuta na DLBCL. Yana da asibiti da kuma biologically alaka da nodular sclerosing Hodgkin lymphoma, wanda kuma taso daga thymic B-sel.
PMBL yana da mummunar tashin hankali kuma yana tasowa a cikin taro . Yawancin marasa lafiya suna da maye gurbin a cikin hanyar BCL-6. Tsararren immunochemotherapy ba tasiri ba ne, kuma mafi yawan marasa lafiya suna bukatar radiation radiation, wanda zai haifar da mummunar tasiri. Wannan ƙananan lymphoma ne mai ƙananan ba tare da yawancin binciken nazarin asibiti ba; Duk da haka, bayanan da aka mayar da baya a lokuta da suka gabata (nazarin bincike) ya nuna cewa mafi yawan kullimetherapy tsarin sun kasance sun fi tasiri fiye da R-CHOP.
A cikin nazarin da aka sake dubawa, kashi-kashi gazawa ga R-CHOP ya kashi 21 cikin dari, yana nuna cewa akwai bukatar samun magani.
DA-EPOCH-R tana amfani da dabarun janyo hanyoyi wanda ake amfani da kwayoyi da etoposide, doxorubicin, da cyclophosphamide don ingantaccen inganci. Sakamakon gwajin gwaji guda tare da DA-EPOCH-R, wanda masu bincike a NCI suka gudanar, wanda suka bi marasa lafiya 51 har tsawon shekaru 14, an buga su a cikin Afrilu 11, 2013, na New England Journal of Medicine .
Kwararru guda sittin da daya tare da lymphoma B-lymphoma na farko wadanda ba su da kyau sun haɗa su a wannan binciken. Dukkanin marasa lafiya biyu kawai sun sami cikakkiyar gyarawa tare da maganin DA-EPOCH-R, kuma babu wani daga cikin marasa lafiya wanda ya sami cikakkiyar farfadowa wanda ya samo asali na lymphoma. Wadannan marasa lafiya biyu wadanda ba su cimma cikakkiyar remission sun sami radiation ba kuma basu da ciwon sukari ba. Babu wani shaida na wasu cututtuka da suka taso daga baya ko kuma cututtuka masu guba.
Wani bincike da yawa na kananan manya tare da PMBL ya kwatanta lafiyar marasa lafiyar da ake bi da su tare da waɗannan tsarin (132 marasa lafiya da aka gano daga wuraren cibiyoyin 11; 56 R-CHOP da 76 DA-R-EPOCH). Duk da yake yawan tsaftacewa ya karu tare da DA-R-EPOCH (kashi 84 da kashi 70 cikin 100), waɗannan marasa lafiya zasu iya shawo kan abubuwan da ke fama da cutar. A shekaru biyu, kashi 89 cikin dari na marasa lafiya R-CHOP da kashi 91 cikin dari na marasa lafiyar DA-R-EPOCH sun kasance da rai.
R-EPOCH don Burkitt Lymphoma a marasa lafiya tare da / ba tare da HIV
Burkitt lymphoma yafi kowa a cikin kasashen Afirka mafi girma a kasashen Afirka. Burkitt wata cuta ce da take faruwa akai-akai a cikin marasa lafiya marasa lafiya. Cure rates for Burkitt lymphoma a ƙasashen yammacin Turai kusanci kashi 90 cikin yara, yayin da kawai 30 kashi zuwa kashi 50 na yara a Afrika suna warkewa saboda rashin iya aiki a cikin lafiya gudanar da babban magani.
An gabatar da jarrabawar Wilson da abokan aiki a Cibiyar Cancer ta Kasa (NCI) kuma sun bayyana a New England Journal of Medicine. Shari'ar ta shafi nau'o'i biyu na EPOCH-R, wanda ya hada da cigaba da yawa don rage yawan kwayoyi maimakon briefer gabatarwa zuwa mafi girma yawan kwayoyi.
Tamanin marasa lafiya da kwayar lymphoma na Burkitt da ba a yalwata ba sun haɗa su a cikin gwaji. Magunguna sun sami daya daga cikin nau'o'in EPOCH-R guda biyu, dangane da yanayin HIV. Sanda goma sha tara sun kamu da kwayoyin cutar HIV (DA) -EPOCH-R, yayin da 11 marasa lafiya HIV suka karbi SC-EPOCH-RR, wanda ke da gajeren hanya (SC) na bambancin EPOCH-R wanda ya hada da na biyu na rituximab da magungunan jiyya kuma yana da ƙaramin jiyya fiye da DA-EPOCH-R.
An gyara gyaran matakan da aka yi don yin kokarin samar da mafi yawan adadin miyagun ƙwayoyi bisa ga haƙuri mutum na chemotherapy. Babban magunguna da aka gani a cikin gwaji sun kasance zazzabi da neutropenia (ƙananan jinin jini); babu wani cututtukan da suka shafi kiwon lafiya ya faru. Tare da sauye-sauyen sauye-sauye na watannin 86 da 73, yawan rayukan rayuwa sun kasance kashi 100 da kashi 90 cikin 100, tare da DA-EPOCH-R da SC-EPOCH-RR.
Bisa ga waɗannan sakamakon, jarrabawa don tabbatar da ingancin EPOCH-R farfadowa a cikin balagagge da kuma likitoci na Burkitt lymphoma marasa lafiya.
Kalma Daga
An tsara tsarin da aka gyara-gyara-EPOCH a Cibiyar Cancer ta Cibiyar Cancer, bisa ga tsammanin cewa ingantawa da zaɓi na miyagun ƙwayoyi, bayarwa da kuma kamuwa da yaduwar cutar ta hanyar ciwon daji zai haifar da kyakkyawan sakamako fiye da tsarin CHOP a marasa lafiya tare da mummunan lymphoma ba Hodgkin.
Duk da yake akwai fatan farko cewa R-EPOCH zai cimma nasara mafi kyau fiye da R-CHOP gaba daya a marasa lafiya tare da DLBCL, yanzu mayar da hankali a kan yiwuwar wannan tsarin zai iya inganta sakamakon ga masu zaɓi marasa lafiya tare da DLBCL da sauran malignancies. Idan ka fada cikin wadannan sassan, tattauna zabin tare da likitanka.
> Sources:
> Curry MA, Liewer S. Yi wani zafin maganin jin dadi ga mummunan lymphoma ba na Hodgkin: tsarin R-CHOP da EPOCH-R. J Hematol Oncol Pharm . 2016; 6 (4): 145-152.
> Dunleavy K, Pittaluga S, Shovlin M, et al. Low-tsanani far a adult Burkitt lymphoma. N Engl J Med. 2013; 369 (20): 1915-25.
> Wilson HW et al. Hanya na III binciken binciken bazuwar R-CHOP tare da DA-EPOCH-R da kuma nazarin kwayoyin da ba a ba da izinin Hanya B-Cell Lymphoma: CALGB / Alliance 50303. 2016 Disamba 4; Oral Abstract # 469: ASH 58th Annual Taro da Exposition, San Diego, CA.