Shin ba zai zama mai girma ba idan likitoci zasu iya kallon ciwon daji, duba sababbin hanyoyin kwantar da hankulan da ke faruwa, da kuma tabbatar da abin da za su iya samun nasara?
Ko da yake masu binciken ilimin likita na iya, a lokuta da dama, suna da kayan aiki masu kyau da kuma bayanai don warwarewa da kuma kwatanta sababbin jiyya, sababbin hanyoyin kwantar da hankali na iya zama mawuyacin hangen nesa, idan ba a samu kwarewa ba.
Kwarewa daga ilimi ya zo ne daga gwaji na gwaji, wanda marasa lafiya sun yarda su shiga karatu tare da kwayoyi masu bincike waɗanda suka nuna wasu alkawura; amma, a matsayin kalmar "fitina" yana nufin, akwai kullun rashin tabbas game da yadda miyagun ƙwayoyi za su yi kuma wanda zai amfana mafi yawan-wato, abin da alamun haƙuri da kuma abin da ke fama da ciwon daji.
Mene Ne Ciwon Murafi Na Imuwa?
Ciwon rigakafi immunotherapy wani magani ne wanda ya shafi wasu ɓangarori na tsarin rigakafin mutum don yaƙar malignancy. Ɗaya daga cikin misalai na immunotherapy shine amfani da kwayar cutar guda daya kamar rituximab da obinutuzumab . Magungunan monoclonal sune kwayoyin halitta, ko kuma sunadarai sunadarai. Wadannan kwayoyin cutar zasu iya kai hari kan wani ɓangare na musamman na kwayar cutar ciwon daji a cikin abin da aka sani da farfadowa .
Sauran cututtukan ciwon daji na immunotherapy sun hada da magungunan magunguna , wanda ke dauke da 'ƙuƙwalwa' daga tsarin rigakafi don taimakawa wajen ganewa da kuma magance ciwon daji.
Duniya na ciwon daji immunotherapy ba ta iyakance ne kawai ga misalai na sama ba, duk da haka, kuma sababbin ra'ayoyin yin amfani da tsarin jikinka na jikinka don yaki da ciwon daji na ci gaba da ci gaba da kuma gwada su.
Shin Ayyukan Immunotherapy na Dukan Magunguna?
Kowane mutum na da mahimmanci, kuma kowane mutum yana da ciwon daji na musamman; Ba kowa ba ne ya amsa daidai da irin wannan immunotherapy.
Yin amfani da kyau, a gaba, wanda mutane zasu iya amsawa ga rigakafin rigakafi zai kasance da dama daga kusurwoyi. Ga masu haƙuri, zai iya adana lokaci mai mahimmanci, wanda zai iya fassarawa a cikin asibiti.
A wasu kalmomi, ba za ku rabu da lokacin ku ba ko hadarin haɗari na gwaji na kokarin wani abu wanda zai iya samun rinjayar kadan lokacin da akwai 'babban bindiga' ko karin farfadowa. Amma ta yaya mutum zai san irin wannan abu a gaba? Ɗaya daga cikin labarun da suka shafi yadda masu ilimin likita da masu bincike na ciwon daji ke tafiya suna yin haka ne tare da wani abu da ake kira neoantigens.
Neoantigens: Ciwon daji na Achilles warke?
Ciwon daji zai iya zama sneaky. Sau da yawa suna da wasu canje-canje a cikin jinsinsu, wasu daga cikinsu zasu iya dacewa da ikon su na yin mummuna da al'ada, kwayoyin lafiya basu iya. Wasu daga cikin waɗannan canje-canje na haifar da bambance-bambance jiki ko kuma a waje da kwayoyin cutar ciwon daji wanda tsarin na rigakafi zai iya gano shi. Wadannan sassa na ciwon daji wanda kwayoyin rigakafi zasu iya ganewa kamar yadda ake kira '' neoantigens '.
Neo, ma'anar sabuwar, saboda sun tashi ne daga jikinmu, sun tafi tare da ciwon daji , kamar yadda akasin masana kimiyyar antigens na yau da kullum suna magana game da cututtukan cututtuka, misali.
Ana iya samun antigens na yau da kullum a waje da kwayoyin cutar, ko kuma kwayoyin cututtukan kwayoyi, misali. Sabanin haka, neoantigens suna kama da launi ja wanda zai iya nuna alamar rigakafi cewa rayukanmu suna ɓarna.
Neoantigens zai kai ga kunna fararen jini wanda aka sani da sassan T- rukuni na yaduwar cutar . Wadannan sassan T-sannan sunyi tafiya cikin jini, kamar maɗauran hanyoyi na Ancient Roma, don isa shafin yanar gizo na masu mummunan ƙwayar cuta, su gurfanar da ciwon sukari da kuma taimakawa wajen ƙaddamar da ƙwayoyin marasa lafiya.
Saboda haka, neoantigens yana daya daga cikin mabuɗin ƙwayoyin maganin cutar kanjamau.
Wancan ya ce, cin nasara a yakin basasa ya ƙunshi rigakafi kawai, kuma ana bukatar yawancin yanayin tsabtace jiki; An yi amfani da rigakafin rigakafi tare da cytotoxic chemotherapy da / ko kuma sauran immunotherpies, dangane da mummunan da mutum mai haƙuri .
Yaya Aikata Ayyukan Immunotherapy?
Wannan wata muhimmiyar tambaya ce a cikin ilimin kimiyyar zamani, kuma wanda ke aiki a hankali. A wannan karshen, nau'i biyu na kwayoyin cutar Kanada zasu iya taimaka wa likitoci su damu da yadda hanyoyin immunotherapies za suyi aiki: TMB da MSI.
Nauyin nauyin nau'i na Tumor, ko TMB , ana iya ɗauka a matsayin alamar dukan waɗannan canje-canje a cikin kwayoyin halitta a cikin kwayar cutar ciwon daji da suka wuce raguwa, alal misali, wanda ke amfani da shi don ƙayyade duk abubuwan al'ada da kwayar halitta zata buƙaci-amma suna da canje-canje ko maye gurbi a cikin yanayin da kwayoyin cututtuka. TMB wani lokaci ana kiransa nauyin nauyin mutunci ko nauyin mutation.
Tumors da ke da babban TMB suna da karin sunadaran neoantigens saboda haka zasu iya amsa mafi kyau ga immunotherapy. Ciwon daji zai iya kawo karshen TMB ta hanyar labarun da suka hada da ciwon daji, ciki har da taba ko haske na UV. Wata hanyar ita ce ta hanyar rashin kwakwalwa ta microsletellite, ko MSI , wani lokacin fasaha wanda yake nufin matsala tare da tsarin jikinka don gyara DNA-matsalar da ke haifar da tsayayyar canji da tsinkaye na jerin DNA.
Ɗaya daga cikin kamfani da ake kira Foundation Medicine yanzu tana ba da cikakken ƙaddamar da ƙididdiga na TMB a matsayin ɓangare na FasahaTa'idarsa, wanda zai iya taimakawa wajen hango yiwuwar amsawar mutum ga immunotherapy.
"Kwayoyin da ba daidai ba ne magungunan dukan magunguna," in ji Vincent Miller, MD, babban likita a Foundation Medicine. "Tumors da yawancin maye gurbin su sun fi samuwa da sababbin sunadaran da ake kira neoantigens. Tsarin na rigakafi ya gane wadannan ƙananan halittu kamar sauran kasashen waje kuma yana cike da faɗakarwa, farawa jerin matakan da zasu iya magance kututtukan. "
Za a yi Ma'aikatar Ma'aikatar Bincike na Bincike Aiki na Ni?
Wannan mãkirci yana raguwa a cikin cewa wasu ciwon sukari sun taso da hanyoyi masu banƙyama don kawar da kwayoyin halitta - ta hanyar samar da sunadarin sunadaran da ba da izinin wasu nau'in kwayoyin halittarku ba. Za a iya yin watsi da na'urar halitta , idan kun so.
Don hana ciwon daji daga tayar da kanta ta wannan hanyar, an tsara wasu immunotherapies don toshe wadannan sunadarin sunadarai. Wadannan immunotherapies, da aka sani da masu hana masu bincike , sun hada da wadanda ake kira anti-PD1 da anti-PDL1 . Kuma, kamar yadda yake tare da wasu nau'o'in immunotherapy, akwai shaida da ke nuna matakan da suka fi girma a cikin kwayoyin cutar Kankara suna hade da mafi kyawun martani ga masu hana masu bincike.
Amsawa ga masu shayarwa na mahimmanci ya bambanta daga kimanin kashi 20 a cikin cutar ciwon huhu a cikin kashi 80 cikin dari a lymphoma na Hodgkin. Dalilin da yasa wasu ciwon daji suka amsa wa masu hana masu dubawa da wasu ba su da cikakke ba.
Muhimmancin Maganar Harkokin Kwayoyin Gida
Wadannan kayan aiki masu ban mamaki da nasarar su shine batun tattaunawar a wannan shekara ta haɗin Cibiyar Nazarin Cibiyar Nazarin Kwayoyin Nahiyar Amirka, ko ASCO.
An nuna TMB a hangen nesa da yiwuwar amsawa da kuma tsawon lokacin da za a mayar da shi ga ciwon daji na immunotherapies a cikin marasa lafiya da ciwon magungunan ciwon daji, ciwon huhu na huhu, melanoma da sauran ciwon daji. Bugu da ƙari, TMB, FoundationOne kuma yana daidaita yanayin rashin lafiyar microsatellite, yana wakiltar gwaje-gwajen guda daya don shiryar da yanke shawara don magance hanyoyin magance cutar, gwajin gwaji da kuma immunotherapies na likitancin FDA ta hanyar amfani da kwayar halitta guda daya.
"Ciwon rigakafi na rigakafi na gaba ne a kan maganin ciwon daji, kuma sababbin hanyoyin da ake amfani da su don kimantawa ga wannan muhimmin mawuyacin hali, amma har da tsada, magunguna," in ji Dokta Miller.
"Hanyoyin da za su iya daidaita ma'auni masu yawa a lokaci guda, ciki har da TMB da MSI, wani muhimmin ci gaba ne ga ciwon ciwon daji na immunotherapy, da kuma wanda ke da mahimmanci ga Medicine Foundation," in ji Thomas George, MD, GI, mai kula da shirin ilimin kan ilimin ilimin halittu, Jami'ar Florida . "Foundation Medicine ta hade da ci gaba da dandamali dandamali da kuma musamman-musamman algorithms ya ba ni damar yin amfani da dukan masu dacewa da kwayoyin halitta biologers ga marasa lafiya a yanzu, taimakawa wajen ajiye duka lokaci da nama."
"Mun samu ƙarfafawa daga binciken da aka gabatar a ASCO, ciki har da yiwuwar gano marasa lafiya mafi kusantar suyi amfani da magungunan rigakafi immunotherapy," in ji Dokta Miller. "Manufarmu ita ce ta ƙarfafa likitoci da marasa lafiya tare da cikakkun bayanai masu dacewa, abubuwan da suka dace, kuma muna jin daɗi don bayar da shawararmu na musamman don kimanta TMB da MSI a lokaci ɗaya kuma tare da daidaitattun kwaɗayi, wanda ke tallafawa algorithms sophisticated da kuma samo asali cikin abubuwan fahimta. daga tushen iliminmu FoundationCORE. Wannan ba wani abu ba ne na samar da dandamali na gaba-gaba. "
Gidauniyar Gidauniyar Kasuwanci da Gidauniyar Harkokin Kasuwanci, Harkokin Magani na Ƙasa yana bayar da gwajin gwaji na PD-1 da PD-L1, samar da, a hade tare da Sakamakon FoundationOne, cikakken ciwon ciwon daji na rigakafi na rigakafi na immunotherapy.
Kalma Daga
Duk da yake wannan hakika wani yanki ne mai ban sha'awa, kimiyya har yanzu tana cigaba kuma ana gudanar da bincike da kuma tabbatar da gwaje-gwaje daban-daban. Dukkan masu lura da asibiti na yau da kullum don maganganun maganin asibiti ga masu hana masu bincike suna binciken ne kawai kuma babu wata gwajin da aka yarda da FDA wanda ke iya hango ƙayyadadden amsawa ga masu hanawa.
> Sources:
> Magungunan Fasaha ya gabatar da sababbin bayanai a ASCO 2016 yana nuna cewa FoundationOne na iya taimakawa hango ko hasashen mayar da martani ga ciwon daji immunotherapy a fadin ciwon cancers.
Ansell SM, Lesokhin AM, Borrello I, et al. PD-1 Blockade tare da Nivolumab a Relapsed ko Refractory Hodgkin ta Lymphoma. N Engl J Med. 2015; 372 (4): 311-319.
Pardoll DM. Ginin ta rigakafi a cikin ciwon daji immunotherapy. Nat Rev Cancer. 2012; 12 (4): 252-64.