Okudingeka Ukwazi Ngokuhlolwa Kofuzo Komdlavuza Wamaphaphu

-Delile

• Kuyini ukuguqulwa kwezakhi zofuzo?
• Zingaki izinhlobo ze-NSCLC ezikhona?
• Yini engidinga ukuyazi ngokuhlolwa kofuzo?
• Lokhu kuguquka kukuthinta kanjani ukwelashwa?
• EGFR
• EGFR T790M
• ALK / EML4-ALK
• Ezinye izindlela zokwelapha

Umdlavuza wamangqamuzana ongewona omncane (i-NSCLC) yigama lesimo esidalwa ukuguquka kofuzo okungaphezu koyedwa emaphashini. Ukuhlolwa kwalezi zinguquko ezihlukile kungathinta izinqumo zokwelashwa kanye nemiphumela.

Qhubeka ufunde ukuze ufunde ngezinhlobo ezahlukahlukene ze-NSCLC, kanye nokuhlolwa nokwelashwa okutholakalayo.

Kuyini ukuguqulwa kwezakhi zofuzo?

Ukuguqulwa kwezakhi zofuzo, noma ngabe kuzuzwe njengefa noma kutholakala, kudlala indima enkulu ekuthuthukiseni umdlavuza. Izinguquko eziningi ezithintekayo kwi-NSCLC sezivele zikhonjisiwe. Lokhu kusize abacwaningi ukuthi bakhe imishanguzo ebheke ezinye zalezo zinguquko ezithile.

Ukwazi ukuthi yiziphi izinguquko ezishayela umdlavuza wakho kunganikeza udokotela wakho umbono wokuthi umdlavuza uzoziphatha kanjani. Lokhu kungasiza ekunqumeni ukuthi imiphi imishanguzo engasebenza kakhulu. Ingakhomba nezidakamizwa ezinamandla okungenzeka zikusize ekwelashweni kwakho.

Kungakho ukuhlolwa kofuzo ngemuva kokutholakala kwe-NSCLC kubaluleke kakhulu. Kuyasiza ukwenza ukwelashwa kube ngokwakho.

Inani lezindlela zokwelashwa ezihlosiwe ze-NSCLC liyaqhubeka nokukhula. Singalindela ukubona intuthuko ethe xaxa njengoba abacwaningi bethola okuningi ngokuguqulwa okuthile kwezakhi zofuzo okwenza ukuthi i-NSCLC iqhubeke.

Zingaki izinhlobo ze-NSCLC ezikhona?

Kunezinhlobo ezimbili ezinkulu zomdlavuza wamaphaphu: umdlavuza omncane wamaphaphu wamangqamuzana nomdlavuza wamangqamuzana ongewona omncane. Cishe amaphesenti angama-80 kuya kwangu-85 awo wonke umdlavuza wamaphaphu yi-NSCLC, engahlukaniswa ngokuhlukaniswa kulawa ma-subtypes:

• I-Adenocarcinoma
  iqala kumaseli amancane akhipha amafinyila. Le subtype evame ukutholakala ku-
  izingxenye zangaphandle zamaphaphu. Kuvame ukwenzeka kaningi kwabesifazane kunabesilisa futhi
  kubantu abasha. Ngokuvamile umdlavuza okhula kancane, uwenze ube ngaphezulu
  kutholakala ngezigaba zokuqala.
• Okukhathazayo
  ama-carcinomas weseli qala kumaseli ayizicaba aqondane nengaphakathi lendlela yomoya
  emaphashini akho. Lolu hlobo kungenzeka luqale eduze kwomoya omkhulu ophakathi nendawo
  wamaphaphu.
• Okukhulu
  ama-carcinomas weseli ingaqala noma kuphi emaphashini futhi ingaba nolaka impela.

Ama-subtypes angavamile kakhulu afaka phakathi i-adenosquamous carcinoma ne-sarcomatoid carcinoma.

Lapho usukwazi ukuthi yiluphi uhlobo lwe-NSCLC onayo, isinyathelo esilandelayo imvamisa ukunquma ukuguqulwa okuthile kofuzo okungabandakanyeka.

Yini engidinga ukuyazi ngokuhlolwa kofuzo?

Lapho une-biopsy yakho yokuqala, udokotela wezifo zakho wayehlola ubukhona bomdlavuza. Isampula efanayo yezicubu ezivela ku-biopsy yakho ingasetshenziselwa ukuhlolwa kofuzo. Ukuhlolwa kofuzo kungabhekela ukuguqulwa kwamakhulu.

Lokhu okunye kokushintshwa okuvame kakhulu ku-NSCLC:

• EGFR
  ukuguquka kwezakhi zofuzo kwenzeka cishe kumaphesenti ayishumi abantu abane-NSCLC. Cishe uhhafu wabantu abane-NSCLC abangakaze babheme
  zitholakala zinalokhu kuguqulwa kofuzo.
• EGFR T790M
  ukuhluka kweprotheni ye-EGFR.
• IKRAS
  ukuguquka kwezakhi zofuzo kubandakanyeka cishe kumaphesenti angama-25 esikhathi.
• ALK / EML4-ALK
  ukuguquka kwesifo kutholakala cishe kumaphesenti ama-5 abantu abane-NSCLC. Kujwayele
  faka abantu abasha nabangabhemi, noma ababhemayo abancane abane-adenocarcinoma.

Ukuguqulwa okuncane okujwayelekile kofuzo okuhambisana ne-NSCLC kufaka:

• IBRAF
• I-HER2 (ERBB2)
• I-MEK
• MET
• RET
• ROS1

Lokhu kuguquka kukuthinta kanjani ukwelashwa?

Kunezindlela zokwelapha eziningi ezahlukahlukene ze-NSCLC. Ngoba akuyona yonke i-NSCLC efanayo, ukwelashwa kufanele kucatshangelwe ngokucophelela.

Ukuhlolwa okuningiliziwe kwamangqamuzana kungakutshela ukuthi ngabe isimila sakho sinezinguquko ezithile zofuzo noma amaprotheni. Izindlela zokwelashwa ezihlosiwe zenzelwe ukwelapha izici ezithile zesimila.

Lezi ezinye zezindlela zokwelashwa ezihlosiwe ze-NSCLC:

EGFR

Ama-inhibitors e-EGFR avimba isinali elivela kuhlobo lwe-EGFR olukhuthaza ukukhula. Lokhu kufaka phakathi:

• i-afatinib (Gilotrif)
• i-erlotinib (Tarceva)
• i-gefitinib (Iressa)

Yonke le yimithi yokwelapha ngomlomo. Kwi-NSCLC esezingeni eliphezulu, le mithi ingasetshenziswa yodwa noma nge-chemotherapy. Lapho i-chemotherapy ingasebenzi, le mithi isengasetshenziswa noma ngabe awunakho ukuguqulwa kwe-EGFR.

INecitumumab (Portrazza) ingenye ye-EGFR inhibitor esetshenziselwa i-squamous cell NSCLC. Inikezwa nge-infravenous (IV) ukumnika ngokuhlanganiswa ne-chemotherapy.

EGFR T790M

Ama-inhibitors e-EGFR anciphisa izicubu, kepha le mithi ingagcina iyeke ukusebenza. Uma lokho kwenzeka, udokotela wakho angalawula i-tumor biopsy eyengeziwe ukuze abone ukuthi ngabe ufuzo lwe-EGFR luthuthukise olunye ushintsho olubizwa nge-T790M.

Ngo-2017, i-U.S. Food and Drug Administration (FDA) eya osimertinib (Tagrisso). Lesi sidakamizwa siphatha i-NSCLC esezingeni eliphakeme efaka ukuguqulwa kwe-T790M. Isidakamizwa sanikezwa imvume esheshayo ngo-2015. Ukwelashwa kuboniswa lapho i-EGFR inhibitors ingasebenzi.

I-Osimertinib imithi yokwelashwa ethathwa kanye ngosuku.

ALK / EML4-ALK

Izindlela zokwelashwa ezibhekise kumaprotheni angajwayelekile e-ALK zifaka:

• i-alectinib (Alecensa)
• i-brigatinib (Alunbrig)
• i-ceritinib (iZykadia)
• i-crizotinib (Xalkori)

Le mithi yomlomo ingasetshenziswa esikhundleni se-chemotherapy noma ngemuva kokuthi i-chemotherapy iyekile ukusebenza.

Ezinye izindlela zokwelapha

Ezinye izindlela zokwelashwa ezihlosiwe zifaka:

• I-BRAF: i-dabrafenib (i-Tafinlar)
• I-MEK: trametinib (Mekinist)
• I-ROS1: i-crizotinib (i-Xalkori)

Njengamanje, alukho umuthi ohlosiwe ogunyaziwe wokuguqulwa kwe-KRAS, kepha ucwaningo luyaqhubeka.

Izimila zidinga ukwakha imithambo yegazi emisha ukuze iqhubeke nokukhula. Udokotela wakho angakunikeza ukwelashwa ukuvimba ukukhula okusha komkhumbi wegazi ku-NSCLC esezingeni eliphakeme, njenge:

• i-bevacizumab (Avastin), engasetshenziswa ne- or
  ngaphandle kwamakhemikhali
• ramucirumab (Cyramza), engahlanganiswa ne
  chemotherapy futhi uvame ukunikezwa ngemuva kokunye ukwelashwa akusasebenzi

Ezinye izindlela zokwelashwa ze-NSCLC zingafaka:

• ukuhlinzwa
• ukwelashwa ngamakhemikhali
• imisebe
• ukwelashwa okunciphisayo ukunciphisa izimpawu

Ukuhlolwa kwemitholampilo kuyindlela yokuhlola ukuphepha nokusebenza kwezindlela zokwelapha ezingakavunyelwa ukusetshenziswa. Khuluma nodokotela wakho uma ungathanda ukufunda kabanzi mayelana nokuhlolwa kwemitholampilo kwe-NSCLC.