Umlobi: John Stephens
Usuku Lokudalwa: 2 Ujanuwari 2021
Ukuvuselela Usuku: 14 Unovemba 2024
Anonim
GLEEVEC (IMATINIB) MOA
Ividiyo: GLEEVEC (IMATINIB) MOA

-Delile

Yini iGleevec?

IGleevec ngumuthi kadokotela ogama lomuthi. Isetshenziselwa ukwelapha izinhlobo ezithile zomdlavuza wegazi kubantu abadala nasezinganeni. IGleevec isetshenziselwa ukwelapha uhlobo lomdlavuza wesikhumba kanye nohlobo lomdlavuza wamathumbu.

IGleevec iqukethe imatinib mesylate yezidakamizwa, okungeyesigaba semithi ebizwa nge-tyrosine kinase inhibitors.

IGleevec iza njengethebhulethi oyithatha ngomlomo. Uphuza lesi sidakamizwa kanye noma kabili ngosuku, kuya ngomthamo kadokotela wakho.

Lokho okwenzayo

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuvume i-Gleevec ukwelapha izinhlobo ezithile zomdlavuza wegazi, kufaka phakathi:

  • I-Philadelphia chromosome-positive (Ph +) chronic myeloid leukemia (CML) kubantu abadala nasezinganeni
  • I-Ph + acute lymphocytic leukemia (YONKE) ebuyiselwe emuva * noma i-refractory * kubantu abadala
  • okusanda kutholakala i-Ph + BONKE ezinganeni
  • Izifo ze-myelodysplastic / myeloproliferative (umdlavuza womnkantsha wamathambo) kubantu abadala abane-rearrangement yofuzo olwenziwe ngeplatelet (PDGFR)
  • i-hypereosinophilic syndrome noma i-leukemia engapheli ye-eosinophilic kubantu abadala
  • i-mastocytosis enobudlova kubantu abadala ngaphandle kokuguqulwa kwe-D816v c-Kit

Umdlavuza obuyile ubuyile emuva kokuxolelwa, okuwukwehla kwezimpawu nezimpawu zomdlavuza. Umdlavuza obonakalisayo awukaphenduli ekwelashweni komdlavuza okwedlule.


IGleevec nayo ivunyelwe ukwelapha:

  • uhlobo lomdlavuza wesikhumba obizwa nge-dermatofibrosarcoma protuberans (DFSP) kubantu abadala
  • uhlobo lomdlavuza wamathumbu obizwa nge-Kit-positive gastrointestinal stromal tumors (GIST) kubantu abadala

Ngemininingwane, bheka izigaba ze- “Gleevec for CML” ne- “Other uses for Gleevec.”

Ukusebenza kwe-Gleevec

IGleevec itholakale isebenza ngempumelelo ekwelapheni izinhlobo eziningana zomdlavuza wegazi.

Kwesinye isifundo somtholampilo, abantu abadala abane-CML esanda kutholakala esigabeni esingalapheki bathatha uGleevec iminyaka eyisikhombisa. Kuleli qembu, abantu abangama-96.6% bathole impendulo ephelele kulo muthi. Lokhu kusho ukuthi awekho amangqamuzana anomdlavuza atholakele egazini lawo, futhi abengenazo izimpawu zomdlavuza.

Ukuphendula okuphelele kungenye yezindlela zokuchaza izinga lokuphumelela. Eqenjini labantu abathole i-chemotherapy ejwayelekile, ama-56.6% abe nempendulo ephelele.

I-Gleevec nayo itholakale isebenza kahle ekwelapheni izicubu zomzimba emathunjini (GIST) ezifundweni zokwelashwa. Izinga lokusinda lilonke lalicishe libe yiminyaka emine. Lokhu kusho ukuthi uhhafu wabantu abasesifundweni baphila cishe iminyaka emine ngemuva kokuqala kwabo ukuthatha iGleevec. Abantu abathathe uGleevec ngemuva kokuhlinzwa baphila cishe iminyaka emihlanu ngemuva kokuqala umuthi.


Ukuze ufunde ukuthi iGleevec isebenza kahle kangakanani ekwelapheni ezinye izinhlobo zomdlavuza, bheka isigaba “Okunye ukusetshenziswa kweGleevec”.

Gleevec ejwayelekile

IGleevec itholakala njengomuthi wegama lomkhiqizo futhi njengefomu elejwayelekile.

IGleevec iqukethe isithako semithi esisebenzayo imatinib mesylate.

Imiphumela emibi ye-Gleevec

IGleevec ingadala imiphumela emibi noma emibi. Uhlu olulandelayo luqukethe eminye yemiphumela emibi engase ivele ngenkathi uthatha iGleevec. Lezi zinhlu azibandakanyi yonke imiphumela emibi engaba khona.

Ukuthola eminye imininingwane ngemiphumela engemihle ye-Gleevec, khuluma nodokotela wakho noma usokhemisi. Bangakunika amathiphu okuthi ungabhekana kanjani nanoma yimiphi imiphumela emibi engase ikukhathaze.

Imiphumela emibi ejwayelekile

Imiphumela emibi ejwayelekile yeGleevec ingafaka:

  • isifo sohudo
  • ubuhlungu besisu
  • ukukhathala (ukungabi namandla)
  • i-edema (ukuvuvukala, imilenze yakho, amaqakala, noma izinyawo kanye namehlo akho)
  • amajaqamba noma ubuhlungu
  • isicanucanu
  • ukuhlanza
  • ukuqubuka

Eminingi yale miphumela emibi ingahle ihambe kungakapheli izinsuku ezimbalwa noma amasonto ambalwa. Uma zinzima kakhulu noma zingahambi, khuluma nodokotela wakho noma usokhemisi.


Imiphumela emibi kakhulu

Imiphumela emibi ebucayi evela ku-Gleevec ayijwayelekile, kepha ingenzeka. Shayela udokotela wakho ngokushesha uma unemiphumela emibi kakhulu. Shayela u-911 uma izimpawu zakho zizizwa zisongela impilo noma uma ucabanga ukuthi unezimo eziphuthumayo zezokwelapha.

Imiphumela emibi kanye nezimpawu zayo zingafaka okulandelayo:

  • Ukugcina uketshezi olunamandla (uketshezi oluningi kakhulu noma amanzi) ngaphakathi nangaseduze kwenhliziyo yakho, amaphaphu (ukungxenywa kwe-pleural effusion), nesisu (ascites). Izimpawu zingafaka:
    • okungalindelekile, ukuzuza ngokushesha kwesisindo
    • ubuhlungu besifuba
    • ukuphelelwa umoya
    • unenkinga yokuphefumula kanzima
    • ukuphefumula kanzima lapho ulala phansi
    • ukukhwehlela okomile
    • isisu esivuvukile
  • Ukuphazamiseka kwegazi, kufaka phakathi i-anemia (amazinga aphansi amaseli abomvu egazi), i-neutropenia (amazinga aphansi amangqamuzana amhlophe egazi), ne-thrombocytopenia (amazinga aphansi ama-platelets). Izimpawu zingafaka:
    • ukukhathala (ukungabi namandla)
    • ukushaya kwenhliziyo okusheshayo
    • ukuphelelwa umoya
    • ukutheleleka okuvamile
    • imfiva
    • ukulimaza kalula
    • izinsini ezophayo
    • igazi emchameni noma esitulweni
  • Ukwehluleka kwenhliziyo okuxineneyo nezinye izinkinga zenhliziyo, njengokuhluleka kwenhliziyo emaceleni. Izimpawu zingafaka:
    • ukuzuza kwesisindo okungalindelekile
    • i-edema (ukuvuvukala kwezinyawo zakho, amaqakala, nemilenze)
    • ukushaya kwenhliziyo okungajwayelekile noma isigqi (ukushaya kwenhliziyo okushesha kakhulu, kuhamba kancane kakhulu, noma okungajwayelekile)
    • ubuhlungu besifuba
    • ukuphelelwa umoya
  • Ukulimala kwesibindi noma ukwehluleka kwesibindi. Izimpawu zingafaka:
    • isicanucanu
    • isifo sohudo
    • ukulahlekelwa isifiso sokudla
    • isikhumba esilumayo
    • i-jaundice (umbala ophuzi wesikhumba sakho kanye namhlophe wamehlo akho)
    • i-edema (ukuvuvukala kwemilenze yakho, amaqakala, nezinyawo)
    • i-ascites (i-fluid buildup esiswini sakho)
    • ukulinyazwa njalo
    • ukopha njalo
  • Ukopha kakhulu (ukuphuma okungapheli), kuvame emathunjini akho. Izimpawu zingafaka:
    • igazi esitokisini
    • indle emnyama noma yokulibala
    • ukukhathala (ukungabi namandla)
    • ekhwehlela igazi
    • ekhwehlela udaka olumnyama
    • isicanucanu
    • amajaqamba esiswini
  • Izinkinga zamathumbu, kufaka phakathi ukubola (izinyembezi) esiswini noma emathunjini akho. Izimpawu zingafaka:
    • isicanucanu
    • ukuhlanza
    • ubuhlungu obukhulu esiswini sakho
    • imfiva
    • ukuphelelwa umoya
    • ukushaya kwenhliziyo okusheshayo
  • Izinkinga ezinzima zesikhumba. Izimpawu zingafaka:
    • i-erythema multiforme (amabala abomvu noma amabhamuza, imvamisa ematheni ezinyawo zakho noma ezintendeni zezandla zakho)
    • I-Stevens-Johnson syndrome (umkhuhlane; izilonda ezibuhlungu emlonyeni wakho, emphinjeni, emehlweni, ezithweni zangasese, noma emzimbeni wonke)
    • imfiva
    • Ubuhlungu bomzimba
  • I-Hypothyroidism (amazinga aphansi e-thyroid) kubantu abasuswe i-thyroid futhi bathatha imishanguzo yokufaka i-thyroid. Izimpawu zingafaka:
    • ukukhathala (ukungabi namandla)
    • ukuqunjelwa
    • ukudana
    • ngizwe kubanda
    • isikhumba esomile
    • ukuzuza kwesisindo
    • izinkinga zememori
  • Ukukhula kancane kubantwana. Izimpawu zingafaka:
    • ingakhuli ngezinga elijwayelekile
    • usayizi omncane kunezinye izingane ezingontanga yabo
  • I-Tumor lysis syndrome (lapho amangqamuzana omdlavuza ededela amakhemikhali ayingozi egazini lakho). Izimpawu zingafaka:
    • ukukhathala (ukungabi namandla)
    • isicanucanu
    • ukuhlanza
    • isifo sohudo
    • amajaqamba
    • isigqi senhliziyo esingajwayelekile (ukushaya kwenhliziyo okushesha kakhulu, kuhamba kancane kakhulu, noma okungajwayelekile)
    • isithuthwane
  • Ukulimala kwezinso. Izimpawu zingafaka:
    • ukuchama kaningi kunokujwayelekile
    • i-edema (ukuvuvukala kwemilenze yakho, amaqakala, nezinyawo)
    • ukukhathala (ukungabi namandla)
    • isicanucanu
    • ukudideka
    • umfutho wegazi ophakeme
  • Imiphumela emibi engaholela ezingozini zezimoto. Izimpawu zingafaka:
    • isiyezi
    • ubuthongo
    • ukungaboni kahle

Imininingwane yomphumela oseceleni

Ungazibuza ukuthi kaningi kangakanani imiphumela emibi ethile eba khona ngalo muthi, noma ukuthi imiphumela ethile engemihle ihlobene nawo yini.Nayi eminye imininingwane ngemiphumela emibi eminingi lo muthi ongahle uyibangele noma ongabanga yiyo.

Ukusabela okweqile

Njengezidakamizwa eziningi, abanye abantu bangaba neguliswa ngemuva kokuthatha iGleevec. Izimpawu zokuphendula okuncane komzimba zingabandakanya:

  • ukuqubuka kwesikhumba
  • ukulunywa
  • ukuqhuma (ukufudumala nokubomvu esikhunjeni sakho)

Ukusabela okweqile okwedlulele akuvamile kodwa kungenzeka. Izimpawu zokuphendula okweqile kakhulu zingabandakanya:

  • i-angioedema (ukuvuvukala ngaphansi kwesikhumba sakho, imvamisa ezinkalweni zakho, izindebe, izandla, noma izinyawo)
  • ukuvuvukala kolimi lwakho, umlomo, noma umphimbo
  • inkinga yokuphefumula

Shayela udokotela wakho khona manjalo uma unegciwane elinamandla ku-Gleevec. Shayela u-911 uma izimpawu zakho zizizwa zisongela impilo noma uma ucabanga ukuthi unezimo eziphuthumayo zezokwelapha.

Imiphumela emibi yesikhathi eside

Eminye yemiphumela emibi ebonwe ezifundweni zokwelashwa ingenzeka ngokusetshenziswa kwesikhathi eside kwe-Gleevec. Lokhu kufaka phakathi izinkinga zenhliziyo, njengokuhluleka kwenhliziyo okucinana kanye nokwehluleka kwenhliziyo emaceleni.

Esifundweni somtholampilo, abantu abangaphezu kuka-500 abathatha iGleevec ukuthola i-myeloid leukemia (CML) engalapheki balandelwa kwaze kwaba yiminyaka eyi-11. Abantu abakulesi sifundo sesikhathi eside banemiphumela emibi efanayo efanayo ebikwe ezifundweni ezimfishane. Kodwa-ke, le miphumela emibi ibonakale ithuthuka ngokuhamba kwesikhathi.

Imiphumela emibi ebonakala ngokusetshenziswa kwesikhathi eside ifakiwe:

  • ukuphazamiseka okukhulu kwegazi (amazinga aphansi amaseli abomvu egazi, amaseli amhlophe egazi, noma ama-platelets) kubantu abayisithupha
  • izinkinga zenhliziyo, kufaka phakathi ukwehluleka kwenhliziyo okuxinekile, kubantu abayisikhombisa
  • amacala ayisithupha omdlavuza omusha, kufaka phakathi i-myeloma eminingi kumuntu oyedwa nomdlavuza wekoloni komunye umuntu

Imiphumela emibi yayivame kakhulu onyakeni wokuqala wokwelashwa nge-Gleevec. Kepha ngokuya kwesikhathi lapho abantu bethatha i-Gleevec, kulapho bebevame ukuba nemiphumela emibi eminingi. Isibonelo, ngonyaka wokuqala wesifundo, abantu abathathu babenezifo ezimbi zegazi, kepha ngemuva konyaka wesihlanu, munye kuphela umuntu owaba naso.

Ocwaningweni lweminyaka emihlanu lwabantu abanezicubu zomzimba ezinamathumbu (GIST), abantu abangu-16% bayeka ukuthatha iGleevec ngenxa yemiphumela engemihle. Imiphumela emibi ibifana naleyo echazwe esifundweni se-CML ngenhla. Abantu abangamaphesenti angama-40 ocwaningweni banqunyelwe imithamo ephansi yomuthi ukunciphisa imiphumela yabo emibi.

Uma ukhathazekile ngemiphumela emibi yesikhathi eside ye-Gleevec, khuluma nodokotela wakho. Bangaphakamisa izindlela zokunciphisa izingozi zakho zemiphumela ethile eseceleni.

Imiphumela emibi ehlobene neso

Ezifundweni zomtholampilo zeGleevec, abanye abantu baba nemiphumela emibi ehlobene neso njengokuvuvukala nokubona okufiphele.

Ukuvuvukala kwejwabu leso nokuvuvukala okuzungeze amehlo eminye yemiphumela emibi kakhulu. Kuze kube ngu-74.2% wabantu abathathe iGleevec babene-periorbital edema (ukuvuvukala kwendawo yamehlo).

Uma unale mphumela ohlangothini, udokotela wakho angakunikeza isisu (esivame ukubizwa ngokuthi iphilisi lamanzi). Izidakamizwa zisiza umzimba wakho ukukhipha amanzi nosawoti owengeziwe lapho uchama. Lokhu kunciphisa ukwakheka kwamanzi. Udokotela wakho futhi angawehlisa umthamo wakho we-Gleevec, uma kudingeka.

Ngaphezu kwalokho, izifundo zomtholampilo zibike ukuthi abantu abangafika ku-11.1% abathathe iGleevec banombono wokufiphala. Uma unombono ofiphele, ungashayeli noma usebenzise imishini esindayo. Futhi qiniseka ukuthi utshela udokotela wakho ukuthi awukwazi ukubona kahle.

Eminye imiphumela emibi ejwayelekile ehlobene neso ifakiwe:

  • iso elomile
  • amehlo anamanzi
  • ukucasuka kweso
  • i-conjunctivitis (evame ukubizwa ngeso elibomvana)
  • imithambo yegazi ephukile esweni
  • ukuvuvukala kwe-retina (ungqimba lwezicubu ngemuva kweso lakho)

Uma uthatha i-Gleevec futhi unemiphumela engemihle ehlobene neso, khuluma nodokotela wakho. Bangaphakamisa izindlela zokunciphisa izimpawu zakho.

Ukulahleka kwezinwele

Ukulahleka kwezinwele (i-alopecia) kungumphumela ohlangothini wokuthatha i-Gleevec.

Ucwaningo olulodwa luhlolisise ukuthi iGleevec isebenza kanjani kubantu abanePhiladelphia chromosome-positive (Ph +) chronic myeloid leukemia (CML). Amaphesenti ayisikhombisa alaba bantu alahlekelwe yizinwele ngemuva kokuphuza lesi sidakamizwa.

Kwesinye isifundo, abantu bathathe uGleevec ukwelapha izicubu zomzimba emathunjini (GIST). Phakathi kuka-11.9% no-14.8% walaba bantu banezinwele. Lo mphumela ohlangothini ubonakale kaningi kubantu abathathe imithamo ephezulu ye-Gleevec.

Ukulahleka kwezinwele ngenxa yokwelashwa komdlavuza kuvame ukuba kwesikhashana. Uma ukhathazekile ngalo mphumela oseceleni, khuluma nodokotela wakho. Bangaphakamisa amathiphu wokukusiza ukunciphisa ukwehla kwezinwele ngesikhathi sokwelashwa kwakho.

Ukuqubuka neminye imiphumela emibi yesikhumba

I-Gleevec ingadala imiphumela emibi futhi emibi kakhulu esikhumbeni sakho.

Ukusabela okuvamile kwesikhumba

Ukuqubuka nokunye ukusabela kwesikhumba okuncane kuvame kakhulu kubantu abathatha iGleevec.

Ezifundweni zokwelashwa, abantu bathathe uGleevec ukwelapha i-Ph + chronic myeloid leukemia (CML). Kuze kube ngu-40.1% walaba bantu abebeneziqubu noma okunye ukusabela kwesikhumba ngemuva kokuthatha lesi sidakamizwa.

Kwezinye izifundo zokwelashwa, abantu bathathe uGleevec ukuthola izicubu zomzimba emathunjini (GIST). Ngemuva kokuthatha lesi sidakamizwa, kuze kufike ku-49.8% walaba bantu babe nokuqubuka noma okunye ukusabela kwesikhumba. Lokhu kufaka phakathi:

  • ukuxebuka kwesikhumba
  • isikhumba esomile
  • ukuguqulwa kwesikhumba (i-tint eluhlaza okwesibhakabhaka esikhunjeni)
  • ukutheleleka kwezinwele zezinwele (amasaka ngaphansi kwesikhumba sakho aphethe izimpande zezinwele zakho)
  • i-erythema (ukubomvu kwesikhumba)
  • i-purpura (izindawo ezinombala onsomi esikhunjeni)

Le miphumela emibi ibivame kakhulu kubantu abathathe imithamo ephezulu ye-Gleevec.

Uma ukhathazekile ngokuqubuka noma okunye ukusabela okuncane kwesikhumba ngenxa yeGleevec, khuluma nodokotela wakho. Bangaphakamisa izindlela zokusiza ukunciphisa izimpawu zakho.

Ukusabela kwesikhumba okunzima

Ezifundweni zomtholampilo, ukusabela okungathi sína kwesikhumba bekuyivelakancane kakhulu kubantu abathathe iGleevec. Kuze kube ngu-1% wabantu abathathe lesi sidakamizwa babephendula kanzima esikhunjeni. Izibonelo zemiphumela emibi yesikhumba ehlobene nezidakamizwa zifaka:

  • I-Stevens-Johnson syndrome (umkhuhlane; izilonda ezibuhlungu emlonyeni wakho, emphinjeni, emehlweni, ezithweni zangasese, noma emzimbeni wonke)
  • i-exfoliative dermatitis (isikhumba sikhipha izingxenye ezinkulu zomzimba wakho)
  • ukuqhuma kwe-vesicular (amabhamuza amancane nokuqubuka)

Ama-Rash namabhaladi angaba buhlungu kakhulu. Futhi uma zingelashwa, zingabamba amabhaktheriya futhi ziholele ekuthelelekeni okungathi sína. Ngakho-ke uma uthatha i-Gleevec futhi unamaqubu noma amabhamuza anomkhuhlane noma ungazizwa kahle, tshela udokotela wakho khona manjalo. Yisho nokunye ukuphendula kwesikhumba onakho.

Imiphumela emibi ethinta ukushayela

Ezifundweni zokwelashwa, abanye abantu abathathe iGleevec baba nemiphumela engemihle engathinta amandla abo okushayela. Lokhu kufaka phakathi:

  • isiyezi: kufika kubantu abangu-19.4%
  • umbono ofiphele: kufika kubantu abangu-11.1%
  • ukukhathala: kubantu abangama-74.9%

Le miphumela emibi ingathinta ikhono lakho lokushayela noma lokusebenzisa imishini esindayo. Kuke kwaba nemibiko yezingozi zezimoto ngabantu abathathe iGleevec. Ngakho-ke kufanele uqaphele lapho ushayela noma usebenzisa imishini ngenkathi uthatha iGleevec.

Ukuphulukiswa kwesilonda (hhayi umphumela ohlangothini)

Ukuphulukiswa kwesilonda okwenziwe kancane akubikanga ezifundweni zokwelashwa zaseGleevec.

Ezinye izinhlobo zokwelashwa komdlavuza, njenge-radiation ne-chemotherapy, zinganciphisa amasosha akho omzimba. Lokhu kungenza amanxeba aphole kancane.

Uma ukhathazekile ngokuphulukiswa kwesilonda, buza udokotela wakho ukuthi ngabe unengozi enkulu yini ngale nkinga ngokuya ngesimo sakho sezempilo.

Umdlavuza wesibindi (kungahle kungabi nomphumela oseceleni)

Umdlavuza wesibindi awuzange ubikwe njengomphumela oseceleni ezifundweni zokwelashwa zaseGleevec. Kodwa-ke, ukulimala kwesibindi kwenzeke ekusetshenzisweni kwesikhashana nangesikhathi eside kwe-Gleevec. Ezinye izimo zokulimala kwesibindi ziholele ekuhlulekeni kwesibindi nasekufakelweni kwesibindi.

Ukulimala kwesibindi kuvame ukutholakala lapho odokotela beqapha ama-enzyme (amaprotheni akhethekile) enziwa esibindi. Amazinga e-enzyme aphezulu kunokujwayelekile angaba uphawu lokulimala kwesibindi.

Ezinye izimpawu zomzimba zokulimala kwesibindi zifaka:

  • isicanucanu
  • isifo sohudo
  • ukulahlekelwa isifiso sokudla
  • isikhumba esilumayo
  • i-jaundice (umbala ophuzi wesikhumba sakho nabamhlophe bamehlo)
  • i-edema (ukuvuvukala kwemilenze yakho, amaqakala, nezinyawo)
  • i-ascites (i-fluid buildup esiswini sakho)
  • ukulinyazwa njalo
  • ukopha njalo

Ngesikhathi sokuhlolwa komtholampilo, abantu abangafika ku-5% abane-leukemia engapheli (i-CML) babenamazinga aphezulu e-enzyme yesibindi ngesikhathi sokwelashwa kwe-Gleevec. Kuze kufike ku-6.8% wabantu abanezicubu zomzimba emathunjini (i-GIST) babenamazinga aphezulu e-enzyme yesibindi ngenkathi belashwa. Futhi kuze kufike ku-0.1% wabantu abathathe iGleevec behluleka ukusebenza kwesibindi.

Ngenkathi uthatha iGleevec, udokotela wakho uzoqapha ukuthi isibindi sakho sisebenza kanjani. Uma unezimpawu zokulimala kwesibindi ngenkathi uthatha i-Gleevec, udokotela wakho anganciphisa umthamo wakho. Lokhu kungavimbela ukulimala okungaholela ekuhlulekeni kwesibindi.

Imiphumela emibi ezinganeni

Izingane ezifundweni zokwelashwa ezithathe iGleevec zibe nemiphumela engemihle efana ncamashi naleyo yabantu abadala. Kepha abacwaningi bathole lokhu okuhlukile:

  • zimbalwa izingane ezazinobuhlungu bemisipha noma bamathambo kunabantu abadala
  • i-edema (ukuvuvukala kwemilenze, amaqakala, izinyawo, nendawo ezungeze amehlo) akuzange kubikwe ezinganeni

Imiphumela emibi ebikwa kakhulu ebikwa ezinganeni kwakuwukuhlanza nokuhlanza. Imiphumela emibi kakhulu ebibangelwe ngamazinga aphansi amangqamuzana amhlophe egazi nama-platelets.

Uma ingane yakho inale miphumela emibi, khuluma nodokotela wengane yakho ngezindlela zokuyilawula.

I-Gleevec ye-CML

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuvume iGleevec kubantu abathile abane-chromosome-positive (Ph +) chronic myeloid leukemia (CML). I-chromosome yaseFiladelphia iyinombolo ye-chromosome engu-22 enesici. Abantu abane-Ph + CML banoshintsho oluthile ku-DNA yabo ebangela ukuthi amangqamuzana amhlophe egazi amaningi kakhulu akheke.

I-CML ihlukaniswe izigaba ezintathu:

  • Isigaba esingapheli. Lesi yisigaba sokuqala se-CML. Iningi labantu litholwa ukuthi line-CML ngesikhathi sesigaba esingelapheki. Izimpawu zivame ukuba mnene, uma zikhona nhlobo.
  • Isigaba esisheshayo. Kulesi sigaba sesibili, liyanda inani lamangqamuzana omdlavuza egazini lakho. Ungaba nezimpawu eziningi, ezifana nomkhuhlane kanye nokwehlisa isisindo.
  • Isigaba senkinga yokuqhuma. Kulesi sigaba esithuthuke kakhulu, amangqamuzana omdlavuza egazini lakho asabalele kwezinye izitho nezicubu. Izimpawu zakho zingase zibe nzima kakhulu.

IGleevec ivunyelwe ukwelapha i-Ph + CML esanda kutholakala esigabeni esingapheli kubantu bayo yonke iminyaka.

Futhi kuvunyelwe ukwelapha i-Ph + CML esigabeni esibucayi esingapheli, esisheshayo, noma sokuqhuma kubantu abaye bathola ukwelashwa okungaphumelelanga nge-interferon-alpha therapy. I-Interferon-alpha isidakamizwa ebesisetshenziswa kaningi esikhathini esedlule ukwelapha i-CML. Kuthathelwe indawo yimithi efana neGleevec ekhonjiswe ukuthi isebenza kangcono.

Ukusebenza ngempumelelo

Esifundweni semitholampilo seminyaka eyisikhombisa, inani lokusinda kwabantu abadala abathathe iGleevec nge-Ph + CML esanda kutholakala lalingama-86.4%. Lokhu kusho ukuthi abantu abadala abangama-86.4% basinda iminyaka eyisikhombisa ngemuva kokuqala kwabo ukuthatha iGleevec. Lokhu kwaqhathaniswa nabantu abangama-83.3% abathatha imishanguzo ejwayelekile yamakhemikhali.

Esifundweni somtholampilo, abantu ababeke bazama i-interferon-alpha ye-CML bathatha uGleevec. Abanye balaba bantu babe nempendulo ephelele ekwelashweni kweGleevec. Lokhu kusho ukuthi awekho amangqamuzana anomdlavuza atholakele egazini lawo, futhi abengenazo izimpawu zomdlavuza. Nakhu ukuthi bangaki abantu abane-CML abanempendulo ephelele ekuthatheni iGleevec:

  • Ama-95% abantu abasesigabeni esingelapheki
  • Ama-38% abantu abasesigabeni esisheshisiwe
  • I-7% yabantu esigabeni senhlekelele yokuqhuma

Ucwaningo lomtholampilo lufake nezingane ezine-Ph + CML esigabeni esingapheli. Eqenjini elithathe iGleevec, izingane ezingama-78% zithole impendulo ephelele kulo muthi.

Okunye ukusetshenziswa kweGleevec

Ngaphezu kwalokho i-myeloid leukemia engalapheki (bheka ngenhla), i-Food and Drug Administration (i-FDA) ivumile iGleevec ukwelapha ezinye izimo eziningana.

I-Gleevec ye-acute lymphocytic leukemia (YONKE)

IGleevec ivunyelwe ukwelashwa yi-FDA:

  • I-Philadelphia chromosome-positive (Ph +) acute lymphocytic leukemia (ALL) ebuyiselwe emuva * noma i-refractory * kubantu abadala
  • i-Ph + BONKE esanda kutholakala ezinganeni lapho isetshenziswa ngamakhemikhali

Umdlavuza obuyile ubuyile emuva kokuxolelwa, okuwukwehla kwezimpawu nezimpawu zomdlavuza. Umdlavuza obonakalisayo awukaphenduli ekwelashweni komdlavuza okwedlule.

Ocwaningweni lomtholampilo, i-19% yabantu abadala ababuyele emuva noma abangavumiyo BONKE abathathe uGleevec babenempendulo ephelele egazini labo ekwelashweni. Lokhu kusho ukuthi babengenazo izimpawu zomdlavuza.

Ucwaningo lomtholampilo lubuye lwabheka izingane ezinabo BONKE abathathe i-Gleevec futhi bathola i-chemotherapy. Ezinganeni ezingama-70%, umdlavuza wazo awuzange ube mubi iminyaka emine.

I-Gleevec yezinye izinhlobo zomdlavuza wegazi

IGleevec ivunyelwe yi-FDA ukwelapha ezinye izinhlobo zomdlavuza wegazi, kufaka phakathi:

  • Izifo ze-Myelodysplastic / myeloproliferative (umdlavuza womnkantsha wamathambo) kubantu abadala abane-rearrangement yezakhi zofuzo ezithathwe ngeplatelet (PDGFR). Ocwaningweni oluncane lomtholampilo, abantu abangama-45% abaphathwe nge-Gleevec bathole impendulo ephelele egazini labo ekwelashweni. Lokhu kusho ukuthi awekho amangqamuzana omdlavuza atholakele egazini lawo, futhi abengenazo izimpawu zomdlavuza.
  • I-Hypereosinophilic syndrome kanye / noma i-leukemia engapheli ye-eosinophilic kubantu abadala, kufaka phakathi abantu abane-FIP1L1-PDGFRcy fusion kinase. Ezifundweni ezincane zemitholampilo, i-100% yabantu abane-PDGFR gene mutation abathathe uGleevec babe nempendulo ephelele egazini labo ekwelashweni. Phakathi kuka-21% no-58% wabantu ngaphandle kokushintshwa kwezakhi zofuzo noma abanesimo sokuguqula isimo esingaziwa abathathe uGleevec babe nempendulo ephelele egazini labo.
  • I-aggressive systemic mastocytosis kubantu abadala ngaphandle kokuguqulwa kwe-D816v c-Kit. Esifundweni esincane somtholampilo, i-100% yabantu abane-FIP1L1-PDGFRcy fusion kinase mutation abaphathwa nge-Gleevec babenempendulo ephelele ekwelashweni.

I-Gleevec yomdlavuza wesikhumba

IGleevec igunyazwe yi-FDA ukwelapha i-dermatofibrosarcoma protuberans, uhlobo olungandile lomdlavuza wesikhumba, kubantu abadala. Kuvunyelwe kubantu abanomdlavuza:

  • ayikwazi ukuhlinzwa
  • ubuyile ngemuva kokwelashwa
  • i-metastatic (isakaze kwezinye izingxenye zomzimba)

Inani elincane labantu selilashwe noGleevec ngalesi simo ezifundweni zokwelashwa. Kulabo bantu abathathe iGleevec, ama-39% abe nempendulo ephelele ekwelashweni. Lokhu kusho ukuthi i-biopsy yesikhumba (ukususa nokuhlola isampula elincane lesikhumba) ayibonisanga zimpawu zomdlavuza.

I-Gleevec yomdlavuza wamathumbu

I-Gleevec igunyazwe yi-FDA ukwelapha izicubu ze-Kit-positive gastrointestinal stromal tumors (GIST) kubantu abadala ezingeke zihlinzwe noma zi-metastatic (zisabalalele kwezinye izingxenye zomzimba). IGleevec nayo ivunyelwe ukwelapha i-GIST kubantu abadala abahlinzwe ukukhipha izicubu. Le ndlela yokwelashwa (i-adjuvant treatment) isetshenziselwa ukuvimbela umdlavuza ukuthi ungabuyi emuva kokuhlinzwa.

Ezifundweni zokwelashwa, abantu abane-GIST ebingasuswa ngokuhlinzwa bathathe ama-400 noma ama-800 mg we-Gleevec. Basinda cishe iminyaka emine.

Abanye abantu abane-GIST bathola ukuhlinzwa. Phakathi kwezinsuku eziyi-14 nezingama-70 kamuva, baqala ukuthatha uGleevec esifundweni. Babenobungozi obucishe bube ngama-60% bokufa noma ukubuya komdlavuza esikhathini esiyizinyanga eziyi-12. Lokhu kwaqhathaniswa nabantu abathathe i-placebo (ukwelashwa ngaphandle kwemithi esebenzayo).

Ukusetshenziswa okungekho kwelebula kweGleevec

Ngokungeziwe ekusetshenzisweni okubalwe ngenhla, i-Gleevec ingasetshenziswa ngaphandle kwelebula kokunye ukusetshenziswa. Ukusetshenziswa kwezidakamizwa ezingekho kwelebula kulapho umuthi ovunyelwe ukusetshenziswa kokunye unqunyiwe komunye ohlukile ongavunyelwe.

IGleevec ingasetshenziswa ngaphandle kwelebula kwamanye amagciwane, kufaka phakathi:

  • umdlavuza wendlala yesinye, ngokocwaningo lwango-2015
  • i-melanoma, ngokwemihlahlandlela yokwelashwa yeNational Comprehensive Cancer Network
  • thayipha isifo sikashukela esingu-1, ngokusho kwesivivinyo somtholampilo sango-2018

Kodwa-ke, akukho lucwaningo oluningi lokuthi uGleevec usebenza kanjani kubantu ngalezi zimo. Kudingeka ezinye izifundo ukuthola ukuthi iGleevec iyasiza yini ukwelapha isimo ngasinye.

Gleevec yezingane

IGleevec igunyazwe yi-FDA njengokwelashwa kwezingane ezinezimo ezilandelayo:

  • okusanda kutholakala ukuthi iPhiladelphia-positive (Ph +) chronic myeloid leukemia (CML) esigabeni esingelapheki (isigaba sokuqala sesifo)
  • i-Ph + acute lymphocytic leukemia (ALL) esanda kutholakala lapho isetshenziswa ngamakhemikhali

IGleevec ivunyelwe ukusetshenziswa ezinganeni zayo yonke iminyaka. Kodwa-ke, akuzange kube nezifundo zokuthi i-Gleevec iphephe noma isebenza kanjani ezinganeni ezingaphansi kweminyaka yobudala engu-1.

Izindleko ze-Gleevec

Njengayo yonke imithi, izindleko ze-Gleevec zingahluka.

Inani langempela ozolikhokha lincike ekusetshenzisweni kwakho komshuwalense nasekhemisi oyisebenzisayo.

Usizo lwezezimali nolomshuwalense

Uma udinga uxhaso lwezezimali ukukhokhela i-Gleevec, noma uma udinga usizo lokuqonda umshuwalense wakho, usizo luyatholakala.

INovartis Pharmaceutical Corporation, engumkhiqizi wakwaGleevec, inikela ngohlelo olubizwa ngeNovartis Oncology Universal Co-pay Programme. Ukuthola eminye imininingwane nokuthola ukuthi uyakufanelekela yini ukwesekwa, shayela ku-877-577-7756 noma uvakashele iwebhusayithi yohlelo.

Isilinganiso se-Gleevec

Umthamo we-Gleevec odonswa ngudokotela wakho uzoncika ezicini ezithile. Lokhu kufaka phakathi:

  • uhlobo nobukhali besimo osisebenzisayo ukwelapha i-Gleevec
  • ubudala
  • isisindo (sezingane)
  • ukutholakala kwezakhi zofuzo
  • ezinye izimo zezokwelapha ongahle ube nazo
  • eminye imithi ongayiphuza
  • imiphumela emibi ongaba nayo

Umthamo ozowuthola uncike kumdlavuza wakho. Kweminye imidlavuza, udokotela wakho angakuqala ngomthamo ophansi. Ngemuva kwalokho bazoyilungisa ngokuhamba kwesikhathi ukufinyelela kumthamo olungele wena.

Imininingwane elandelayo ichaza imithamo esetshenziswa kakhulu noma enconywayo. Kodwa-ke, qiniseka ukuthatha isilinganiso udokotela wakho akubekela sona. Udokotela wakho uzonquma isilinganiso esihle kakhulu ukuhlangabezana nezidingo zakho.

Amafomu wezidakamizwa namandla

IGleevec iza njengethebhulethi oyiphuza ngomlomo (uyayigwinya). Itholakala kumathebulethi ayi-100-mg kanye namaphilisi angama-400-mg.

Amaphilisi e-100-mg nama-400-mg angena ngamabhodlela. Amathebulethi angama-400-mg abuye afike namaphakethe amabhamuza okunzima ukuthi izingane zivulwe.

Imithamo ye-Gleevec

Imithamo elandelayo imithamo ejwayelekile yokuqala yesimo ngasinye:

  • abadala abane-Philadelphia-positive (Ph +) chronic myeloid leukemia (CML) esigabeni esingelapheki (isigaba sokuqala sesifo): 400 mg / ngosuku
  • Abantu abadala abane-Ph + CML esigabeni esisheshayo noma sokuqhuma kwenhlekelele (isigaba sesibili nesesithathu sesifo): 600 mg / ngosuku
  • Abantu abadala abane-Ph + acute lymphocytic leukemia (BONKE): 600 mg / ngosuku
  • Abantu abadala abane-myelodysplastic / isifo se-myeloproliferative: 400 mg / ngosuku
  • abantu abadala abane-mastocytosis enobudlova: 100 mg noma 400 mg / ngosuku
  • abantu abadala abane-hypereosinophilic syndrome kanye / noma i-leukemia engapheli ye-eosinophilic: 100 mg / ngosuku noma 400 mg / ngosuku
  • Abantu abadala abane-dermatofibrosarcoma protuberans: 800 mg / ngosuku
  • abantu abadala abanezicubu zomzimba emathunjini (GIST): 400 mg / ngosuku

Udokotela wakho angakunikeza isilinganiso esithile. Bazoyisekela ekutheni umzimba wakho uphendula kahle kanjani kumuthi, ukuthi imiphumela emibi yakho inzima kangakanani, nezinye izinto. Uma unemibuzo mayelana nesilinganiso esifanele se-Gleevec sakho, khuluma nodokotela wakho.

Umthamo wezingane

Imithamo yezingane yile elandelayo:

  • izingane ezine-Ph + CML esigabeni esingelapheki (isigaba sokuqala sesifo): 340 mg / m2 / ngosuku
  • izingane ezine-Ph + BONKE: 340 mg / m2 / ngosuku okumele kuthathwe ngamakhemikhali

Udokotela wengane yakho uzokhipha isilinganiso kubude nesisindo sengane yakho. (Ngakho-ke i-340 mg / m2 isho ama-340 mg ngemitha eyisikwele yendawo engaphezulu yomzimba.) Isibonelo, uma ingane yakho ingamamitha amane ubude futhi inesisindo esingama-49 lbs., Indawo yomzimba wayo ingu-0.87 m2. Ngakho umthamo we-Ph + CML uzoba ngu-300 mg.

Kuthiwani uma ngiphuthelwa umthamo?

Uma uphuthelwa umthamo we-Gleevec, thatha owodwa ngokushesha nje lapho ukhumbula. Uma cishe sekuyisikhathi somthamo wakho olandelayo, linda bese uthatha umthamo olandelayo njengoba kuhlelwe. Ungathathi imithamo emibili ukwenza umthamo ongabanjwanga. Lokhu kungandisa ingozi yemiphumela emibi kakhulu.

Ngabe kuzodingeka ngisebenzise lesi sidakamizwa isikhathi eside?

I-Gleevec yenzelwe ukuthi isetshenziswe njengokwelashwa kwesikhathi eside. Uma wena nodokotela wakho nibona ukuthi i-Gleevec iphephile futhi isebenza kahle kini, kungenzeka niyithathe isikhathi eside.

Ezinye izindlela zeGleevec

Ezinye izidakamizwa ziyatholakala ezingelapha isimo sakho. Ezinye zingakulungela kangcono kunabanye. Uma unentshisekelo yokuthola enye indlela ye-Gleevec, khuluma nodokotela wakho ukuze ufunde kabanzi ngeminye imithi engakusebenzela kahle.

Qaphela: Eminye yemithi efakwe kuhlu lapha isetshenzisiwe ngaphandle kwelebula ukwelapha lezi zimo ezithile.

Ezinye izindlela ze-CML

Izibonelo zeminye imishanguzo engasetshenziselwa ukwelapha i-myeloid leukemia (CML) engapheli i-Philadelphia-positive (CML) yilezi:

  • i-dasatinib (Sprycel)
  • I-nilotinib (Tasigna)
  • bosutinib (Bosulif)
  • i-ponatinib (Iclusig)
  • i-omacetaxine (Synribo)
  • i-daunorubicin (i-Cerubidine)
  • cytarabine
  • i-interferon-alpha (Intron A)

Ezinye izindlela ze-GIST

Izibonelo zezinye izidakamizwa ezingasetshenziswa ukwelapha izicubu zomzimba emathunjini (GIST) yilezi:

  • i-sunitinib (Sutent)
  • regorafenib (Stivarga)
  • I-sorafenib (Nexavar)
  • I-nilotinib (Tasigna)
  • i-dasatinib (Sprycel)
  • i-pazopanib (Votrient)

Ezinye izindlela zezinye izimo i-Gleevec engazelapha ziyatholakala. Khuluma nodokotela wakho mayelana nokuthi imiphi imithi engasetshenziselwa isimo sakho.

IGleevec vs. Tasigna

Ungase uzibuze ukuthi uGleevec uqhathanisa kanjani neminye imithi enikezwe ukusetshenziswa okufanayo. Lapha sibheka ukuthi uGleevec noTasigna bafana futhi bahlukene kanjani.

Isebenzisa

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuvume kokubili iGleevec neTasigna ukwelapha izinhlobo ezithile zomdlavuza wegazi.

Zombili lezi zidakamizwa zivunyelwe i-FDA ukwelapha i-Philadelphia-positive (Ph +) chronic myeloid leukemia (CML) esanda kutholakala esigabeni esingapheli kubantu abadala nasezinganeni.

I-chronic myeloid leukemia (CML) ihlukaniswe izigaba ezintathu:

  • Isigaba esingapheli. Lesi yisigaba sokuqala se-CML. Iningi labantu litholwa ukuthi line-CML ngesikhathi sesigaba esingelapheki. Izimpawu zivame ukuba mnene, uma zikhona nhlobo.
  • Isigaba esisheshayo. Kulesi sigaba sesibili, liyanda inani lamangqamuzana omdlavuza egazini lakho. Ungaba nezimpawu eziningi, ezifana nomkhuhlane kanye nokwehlisa isisindo.
  • Isigaba senkinga yokuqhuma. Kulesi sigaba esithuthuke kakhulu, amangqamuzana omdlavuza egazini lakho asabalele kwezinye izitho nezicubu. Izimpawu zakho zingase zibe nzima kakhulu.

I-Gleevec ivunyelwe ukwelapha i-Philadelphia-positive (Ph +) CML kubantu abadala abasesigabeni esibucayi esingapheli, esisheshayo, noma sokuqhuma uma ukwelashwa kwe-interferon-alpha kungasebenzi.

I-Interferon-alpha yisidakamizwa esasivame ukusetshenziswa ukwelapha i-CML esikhathini esedlule. Kungumuthi owenziwe umuntu osebenza njengamaprotheni athile omzimba omzimba futhi avimbele ukukhula kwamangqamuzana omdlavuza.

I-Tasigna ivunyelwe ukwelapha i-Ph + CML ngezigaba ezingamahlalakhona noma ezisheshayo kubantu abadala uma ezinye izindlela zokwelapha zingazange zisebenze, kufaka phakathi ukwelashwa nge-Gleevec. I-Tasigna ayivunyelwe esigabeni senhlekelele yokuqhuma.

I-Tasigna nayo ivunyelwe ukwelapha i-Ph + CML ezinganeni ezineminyaka engu-1 nangaphezulu uma ezinye izindlela zokwelapha zingasebenzi. IGleevec ivunyelwe ukwelapha i-Ph + CML esanda kutholakala ezinganeni.

IGleevec nayo ivunyelwe ukwelapha ezinye izinhlobo zomdlavuza. Bona isigaba “Okunye ukusetshenziswa kweGleevec” ukuze ufunde kabanzi.

Amafomu wezidakamizwa nokuphathwa

IGleevec iqukethe imatinib yezidakamizwa. I-Tasigna iqukethe isidakamizwa i-nilotinib.

IGleevec iza njengethebhulethi. UTasigna uza njengephilisi. Yomibili le mithi iphuzwa ngomlomo.

I-Gleevec ithathwa kanye noma kabili ngosuku, kuya ngomthamo wakho. I-Tasigna ithathwa kabili ngosuku.

IGleevec iza njengamaphilisi ayi-100-mg kanye nama-400-mg. I-Tasigna iza njenge-50-mg, 150-mg, ne-200-mg capsules.

Imiphumela emibi kanye nezingozi

IGleevec neTasigna ziqukethe izidakamizwa ezifanayo. Ngakho-ke, yomibili le mithi ingadala imiphumela emibi efanayo. Ngezansi kunezibonelo zale miphumela emibi.

Imiphumela emibi ejwayelekile

Lezi zinhlu ziqukethe izibonelo zemiphumela emibi ejwayelekile engenzeka ngeGleevec, neTasigna, noma ngazo zombili izidakamizwa (uma zithathwa ngazodwana).

  • Kungenzeka nge-Gleevec:
    • i-edema (ukuvuvukala kwemilenze yakho, amaqakala, nezinyawo, naseduze kwamehlo akho)
    • amajaqamba
    • ubuhlungu bemisipha
    • ubuhlungu bamathambo
    • ubuhlungu besisu
  • Kungenzeka ngeTasigna:
    • ikhanda
    • isikhumba esilumayo
    • ukukhwehlela
    • ukuqunjelwa
    • ubuhlungu obuhlangene
    • i-nasopharyngitis (umkhuhlane ovamile)
    • imfiva
    • ukujuluka ebusuku
  • Kungenzeka ngamabili uGleevec noTasigna:
    • isicanucanu
    • ukuhlanza
    • isifo sohudo
    • ukuqubuka
    • ukukhathala (ukungabi namandla)

Imiphumela emibi kakhulu

Lezi zinhlu ziqukethe izibonelo zemiphumela emibi engaba khona ne-Gleevec, ne-Tasigna, noma ngazo zombili izidakamizwa (uma zithathwa ngazodwana).

  • Kungenzeka nge-Gleevec:
    • ukuhluleka kwenhliziyo okuxakile noma izinkinga zenhliziyo njengokuhluleka kwenhliziyo emaceleni
    • ukuqhuma kwamathumbu (izimbobo esiswini sakho noma emathunjini)
    • ukusabela okukhulu kwesikhumba, kufaka phakathi i-Stevens-Johnson syndrome (umkhuhlane; izilonda ezibuhlungu emlonyeni wakho, umphimbo, amehlo, izitho zangasese, noma umzimba wonke)
    • ukulimala kwezinso
    • i-hypothyroidism (amazinga aphansi e-thyroid) kubantu abasuswe i-thyroid
  • Kungenzeka ngeTasigna:
    • isikhathi eside se-QT (umsebenzi kagesi ongajwayelekile enhliziyweni yakho), okungajwayelekile kepha kungaholela ekufeni okungazelelwe
    • ivimbe imithambo yegazi enhliziyweni
    • isifo sokuqaqamba kwamalunga
    • ukungalingani kwe-electrolyte (amazinga aphezulu noma aphansi wamaminerali athile)
  • Kungenzeka ngamabili uGleevec noTasigna:
    • ukuphazamiseka kwegazi, kufaka phakathi i-anemia (amazinga aphansi amaseli abomvu egazi), i-neutropenia (amazinga aphansi amaseli amhlophe egazi), ne-thrombocytopenia (amazinga aphansi wama-platelets)
    • ukulimala kwesibindi
    • i-tumor lysis syndrome (amangqamuzana omdlavuza akhipha amakhemikhali ayingozi egazini lakho)
    • ukopha (ukuphuma okungapheli)
    • ukugcinwa oketshezi okunzima (uketshezi oluningi noma amanzi)
    • ukwehlisa ukukhula ezinganeni

Ukusebenza ngempumelelo

IGleevec neTasigna banezindlela ezahlukahlukene ezisetshenziswa yi-FDA. Kepha bobabili baphatha i-Ph + CML ngezigaba ezingamahlalakhona nezisheshayo uma ezinye izindlela zokwelapha zingasebenzi. I-CML inezigaba ezintathu: okungamahlalakhona (isigaba 1), ukusheshisa (isigaba 2), kanye nenkinga yokuqhuma (isigaba 3).

Ukusetshenziswa kweGleevec neTasigna ekwelapheni i-Ph + CML esanda kutholakala kubantu abadala kuqhathaniswe ngqo esifundweni somtholampilo. Abaphenyi baqhathanisa abantu abathatha ama-400 mg we-Gleevec kanye ngosuku noma ama-300 mg weTasigna kabili ngosuku.

Ngemuva kwezinyanga eziyi-12 zokwelashwa, abantu abangama-65% abathathe uGleevec babengenawo amaseli e-Ph + emnkantsheni wabo (lapho kukhula khona amaseli e-CML anomdlavuza). Kubantu abathathe iTasigna, ama-80% abengenawo amaseli e-Ph + emnkantsheni wabo.

Ngemuva kweminyaka emihlanu belashwa, ama-60% abantu abathathe i-Gleevec babenenani elincishiswe kakhulu lohlobo lomdlavuza egazini labo. Lokhu kwaqhathaniswa nabantu abangama-77% abathathe iTasigna.

Futhi ngemuva kweminyaka emihlanu yokwelashwa, abantu abangu-91.7% abathathe uGleevec basaphila. Lokho kuqhathaniswa nabantu abangama-93.7% abathathe iTasigna.

Imiphumela yalolu cwaningo iphakamisa ukuthi iTasigna ingasebenza kakhulu kuneGleevec ekwelapheni i-Ph + CML esanda kutholakala esigabeni esingalapheki.

Izindleko

IGleevec neTasigna yizidakamizwa ezibizwa ngamagama. I-Tasigna ayinayo ifomu ejwayelekile, kepha i-Gleevec inefomu ejwayelekile ebizwa nge-imatinib. Imithi enegama lomkhiqizo ivame ukubiza ngaphezu kwama-generic.

Ngokuya ngokulinganiselwa ku-GoodRx.com, igama lomkhiqizo iGleevec lingabiza ngaphansi kukaTasigna. Indlela ejwayelekile yeGleevec (imatinib) nayo ibiza ngaphansi kukaTasigna. Intengo yangempela ozoyikhokhela noma yimuphi umuthi incike kumthamo wakho, uhlelo lomshuwalense, indawo okuyo nasekhemisi oyisebenzisayo.

IGleevec vs. Sprycel

Ungase uzibuze ukuthi uGleevec uqhathanisa kanjani neminye imithi enikezwe ukusetshenziswa okufanayo. Lapha sibheka ukuthi i-Gleevec ne-Sprycel ziyefana futhi zehlukile kanjani.

Isebenzisa

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuvume kokubili iGleevec neSprycel ukwelapha izinhlobo ezithile zomdlavuza wegazi.

Zombili lezi zidakamizwa zivunyelwe yi-FDA ukuphatha ukwelashwa kwe-myeloid leukemia (CM +) esanda kutholakala kusigaba esingalapheki kubantu abadala nasezinganeni.

I-CML ihlukaniswe izigaba ezintathu:

  • Isigaba esingapheli. Lesi yisigaba sokuqala se-CML. Iningi labantu litholwa ukuthi line-CML ngesikhathi sesigaba esingelapheki. Izimpawu zivame ukuba mnene, uma zikhona nhlobo.
  • Isigaba esisheshayo. Kulesi sigaba sesibili, liyanda inani lamangqamuzana omdlavuza egazini lakho. Ungaba nezimpawu eziningi, ezifana nomkhuhlane kanye nokwehlisa isisindo.
  • Isigaba senkinga yokuqhuma. Kulesi sigaba esithuthuke kakhulu, amangqamuzana omdlavuza egazini lakho asabalele kwezinye izitho nezicubu. Izimpawu zakho zingase zibe nzima kakhulu.

IGleevec neSprycel kusetshenziselwa ukwelapha i-Ph + CML kubantu abadala abasesigabeni esingelapheki.

I-Gleevec iphinde isetshenziselwe ukwelapha i-Ph + CML kubantu abadala ezigabeni ezingamahlalakhona, ezisheshayo, noma zokuqhuma uma ukwelashwa kwe-interferon-alpha kungasebenzi. I-Interferon-alpha yisidakamizwa esasivame ukusetshenziswa ukwelapha i-CML esikhathini esedlule. Kungumuthi owenziwe umuntu osebenza njengamaprotheni athile omzimba omzimba futhi avimbele ukukhula kwamangqamuzana omdlavuza.

ISprycel iphinde isetshenziselwe ukwelapha i-Ph + CML kubantu abadala ezigabeni ezingamahlalakhona, ezisheshayo, noma zokuqhuma uma uGleevec engasebenzi.

Kokubili iGleevec neSprycel kuvunyelwe ukwelapha i-Ph + CML esigabeni esingapheli ezinganeni. Zombili zivunyelwe nokwelapha i-Ph + acute lymphocytic leukemia (ALL) ezinganeni kanye ne-chemotherapy.

IGleevec nayo ivunyelwe ukwelapha ezinye izinhlobo zomdlavuza. Bona isigaba “Okunye ukusetshenziswa kweGleevec” ukuze ufunde kabanzi.

Amafomu wezidakamizwa nokuphathwa

IGleevec iqukethe imatinib yezidakamizwa. I-Sprycel iqukethe i-dasatinib yezidakamizwa.

IGleevec neSprycel womabili eza njengamaphilisi owaphuza ngomlomo (uyawagwinya).

Amaphilisi e-Gleevec anezikhwepha ezimbili: 100 mg no-400 mg. Kuthathwa kanye noma kabili ngosuku, kuya ngomthamo wakho.

Amaphilisi e-Sprycel angena ngamandla alandelayo: 20 mg, 50 mg, 70 mg, 80 mg, 100 mg, no-140 mg. I-Sprycel ithathwa kanye ngosuku.

Imiphumela emibi kanye nezingozi

IGleevec neSprycel ziyefana kodwa ziqukethe izidakamizwa ezahlukahlukene. Ngakho-ke, yomibili le mithi ingadala imiphumela emibi efanayo. Ngezansi kunezibonelo zale miphumela emibi.

Imiphumela emibi ejwayelekile

Lezi zinhlu ziqukethe izibonelo zemiphumela emibi ejwayelekile engenzeka ngeGleevec, ngeSprycel, noma ngazo zombili izidakamizwa (uma zithathwa ngazodwana).

  • Kungenzeka nge-Gleevec:
    • ukuhlanza
    • amajaqamba
    • ubuhlungu besisu
    • indawo ye-edema (ukuvuvukala ngamehlo)
  • Kungenzeka ngeSprycel:
    • inkinga yokuphefumula
    • ikhanda
    • ukopha
    • amasosha omzimba abuthakathaka (umzimba wakho awukwazi ukulwa nezifo)
  • Kungenzeka ngamabili uGleevec noSprycel:
    • i-edema (ukuvuvukala kwemilenze yakho, amaqakala, nezinyawo)
    • isicanucanu
    • ubuhlungu bemisipha
    • ubuhlungu bamathambo
    • isifo sohudo
    • ukuqubuka
    • ukukhathala (ukungabi namandla)

Imiphumela emibi kakhulu

Lezi zinhlu ziqukethe izibonelo zemiphumela emibi engaba khona ne-Gleevec, ne-Sprycel, noma ngazo zombili izidakamizwa (uma zithathwa ngazodwana).

  • Kungenzeka nge-Gleevec:
    • izinkinga zenhliziyo, njengokuhluleka kwenhliziyo okucinana
    • ukulimala kwesibindi
    • ukuqhuma kwamathumbu (izimbobo esiswini sakho noma emathunjini)
    • ukulimala kwezinso
    • i-hypothyroidism (amazinga aphansi e-thyroid) kubantu abasuswe i-thyroid
  • Kungenzeka ngeSprycel:
    • umfutho wegazi ophezulu wegazi (umfutho wegazi ophakeme emithanjeni yegazi emaphashini akho)
    • isikhathi eside se-QT (uhlobo lomsebenzi kagesi ongajwayelekile enhliziyweni yakho)
    • ischemic heart attack (ukuntuleka komoya-mpilo emisipheni yenhliziyo)
  • Kungenzeka ngamabili uGleevec noSprycel:
    • ukugcinwa oketshezi okunzima (uketshezi oluningi kakhulu noma amanzi) azungeze amaphaphu akho, inhliziyo nesisu
    • ukuphazamiseka kwegazi okunzima (amazinga aphansi amaseli abomvu egazi, ama-platelets, noma amaseli amhlophe egazi)
    • ukopha kakhulu (ukuphuma okungapheli)
    • ukusabela okukhulu kwesikhumba, kufaka phakathi i-Stevens-Johnson syndrome (umkhuhlane; izilonda ezibuhlungu emlonyeni wakho, umphimbo, amehlo, izitho zangasese, noma umzimba wonke)
    • i-tumor lysis syndrome (amangqamuzana omdlavuza akhipha amakhemikhali ayingozi egazini lakho)
    • ukushaya kwenhliziyo okungajwayelekile noma isigqi (ukushaya kwenhliziyo okushesha kakhulu, kuhamba kancane kakhulu, noma okungajwayelekile)
    • ukukhula okungakhuli ezinganeni

Ukusebenza ngempumelelo

IGleevec neSprycel banezindlela ezahlukahlukene ezisetshenziswa yi-FDA. Kepha bobabili baphatha i-Ph + CML esanda kutholakala esigabeni esingapheli (isigaba sokuqala se-CML) kubantu abadala nasezinganeni. I-Gleevec ne-Sprycel nazo zombili zelapha i-Ph + BONKE ezinganeni uma zisetshenziswa zihlangene ne-chemotherapy.

Ngaphezu kwalokho, bobabili uGleevec noSprycel baphatha i-Ph + CML ezigabeni ezithuthukile neziqhuma kubantu abadala, noma i-Ph + BONKE, uma ezinye izidakamizwa zingabasebenzelanga.

Ukusetshenziswa kwe-Gleevec ne-Sprycel ekwelapheni i-Ph + CML esanda kutholakala kubantu abadala kuqhathaniswe ngqo esifundweni somtholampilo. Abaphenyi baqhathanisa abantu abathatha ama-400 mg we-Gleevec ngosuku noma u-100 mg we-Sprycel ngosuku.

Kungakapheli izinyanga eziyi-12, abantu abangama-66.2% abathathe iGleevec babengenawo amaseli e-Ph + emnkantsheni wabo (lapho kuvela amangqamuzana e-CML anomdlavuza). Eqenjini elithathe iSprycel, abantu abangu-76.8% babengenawo amaseli e-Ph + emnkantsheni wabo.

Ngemuva kweminyaka emihlanu belashwa, abantu abalinganiselwa ku-89.6% abathathe uGleevec basaphila. Lokho kuqhathaniswa nabantu abalinganiselwa ku-90.9% abathathe iSprycel.

Imiphumela yalolu cwaningo iphakamisa ukuthi iSprycel ingahle isebenze kancane kune-Gleevec ekwelapheni i-Ph + CML esanda kutholakala esigabeni esingapheli.

Izindleko

IGleevec neSprycel yizidakamizwa ezingamagama womabili. I-Sprycel ayinayo ifomu elejwayelekile, kepha i-Gleevec inefomu ejwayelekile ebizwa nge-imatinib. Imithi enegama lomkhiqizo ivame ukubiza ngaphezu kwama-generic.

Ngokuya ngokulinganiselwa ku-GoodRx.com, igama lomkhiqizo iGleevec lingabiza ngaphansi kukaSprycel. Indlela ejwayelekile yeGleevec (imatinib) nayo ingabiza ngaphansi kukaSprycel. Intengo yangempela ozoyikhokhela noma yimuphi umuthi incike kumthamo wakho, uhlelo lwakho lomshuwalense, indawo okuyo nasekhemisi oyisebenzisayo.

Gleevec notshwala

Akwaziwa ukuthi iGleevec notshwala kuyahlangana yini.

Kodwa-ke, isibindi sakho sigaya (siphula) i-Gleevec kanye notshwala. Ngakho-ke ukuphuza utshwala obuningi ngenkathi uthatha i-Gleevec kungavimbela isibindi sakho ekuphuleni lesi sidakamizwa. Lokhu kungakhuphula amazinga e-Gleevec emzimbeni wakho futhi kwandise ubungozi bemiphumela emibi kakhulu, kubandakanya ukulimala kwesibindi.

Kokubili i-Gleevec notshwala kungadala imiphumela emibi efana nale:

  • isicanucanu
  • isifo sohudo
  • ikhanda
  • ukukhathala (ukungabi namandla)

Ukuphuza utshwala ngesikhathi sokwelashwa kwe-Gleevec kungakhuphula ubungozi bakho bokuthola le miphumela engemihle.

Uma uphuza utshwala, khuluma nodokotela wakho ukuthi kungakanani okuphephile kuwe ngesikhathi sokwelashwa kwe-Gleevec.

Ukusebenzisana kwe-Gleevec

I-Gleevec ingaxhumana neminye imithi eminingana. Ingasebenzisana nezithasiselo ezithile kanye nokudla okuthile.

Ukuxhumana okuhlukile kungadala imiphumela ehlukile. Isibonelo, ezinye zingaphazamisa ukuthi usebenza kanjani umuthi, kanti ezinye zingadala ukwanda kwemiphumela emibi.

Gleevec neminye imithi

Ngezansi kunohlu lwemithi engasebenzisana neGleevec. Lolu hlu aluqukethe yonke imishanguzo engasebenzisana neGleevec.

Ngaphambi kokuthatha iGleevec, khuluma nodokotela wakho nosokhemisi. Batshele ngayo yonke imishanguzo oyinikezwa ngudokotela, i-counter-counter, nezinye izidakamizwa oziphuzayo. Batshele futhi nganoma yimaphi amavithamini, amakhambi, nezithako ozisebenzisayo. Ukwabelana ngalolu lwazi kungakusiza ugweme ukuhlangana okungenzeka.

Uma unemibuzo mayelana nokuhlangana kwezidakamizwa okungakuthinta, buza udokotela wakho noma usokhemisi.

UGleevec noTylenol

Ukuthatha iGleevec ngeTylenol (i-acetaminophen) kungakhuphula ubungozi bakho bemiphumela emibi kakhulu, njengokulimala kwesibindi.

Ama-enzyme (amaprotheni akhethekile) esibindini sakho aphula i-Gleevec ne-Tylenol. Ngokubambisana, le mithi emibili ingadlula ama-enzyme futhi ilimaze amaseli esibindi sakho.

Buza udokotela wakho ukuthi kuphephile yini ukuthi uthathe i-Tylenol ngesikhathi sokwelashwa kwakho kwe-Gleevec.

I-Gleevec nemithi ethile yokubanjwa

Ukuthatha i-Gleevec ngemithi ethile yokuquleka kunganciphisa amazinga we-Gleevec emzimbeni wakho. Lokhu kungenza iGleevec ingasebenzi kahle (isebenze kahle kancane).

Izibonelo zemithi yokubanjwa enganciphisa amazinga we-Gleevec ifaka:

  • i-phenytoin (Dilantin, Phenytek)
  • i-carbamazepine (Carbatrol, Tegretol)
  • lindokuhle

Uma uthatha i-Gleevec kanye nemithi ethile yokuquleka, udokotela wakho angakunika umuthi ohlukile wokubamba noma alungise isilinganiso se-Gleevec.

I-Gleevec kanye nama-antibiotic athile

Ukuthatha i-Gleevec ngemithi elwa namagciwane ethile (imishanguzo elapha ukutheleleka ngamagciwane) kungakhuphula amazinga e-Gleevec emzimbeni wakho. Ama-antibiotic avimbela i-Gleevec ukuthi ingahlehli emzimbeni wakho. Lokhu kwandisa ingozi yakho yemiphumela emibi kakhulu.

Isibonelo semithi elwa namagciwane engakhuphula amazinga e-Gleevec yi-clarithromycin (Biaxin XL).

Uma uthatha i-Gleevec futhi udinga i-antibiotic, udokotela wakho angakuqapha ngemiphumela emibi. Banganciphisa futhi umthamo wakho we-Gleevec isikhashana.

I-Gleevec kanye nama-antifungal athile

Ukuthatha i-Gleevec ngama-antifungal athile (imishanguzo elapha ukutheleleka kwefungal) kungavimbela ukuwohloka kweGleevec emzimbeni wakho. Lokhu kungakhuphula amazinga we-Gleevec egazini lakho futhi kwandise ubungozi bemiphumela emibi kakhulu.

Izibonelo zama-antifungal ezingakhuphula amazinga we-Gleevec yilezi:

  • i-itraconazole (Onmel, Sporanox, Tolsura)
  • i-ketoconazole (Extina, Ketozole, Xolegel)
  • i-voriconazole (Vfend)

Uma uthatha i-Gleevec futhi udinga ukwelashwa kwe-antifungal, udokotela wakho uzokuqapha ngemiphumela emibi. Banganciphisa futhi umthamo wakho we-Gleevec isikhashana.

I-Gleevec nama-opioid

Ukuthatha i-Gleevec ngemithi ethile yobuhlungu kungakhuphula amazinga okudambisa izinhlungu emzimbeni wakho. Lokhu kungakwenza ube nethuba lokuba nemiphumela emibi efana ne-sedation (ukuzwa ukozela nokuxwayisa kancane) nokudangala kokuphefumula (ukuphefumula ngokunensa).

Izibonelo zemithi yobuhlungu ye-opioid engakhuphula amazinga we-Gleevec ifaka:

  • i-oxycodone (i-Oxycontin, i-Roxicodone, i-Xtampza ER)
  • i-tramadol (i-ConZip, i-Ultram)
  • i-methadone (i-Dolophine, i-Methadose)

Khuluma nodokotela wakho mayelana nokuthi kuphephile yini ukuthatha imithi yezinhlungu ngesikhathi sokwelashwa kwakho kwe-Gleevec. Bangaphakamisa ezinye izindlela zokudambisa ubuhlungu bakho.

Gleevec kanye nemithi ethile ye-HIV

Ukuthatha i-Gleevec ngemithi ethile ye-HIV kungandisa ubungozi bemiphumela emibi kakhulu. Imithi ethile ye-HIV ingavimbela i-Gleevec ukuthi ingahlehli, okuholela emazingeni aphezulu we-Gleevec emzimbeni wakho.

Izibonelo zemithi ye-HIV engakhuphula amazinga we-Gleevec ifaka:

  • i-atazanavir (Reyataz)
  • i-nevirapine (Viramune)
  • i-saquinavir (i-Invirase)

Omunye umuthi we-HIV, i-efavirenz (Sustiva), unganciphisa amazinga we-Gleevec emzimbeni wakho. Lokhu kungadala ukuthi iGleevec ingasebenzi kahle.

Imithi eminingi ye-HIV iza njengamaphilisi okuhlanganisa, okusho ukuthi afaka izidakamizwa ezingaphezu kwesisodwa. Ngakho-ke qiniseka ukuthi ukhuluma nodokotela wakho ngayo yonke imishanguzo ye-HIV oyiphuzayo.

Uma udinga ukuthatha i-Gleevec ngemithi ethile ye-HIV, udokotela wakho angashintsha isilinganiso sakho se-Gleevec.

Gleevec nemithi ethile yomfutho wegazi

Ukuthatha i-Gleevec ngemithi ethile yengcindezi yegazi kungakhuphula noma kwehlise amazinga wesidakamizwa emzimbeni wakho. Lokhu kungakwenza ube nemiphumela engemihle noma kunciphise ukuthi imithi isebenza kanjani.

Isibonelo sale mithi sifaka i-verapamil (Calan, Tarka).

Uma udinga ukuthatha i-Gleevec nganoma iyiphi yale mithi, udokotela wakho uzokuqapha kakhulu ngemiphumela emibi. Bangase futhi balungise isilinganiso somuthi noma bancome umuthi ohlukile.

I-Gleevec ne-warfarin

Ukuthatha i-Gleevec nge-warfarin (i-Coumadin, i-Jantoven) kungandisa ingozi yokuphuma kwegazi. IGleevec ivimbela i-warfarin ukuthi ingahlehli emzimbeni wakho. Lokhu kwandisa amazinga e-warfarin futhi kungaholela ekuphumeni kwegazi okunzima ukukulawula.

Uma udinga i-anticoagulant (i-blood thinner) ngenkathi uthatha i-Gleevec, udokotela wakho kungenzeka anikeze umuthi ngaphandle kwe-warfarin.

IGleevec neSt

Ukuthatha i-Gleevec nge-St. John's wort kunganciphisa amazinga we-Gleevec emzimbeni wakho. Lokhu kungenza ukuthi iGleevec ingasebenzi kahle (ingasebenzi futhi).

Buza udokotela wakho ukuthi ngabe iSt John's wort iphephile yini ukuthi ungathatha ngesikhathi sokwelashwa kwakho kwe-Gleevec. Bangancoma enye indlela ye-St. John's Wort noma bandise umthamo wakho we-Gleevec.

I-Gleevec ne-grapefruit

Ukudla izithelo zomvini noma ukuphuza ijusi lamagilebhisi ngesikhathi sokwelashwa kwakho kwe-Gleevec kungandisa ubungozi bemiphumela emibi kakhulu. I-Grapefruit iqukethe amakhemikhali avimbela i-Gleevec ukuthi ingahlehli emzimbeni wakho. Lokhu kudala amazinga anyukayo eGleevec, angaholela emiphumeleni emibi kakhulu.

Qiniseka ukuthi ugwema ukudla isithelo samagilebhisi nokuphuza ijusi lamagilebhisi ngesikhathi sokwelashwa kwakho kwe-Gleevec.

Ungayithatha kanjani iGleevec

Qiniseka ukuthi uthatha iGleevec ngokwemiyalelo kadokotela wakho noma yomhlinzeki wezokunakekelwa kwempilo.

Ukuthatha nini

Ngemithamo ye-Gleevec ka-600 mg noma ngaphansi, umuthi kufanele uphuzwe kanye ngosuku. Ungayithatha noma kunini.

Uma udokotela wakho ekunika u-800 mg we-Gleevec ngosuku, uzokuthatha ngemithamo emibili: 400 mg ekuseni no-400 mg kusihlwa.

Udokotela wakho uzokunika imiyalo lapho kufanele uthathe umthamo wakho.

Ukuthatha iGleevec ngokudla

Thatha uGleevec ngesidlo nengilazi enkulu yamanzi. Lokhu kungasiza ukuvimbela isisu esithukuthele.

Ngabe iGleevec ingachotshozwa, ihlukaniswe, noma ihlafunwe?

Akufanele uchoboze, uhlukanise, noma uhlafune amaphilisi e-Gleevec. Amaphilisi agayiwe futhi ahlukanisiwe angaba yingozi kunoma yisiphi isikhumba noma ezinye izitho zomzimba ezihlangana nazo.

Uma unenkinga yokugwinya amaphilisi e-Gleevec, faka ithebhulethi engilazini enkulu yamanzi noma ujusi we-apula. Hlanganisa amanzi ngesipuni ukusiza ithebhulethi ichitheke. Bese uphuza ingxube ngokushesha.

Isebenza kanjani iGleevec

IGleevec iqukethe imatinib yezidakamizwa, okungeyesigaba semithi ebizwa nge-tyrosine kinase inhibitors (TKIs). Imithi ekilasini lezidakamizwa ze-TKI ibhekiswe ekwelashweni okubhekiswe kukho. Zithinta amaprotheni akhethekile kumaseli womdlavuza.

IGleevec ivunyelwe ukwelapha izimo ezahlukahlukene ezahlukahlukene. Lapha sizohlola ukuthi iGleevec isebenza kanjani ukuphatha ezimbili zazo.

Okwe-Ph + CML

Ku-Philadelphia-positive (Ph +) chronic myeloid leukemia (CML), amaseli akha amangqamuzana amhlophe egazi anephutha ekwakhekeni kofuzo. Leli phutha lofuzo litholakala ochungechungeni lwe-DNA olubizwa nge-chromosome yaseFiladelphia.

I-chromosome yasePhiladelphia iqukethe ufuzo olungavamile (BCR-ABL1) oludala ukwakheka kwamangqamuzana amhlophe egazi amaningi kakhulu. Lawa maseli amhlophe egazi awavuthwa futhi afe njengoba kufanele. Amaseli egazi amhlophe angavuthwa abizwa ngokuthi "ukuqhuma" aminyanisa ezinye izinhlobo zamaseli egazi okudingeka ukuthi igazi lakho lisebenze kahle.

IGleevec isebenza ngokunamathisela iprotheni, ebizwa nge-tyrosine kinase, kumaseli enziwe yi-BCR-ABL1. Lapho uGleevec ebopha kule protein, umuthi uvimbela iseli ekuthumeleni amasiginali atshela iseli ukuthi likhule. Ngaphandle kwalezi zimpawu zokukhula, amangqamuzana egazi anomdlavuza ayafa. Lokhu kusiza ukubuyisela inani lamaseli wokuqhuma enombolweni enempilo.

Okwe-GIST

IGleevec ibuye isize ekwelapheni izicubu zomzimba emathunjini (GIST). Emangqamuzaneni amaningi we-GIST tumor, kunenani eliphakeme lamaprotheni athile, abizwa nge-Kit ne-platelet-derived growth factor (PDGF), kunamaseli ajwayelekile. Lawa maprotheni asiza amangqamuzana omdlavuza ukuba akhule futhi ahlukane.

IGleevec ikhomba lawa maprotheni futhi iwavimbele ekusebenzeni. Lokhu kubambezela ukukhula komdlavuza. Kubuye kubangele ukuthi amangqamuzana omdlavuza afe.

Kuthatha isikhathi esingakanani ukusebenza?

Kuya ngesimo. Isikhathi sokuthi i-Gleevec iqala ukusebenza sihlukile kumuntu ngamunye.

Izifundo zokwelashwa zabheka abantu abane-CML abathathe uGleevec. Ngenyanga eyodwa, inani lamaseli anomdlavuza egazini lehliswa cishe engxenyeni yabantu abasezigabeni zenhlekelele yokuqhuma (isigaba esithuthukile se-CML). Ezifundweni zabantu abane-GIST abathathe i-Gleevec, izicubu ziyeke ukukhula noma zancipha ezinyangeni ezintathu.

Udokotela wakho uzolibheka njalo igazi lakho ukuze abone ukuthi uGleevec uyakusebenzela yini.

Gleevec nokukhulelwa

Kufanele ugweme i-Gleevec uma ukhulelwe. Kuke kwaba nemibiko yokuphuphunyelwa yizisu nokulimala kombungu kwabesifazane abathathe uGleevec besakhulelwe. Futhi ezifundweni zezilwane, abesifazane abakhulelwe abanikezwa uGleevec baba nengozi eyengeziwe yokukhubazeka kokuzalwa.

Uma ukhulelwe, udokotela wakho angakweluleka ukuthi ulinde kuze kube ngemuva kokubeletha kwakho ukuze uqale ukuthatha iGleevec. Noma bazoncoma umuthi ohlukile.

Uma uthatha i-Gleevec, kubalulekile ukusebenzisa ukuvimbela ukubeletha okusebenzayo ukuze ungakhulelwa. Ngemuva kokuthatha umthamo wakho wokugcina we-Gleevec, qhubeka usebenzisa ukulawulwa kokuzalwa izinsuku eziyi-14.

Gleevec nokuncelisa

Ucwaningo lukhombisa ukuthi uGleevec udlula obisini lwebele lomuntu. Lokhu kungadala ingozi enkulu enganeni encelayo.

Uma uncelisa futhi ucabanga ukuthatha i-Gleevec, udokotela wakho angakweluleka ukuthi uyeke ukuncelisa lapho uqala ukwelashwa.

Ngemuva kokuthatha umthamo wakho wokugcina we-Gleevec, linda okungenani inyanga eyodwa ngaphambi kokuqala ukuncelisa.

Ukudlula ngokweqile kwe-Gleevec

Ukuthatha kakhulu iGleevec kungakhuphula ubungozi bakho bemiphumela emibi kakhulu.

Izimpawu zokudlula ngokweqile

Izimpawu zokudlula ngokweqile zingabandakanya:

  • isicanucanu
  • ukuhlanza
  • isifo sohudo
  • ubuhlungu besisu
  • ukuqhuma okukhulu
  • ukuphazamiseka kwemisipha (ukudikiza)
  • ikhanda
  • ukungabi nesifiso sokudla
  • ubuthakathaka bemisipha
  • ukukhathala (ukungabi namandla)
  • ukuvuvukala
  • ukuphazamiseka kwegazi, njengamazinga aphansi wegazi, amaseli abomvu egazi, noma amaseli amhlophe egazi
  • imfiva

Okufanele ukwenze uma kwenzeka ukweqisa ngokweqile

Uma ucabanga ukuthi uthathe kakhulu lo muthi, shayela udokotela wakho. Ungashayela futhi i-American Association of Poison Control Centers ku-800-222-1222 noma usebenzise ithuluzi labo eliku-inthanethi. Kepha uma izimpawu zakho zinzima, shayela ku-911 noma uye egumbini lezimo eziphuthumayo eliseduze ngokushesha.

Imibuzo ejwayelekile ngeGleevec

Nazi izimpendulo zemibuzo ebuzwa njalo ngeGleevec.

Ngabe uGleevec uhlobo lwe-chemotherapy?

I-Gleevec akuyona indlela yokwelashwa ngamakhemikhali. I-Gleevec yindlela yokwelashwa ehlosiwe ethinta ama-molecule athile kumaseli womdlavuza.

Ngokukhetha ama-molecule athile, izindlela zokwelashwa ezihlosiwe njenge-Gleevec zisiza ukunciphisa ukukhula nokusabalala kwamangqamuzana omdlavuza. Udokotela wakho uzokunikeza ukwelashwa okuhlosiwe okuya ngohlobo lomdlavuza onawo.

Imithi yokwelashwa ngamakhemikhali yehlukile kwezokwelapha okubhekiswe kuzo. Imithi yokwelashwa ngamakhemikhali isebenza kuwo wonke amaseli emzimbeni akhula ngokushesha, hhayi amangqamuzana omdlavuza kuphela. Imithi ye-Chemotherapy ivamise ukubulala amangqamuzana akhulayo futhi ithinte amaseli amaningi emzimbeni kunokwelashwa okuhlosiwe.

Ngabe uhlobo olujwayelekile lwe-Gleevec lusebenza njengomuthi wegama lomkhiqizo?

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kudinga abenzi bemithi ejwayelekile ukufakazela ukuthi umkhiqizo wabo une:

  • isithako esisebenzayo esifanayo nomuthi wegama lomkhiqizo
  • amandla afanayo namandla esikali njengomuthi wegama lomkhiqizo
  • indlela efanayo yokuphatha (ukuthi uwuphuza kanjani umuthi)

Umuthi ojwayelekile nawo uyadingeka ukuthi usebenze ngendlela efanayo futhi nomkhiqizo wegama lomkhiqizo.

Ngokuya nge-FDA, uhlobo olujwayelekile lwe-Gleevec luyahlangabezana nalezi zidingo. Lokhu kusho ukuthi i-FDA iqinisekisa ukuthi ifomu elijwayelekile liyasebenza njengomuthi wegama lomkhiqizo.

Ngingakwazi yini ukumelana nokwelashwa nge-Gleevec?

Yebo. Kungenzeka ukuthi uthuthukise ukumelana neGleevec. Ukumelana kusho ukuthi umuthi uyayeka ukusebenza ngokuhamba kwesikhathi. Kucatshangwa ukuthi lokhu kubangelwa ushintsho ezakhiweni zofuzo zamangqamuzana omdlavuza.

Uma uthola ukumelana neGleevec, udokotela wakho angakunikeza umthamo ophakeme. Bazobona ukuthi amangqamuzana omdlavuza aphendula futhi emithini. Udokotela wakho futhi angakunikeza umuthi ohlukile ongenakho ukumelana nawo.

Ingabe ikhona imikhawulo yokudla okufanele ngiyilandele ngenkathi ngithatha i-Gleevec?

Ayikho imingcele ehlelekile yokudla okufanele uyilandele ngenkathi uthatha iGleevec. Kodwa-ke, kufanele ugweme ukudla isithelo samagilebhisi nokuphuza ijusi lamagilebhisi. I-Grapefruit iqukethe ikhemikhali elingavimbela umzimba wakho ekugayeni (ukwephula) iGleevec. Lokhu kungaholela emazingeni aphezulu omuthi osegazini lakho. Izinga le-Gleevec eliphakeme kunokujwayelekile lenyusa ubungozi bemiphumela emibi kakhulu.

Ngaphezu kwalokho, udokotela wakho angakunika izeluleko ezijwayelekile ngokudla kwakho ukusiza ukunciphisa imiphumela emibi ethile. Isibonelo, i-Gleevec ibanga isicanucanu nokuhlanza kubantu abaningi. Ukusiza ukuvimbela lokhu, udokotela wakho angancoma ukuthi ugweme ukudla okungenza isicanucanu sibe sibi kakhulu. Lokhu kufaka ukudla okunzima, okunamafutha, noma okunamafutha, nokudla okubabayo noma okune-asidi. Izibonelo ngososo abomvu kakhulu, ukudla okuthosiwe, nezinto eziningi zokudla okusheshayo.

Ekugcineni, uma uthatha i-Gleevec yomdlavuza wamathumbu, njengamathumbu we-gastrointestinal stromal tumors (GIST), udokotela wakho angancoma imikhawulo ethile yokudla. Umgomo ukuvimbela izinkinga esiswini noma emathunjini akho. Khuluma nodokotela wakho mayelana nokuthi yikuphi ukudla okulungele wena.

Ngizoba nezimpawu zokuhoxa uma ngiyeka ukusebenzisa iGleevec?

Ungahle. Abanye abantu babe nezimpawu zokuhoxa ngemuva kokuqeda ukwelashwa kwabo kwe-Gleevec. Esifundweni esisodwa esincane somtholampilo, abantu abangama-30% babenezinhlungu zemisipha noma zethambo ngemuva kokumisa uGleevec. Ubuhlungu bebuvame emahlombe abo, okhalweni, emilenzeni nasezingalweni. Lesi sibonakaliso sokuhoxa senzeke kungakapheli isonto elilodwa kuya kwayisithupha yokumisa ukwelashwa.

Cishe isigamu sabantu baphatha izinhlungu zabo ngokudambisa izinhlungu okuthengwa ekhawunteni. Enye ingxenye yayidinga imishanguzo kadokotela. Kubantu abaningi ababenezimpawu zokuhoxa, ubuhlungu bemisipha namathambo buhambe phakathi kwezinyanga ezintathu kuya onyakeni noma ngaphezulu.

Ngabe kuzodingeka ngisebenzise ezinye izidakamizwa ne-Gleevec ukwelashwa?

Kuya ngokuthi umdlavuza wakho usuthuthuke kangakanani. Ngezigaba ezithuthukile zomdlavuza noma umdlavuza osabalalele ebuchosheni noma emgogodleni, udokotela wakho angangeza i-chemotherapy ekwelashweni kwakho kwe-Gleevec. Ngaphezu kwalokho, izingane ezine-leukemia ye-lymphocytic acute (Ph +) yaseFiladelphia (i-acute) ingathola i-Gleevec kanye ne-chemotherapy.

Ngezinhlobo ezithile zomdlavuza, udokotela wakho angaphinde anikeze i-steroid. Futhi kungadingeka ukuthi usebenzise imishanguzo ukuphatha imiphumela emibi, njengokunciphisa izinhlungu zobuhlungu bemisipha.

Ukuphelelwa yisikhathi kwe-Gleevec, ukugcina nokulahla

Uma uthola uGleevec ekhemisi, usokhemisi uzokwengeza usuku lokuphelelwa yisikhathi kwilebula esebhodleleni. Lolu suku luvame ukuba unyaka owodwa kusukela ngosuku abanikeze ngalo umuthi.

Usuku lokuphelelwa isikhathi lusiza ukuqinisekisa ukusebenza komuthi ngalesi sikhathi. Isimo samanje se-Food and Drug Administration (i-FDA) ukugwema ukusebenzisa imishanguzo ephelelwe yisikhathi. Uma usebenzise umuthi ongasasetshenziswa osudlulile esikhathini sokuphela, khuluma nosokhemisi wakho. Bangakutshela ukuthi usengakwazi yini ukuyisebenzisa.

Isitoreji

Ukuthi umuthi uhlala ulungile isikhathi eside kangakanani kungancika ezintweni eziningi, kufaka phakathi ukuthi uwugcina kanjani futhi kuphi umuthi.

Gcina amaphilisi akho we-Gleevec ekamelweni lokushisa esitsheni esivalwe ngci. Qiniseka ukuthi ubavikela kumswakama.

Ukulahlwa

Uma ungasadingi ukuthatha i-Gleevec futhi unemithi esele, kubalulekile ukuyilahla ngokuphepha.

Lokhu kusiza ukuvimbela abanye, kufaka phakathi izingane nezilwane ezifuywayo, ekuthatheni lesi sidakamizwa ngengozi. Kuyasiza futhi ukugcina umuthi ungalimazi imvelo.

Iwebhusayithi ye-FDA inikeza amathiphu amaningi awusizo ngokulahlwa kwemithi. Ungabuza futhi usokhemisi wakho imininingwane yokuthi ungayilahla kanjani imithi yakho.

Imininingwane yobungcweti yeGleevec

Imininingwane elandelayo inikezwa odokotela nabanye ochwepheshe bezempilo.

Izinkomba

IGleevec (imatinib) ivunyelwe yi-FDA ukwelapha okulandelayo:

  • abadala nezingane abane-Philadelphia-positive (Ph +) esanda kutholakala i-myeloid leukemia (CML) esigabeni esingapheli
  • abantu abadala abane-Ph + CML kunoma yisiphi isigaba, kulandela ukwehluleka kokwelashwa kwe-interferon-alpha
  • abadala abane-Ph + acute lymphocytic leukemia (BONKE)
  • izingane ezine-Ph + ALL ezisanda kutholakala zihlangene ne-chemotherapy
  • Abantu abadala abane-myelodysplastic / isifo se-myeloproliferative esihlotshaniswa nokuhlelwa kabusha kofuzo okwenziwe ngeplatelet
  • abantu abadala abane-mastocytosis enobudlova ngaphandle kokuguqulwa kwe-D816V c-Kit noma ngesimo sokuguqulwa kwe-c-Kit esingaziwa
  • abantu abadala abane-hypereosinophilic syndrome kanye / noma i-leukemia engapheli ye-eosinophilic ne-FIP1L1-PDGFRcy fusion kinase, engeyona i-FIP1L1-PDGFRcy fusion kinase, noma isimo esingaziwa
  • abantu abadala abane-dermatofibrosarcoma protuberans (DFSP) engaphenduki, ephindaphindwayo, noma e-metastatic
  • abantu abadala abane-Kit engabuyiseki noma e-metastatic malignant + yamathumbu we-gastrointestinal stromal (GIST)
  • ukwelashwa okunciphisayo kwabantu abadala abane-Kit + GIST kulandela ukuthengiswa okuphelele ngokuphelele

Indlela yokusebenza

IGleevec ivimbela i-BCR-ABL tyrosine kinase, okuyi-tyrosine kinase engajwayelekile etholakala ku-Ph + CML. Ukuvinjelwa kwe-BCR-ABL tyrosine kinase kuvimbela ukwanda kwamaselula futhi kubanga i-apoptosis emigqeni yamaseli e-BCR-ABL nasemigqeni yeseli leememic. IGleevec ibuye ivimbele ama-tyrosine kinases we-platelet-derived growth factor (PDGF) ne-stem cell factor (SCF) kanye ne-c-Kit, evimbela ukwanda futhi idale i-apoptosis kumaseli e-GIST.

I-Pharmacokinetics ne-metabolism

Kusho ukutholakala okuphelele kwe-bioavailability ngama-98% kulandela ukuphathwa ngomlomo. Cishe i-95% yedosi iboshelwe kumaprotheni e-plasma (ikakhulukazi i-albhamuin ne-α1-acid glycoprotein).

I-Metabolism yenzeka ngokuyinhloko nge-CYP3A4 kuya ku-metabolite esebenzayo, ne-metabolism encane eyenzeka nge-CYP1A2, CYP2D6, CYP2C9, ne-CYP2C19. I-metabolite esebenzayo ejikelezayo yenziwa ngokuyinhloko yi-CYP3A4. Cishe ama-68% akhishwa endle, kuthi i-13% isemchameni. Ukuqeda isigamu sempilo yesidakamizwa esingashintshi amahora angama-18 kanti isiqingatha sempilo ye-metabolite esebenzayo ngamahora angama-40.

Izimo

Akukho ukuphikisana okuphelele ekusetshenzisweni kweGleevec.

Ukugcina nokuphatha

Amaphilisi we-Gleevec kufanele agcinwe ekamelweni lokushisa (77 ° F / 25 ° C) esitsheni esivaliwe ngokuqinile. Vikela amaphilisi emswakeni.

Amaphilisi e-Gleevec athathwa njengengozi, ngokusho kwamazinga e-Occupational Safety and Health Administration (OSHA). Amathebulethi akufanele achotshozwe. Gwema ukuthinta amaphilisi achotshoziwe. Uma isikhumba noma ulwelwesi lwamafinyila luhlangana namaphilisi achotshoziwe, geza indawo ethintekile ngokuyalelwa yi-OSHA.

Ukuzikhulula: IMedical News Namuhla yenze yonke imizamo yokuqinisekisa ukuthi yonke imininingwane iyiqiniso, iphelele futhi ihambisana nesikhathi. Kodwa-ke, le ndatshana akufanele isetshenziswe njengokungena esikhundleni solwazi nobungoti bochwepheshe bezokunakekelwa kwezempilo onelayisense. Kufanele uhlale uthintana nodokotela wakho noma omunye uchwepheshe wezokunakekelwa kwempilo ngaphambi kokuthatha noma imuphi umuthi. Imininingwane yezidakamizwa equkethwe lapha ingashintsha futhi ayihloselwe ukumboza konke ukusetshenziswa okungaba khona, izinkomba, izixwayiso, izexwayiso, ukuxhumana kwezidakamizwa, ukungezwani komzimba, noma imiphumela emibi. Ukungabikho kwezixwayiso noma olunye ulwazi lomuthi othile awukhombisi ukuthi inhlanganisela yezidakamizwa noma yezidakamizwa iphephile, iyasebenza, noma ilungele zonke iziguli noma konke ukusetshenziswa okuthile.

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