Okudingeka Ukwazi Ngamanani Wempumelelo Ye-Immunotherapy Ye-Melanoma

-Delile

• Ukubuka konke
• Izinhlobo ze-immunotherapy
• Izivimbeli zokuhlola
• Ukwelashwa kweCytokine
• Ukwelashwa kwegciwane le-Oncolytic
• Izinga lokuphumelela le-immunotherapy
• I-Ipilimumab (Yervoy)
• I-Pembrolizumab (Keytruda)
• I-Nivolumab (Opdivo)
• INivolumab + ipilimumab (Opdivo + Yervoy)
• AmaCytokines
• I-Talimogene laherparepvec (Imlygic)
• Imiphumela emibi ye-immunotherapy
• Izindleko ze-immunotherapy
• Ukuhlolwa kwemitholampilo
• Izinguquko zendlela yokuphila
• Umbono

Ukubuka konke

Uma unomdlavuza wesikhumba we-melanoma, udokotela wakho angancoma i-immunotherapy. Lolu hlobo lwezokwelapha lungasiza ukukhulisa impendulo yamasosha akho omzimba kumdlavuza.

Kunezinhlobo eziningi zemithi ye-immunotherapy yokwelapha i-melanoma. Ezimweni eziningi, le mithi inikezwa abantu abanesigaba 3 noma isigaba 4 se-melanoma. Kodwa kwezinye izimo, udokotela wakho angase anikeze i-immunotherapy ukuphatha i-melanoma engaphakeme kakhulu.

Funda ukuze ufunde kabanzi mayelana nendima engadlalwa yi-immunotherapy ekwelapheni lesi sifo.

Izinhlobo ze-immunotherapy

Ukuqonda amazinga okuphumelela kwe-immunotherapy, kubalulekile ukuhlukanisa phakathi kwezinhlobo ezahlukene ezitholakalayo. Kunamaqembu amathathu amakhulu we-immunotherapy asetshenziselwa ukwelapha i-melanoma:

• izivimbeli zokuhlola
• ukwelashwa kwe-cytokine
• ukwelashwa kwegciwane le-oncolytic

Izivimbeli zokuhlola

Ama-Checkpoint inhibitors yizidakamizwa ezingasiza amasosha akho omzimba ukuthi abone futhi abulale amangqamuzana omdlavuza wesikhumba we-melanoma.

Ukuphathwa Kwezokudla Nezidakamizwa (i-FDA) kuvume izinhlobo ezintathu zama-inhibitors okuseshwa ekwelapheni i-melanoma:

• ipilimumab (Yervoy), evimba iprotheni yokuhlola i-CTL4-A
• pembrolizumab (Keytruda), evimba iprotheni lokuhlola PD-1
• i-nivolumab (i-Opdivo), evimba ne-PD-1

Udokotela wakho angakunikeza isibambiso esisodwa noma eziningi zokuhlola uma unesigaba 3 noma isigaba 4 se-melanoma esingasuswa ngokuhlinzwa. Kwezinye izimo, bangahle banikeze izivimbeli zokuhlola ngokuhlangana nokuhlinzwa.

Ukwelashwa kweCytokine

Ukwelashwa ngama-cytokines kungasiza ukukhulisa amasosha akho omzimba futhi kuqinise ukuphendula kwawo kumdlavuza.

I-FDA ivume izinhlobo ezintathu zama-cytokines ekwelapheni i-melanoma:

• i-interferon alfa-2b (Intron A)
• i-interferon alfa-2b (i-Sylatron) ekhishwe
• i-interleukin-2 (aldesleukin, Proleukin)

I-Interferon alfa-2b noma i-peferlated interferon alfa-2b ngokuvamile inqunywa ngemuva kokuthi i-melanoma isuswe ngokuhlinzwa. Lokhu kwaziwa ngokuthi ukwelashwa okusizayo. Kungasiza ukwehlisa amathuba okubuyela komdlavuza.

I-Proleukin isetshenziswa kakhulu ekwelapheni isigaba sesithathu noma isigaba sesine se-melanoma esisakazekile.

Ukwelashwa kwegciwane le-Oncolytic

Amagciwane e-Oncolytic amagciwane aguqulwe ukuze athelele futhi abulale amangqamuzana omdlavuza. Zingahle futhi zibangele ukuthi amasosha omzimba wakho ahlasele amangqamuzana omdlavuza emzimbeni wakho.

I-Talimogene laherparepvec (Imlygic) yigciwane le-oncolytic elivunyelwe ukwelapha i-melanoma. Kuyaziwa nangokuthi yi-T-VEC.

I-Imlygic ijwayele ukunikezwa ngaphambi kokuhlinzwa. Lokhu kwaziwa ngokuthi ukwelashwa kwe-neoadjuvant.

Izinga lokuphumelela le-immunotherapy

I-Immunotherapy ingasiza ukwelula impilo kwabanye abantu abanesigaba 3 noma isigaba 4 se-melanoma - kufaka phakathi abanye abantu abane-melanoma engenakususwa ngokuhlinzwa.

Lapho i-melanoma ingenakususwa ngokuhlinzwa, yaziwa njenge-melanoma enganqandeki.

I-Ipilimumab (Yervoy)

Ekubuyekezweni okushicilelwe ngo-2015, abacwaningi bahlanganisa imiphumela yezifundo eziyi-12 ezedlule ku-inhibitor Yokuhlola. Bathola ukuthi kubantu abasesigabeni sesi-3 noma esiteji sesi-4 esinganqandeki, amaphesenti angama-22 alabo abathola i-Yervoy babephila eminyakeni emi-3 kamuva.

Kodwa-ke, ezinye izifundo zithole amazinga empumelelo aphansi kubantu abaphathwa ngalo muthi.

Lapho abacwaningi abavela ocwaningweni lwe-EURO-VOYAGE bebheka imiphumela yokwelashwa kubantu abayi-1,043 abane-melanoma esezingeni eliphezulu, bathole ukuthi amaphesenti ayi-10.9 athola i-Yervoy ahlala okungenani iminyaka emithathu. Amaphesenti ayisishiyagalombili abantu abathola lo muthi basinda iminyaka engu-4 noma ngaphezulu.

I-Pembrolizumab (Keytruda)

Ucwaningo luphakamisa ukuthi ukwelashwa nge-Keytruda kukodwa kungazuzisa abanye abantu ukwedlula ukwelashwa nge-Yervoy kuphela.

Ku-a, ososayensi baqhathanisa lezi zindlela zokwelashwa kubantu abanesigaba esinganqandeki se-3 noma isigaba 4 se-melanoma. Bathola ukuthi amaphesenti angama-55 alabo abathola i-Keytruda basinda okungenani iminyaka emibili. Ngokuqhathanisa, amaphesenti angama-43 alabo abaphathwa ne-Yervoy basinda iminyaka engu-2 noma ngaphezulu.

Ababhali bocwaningo lwakamuva balinganisela ukuthi izinga lokusinda leminyaka emihlanu kubantu abane-melanoma esezingeni eliphakeme abaphathwa nge-Keytruda lalingamaphesenti angama-34. Bathola ukuthi abantu abathola lesi sidakamizwa baphila isilinganiso esiphakathi kweminyaka emibili.

I-Nivolumab (Opdivo)

Ucwaningo luye lwathola nokuthi ukwelashwa nge-Opdivo kuphela kungakhuphula amathuba okusinda ngaphezu kokwelashwa nge-Yervoy kuphela.

Ngenkathi abaphenyi beqhathanisa lezi zindlela zokwelashwa kubantu abanesigaba esingaqediwe se-3 noma isigaba 4 se-melanoma, bathole ukuthi abantu abelashwa i-Opdivo bodwa basinda ngokwesilinganiso seminyaka cishe emithathu. Abantu abelashwa nge-Yervoy bodwa basinda ngokwesilinganiso esiphakathi cishe sezinyanga ezingama-20.

Ucwaningo olufanayo luthole ukuthi isilinganiso seminyaka engu-4 sokusinda jikelele singamaphesenti angama-46 kubantu abelashwa nge-Opdivo kuphela, uma kuqhathaniswa namaphesenti angama-30 kubantu abaphathwa ngeYervoy bodwa.

INivolumab + ipilimumab (Opdivo + Yervoy)

Eminye yemiphumela yokwelashwa ethembisayo kubantu abane-melanoma enganqandeki itholakale ezigulini ezelashwa ngenhlanganisela ye-Opdivo ne-Yervoy.

Ocwaningweni oluncane olushicilelwe ku-Journal of Clinical Oncology, ososayensi babike inani lokusinda leminyaka emithathu lonke elingamaphesenti angama-63 phakathi kweziguli ezingama-94 eziphathwe ngale nhlanganisela yezidakamizwa. Zonke iziguli zazinesigaba 3 noma isigaba 4 se-melanoma esasingasuswa ngokuhlinzwa.

Yize abacwaningi bexhumanise le nhlanganisela yemithi namazinga okusinda athuthukisiwe, bathole nokuthi ibanga imiphumela emibi ejwayelekile ejwayelekile kunemithi yodwa.

Kudingeka izifundo ezinkulu kule nhlanganisela yokwelashwa.

AmaCytokines

Kubantu abaningi abane-melanoma, izinzuzo ezingaba khona zokwelashwa nge-cytokine therapy zibonakala zincane kunezo zokuthatha ama-inhibitors wokuhlola. Kodwa-ke, ezinye iziguli ezingaphenduli kahle kwezinye izindlela zokwelashwa zingase zizuze ekwelashweni kwe-cytokine.

Ngo-2010, abacwaningi bashicilela ukubuyekezwa kwezifundo nge-interferon alfa-2b ekwelapheni isigaba 2 noma isigaba 3 se-melanoma. Ababhali bathola ukuthi iziguli ezithola imithamo ephezulu ye-interferon alfa-2b ngemuva kokuhlinzwa zinamazinga okusinda angcono angenazifo, uma kuqhathaniswa nalabo abangalutholanga lolu lwazi. Baphinde bathola ukuthi iziguli ezithola i-interferon alfa-2b ngemuva kokuhlinzwa zinamazinga okusinda athe xaxa jikelele.

Ucwaningo olwenziwe nge-pegylated interferon alfa-2b lithole ukuthi kwezinye izifundo, abantu abanesigaba 2 noma isigaba 3 se-melanoma abathole lo muthi ngemuva kokuhlinzwa banamazinga aphezulu okusinda angaphindeki. Kodwa-ke, ababhali bathole ubufakazi obuncane bokuthuthuka kwamazinga okusinda jikelele.

Ngokusho kokunye ukubuyekeza, ucwaningo luthole ukuthi i-melanoma ayibonakali ngemuva kokwelashwa ngemithamo ephezulu ye-interleukin-2 kumaphesenti ama-4 kuya kwayi-9 abantu abane-melanoma enganqandeki. Kwamanye amaphesenti ayi-7 kuye kwayi-13 abantu, amanani aphakeme we-interleukin-2 akhonjisiwe anciphisa izicubu zemelanoma ezinganqandeki.

I-Talimogene laherparepvec (Imlygic)

Ucwaningo olwethulwe engqungqutheleni ye-2019 European Society for Medical Oncology liphakamisa ukuthi ukwelashwa nge-Imlygic ngaphambi kokuhlinzwa kususwe i-melanoma kungasiza ezinye iziguli ziphile isikhathi eside.

Lolu cwaningo luthole ukuthi phakathi kwabantu abane-advanced stage melanoma abaphathwa ngokuhlinzwa bodwa, amaphesenti angama-77.4 asinda okungenani iminyaka emibili. Phakathi kwalabo abaphathwa ngokuhlanganiswa kokuhlinzwa kanye ne-Imlygic, amaphesenti angama-88.9 asinda okungenani iminyaka emibili.

Ucwaningo oluningi luyadingeka ngemiphumela engaba khona yalokhu kwelashwa.

Imiphumela emibi ye-immunotherapy

I-Immunotherapy ingadala imiphumela emibi, eyehluka kuye ngohlobo oluthile nomthamo we-immunotherapy oyitholayo.

Isibonelo, imiphumela emibi engaba khona ifaka:

• ukukhathala
• imfiva
• Ukugodola
• isicanucanu
• ukuhlanza
• isifo sohudo
• ukuqubuka kwesikhumba

Le yiminye nje yemiphumela emibi engaba khona engabangelwa yi-immunotherapy. Ukuze ufunde kabanzi ngemiphumela emibi engaba khona yezokwelapha ezithile ze-immunotherapy, khuluma nodokotela wakho.

Imiphumela emibi ye-immunotherapy ivame ukuba mncane, kepha kwezinye izimo ingaba yimbi.

Uma ucabanga ukuthi ungahle ube nemiphumela emibi, yazisa udokotela wakho ngokushesha.

Izindleko ze-immunotherapy

Izindleko eziphuma ephaketheni ze-immunotherapy ziyahlukahluka, kuya ngengxenye enkulu ku:

• uhlobo nomthamo we-immunotherapy oyitholayo
• noma ngabe unayo inshuwalense yezempilo yokwelashwa noma cha
• ngabe ufanelekile yini kuzinhlelo zosizo lweziguli zokwelashwa
• ukuthi uyayithola yini ukwelashwa njengengxenye yesivivinyo somtholampilo

Ukuze ufunde kabanzi ngezindleko zohlelo lwakho lokwelashwa olunconyiwe, khuluma nodokotela wakho, usokhemisi kanye nomhlinzeki womshuwalense.

Uma ukuthola kunzima ukukhokhela izindleko zokunakekelwa, yazisa iqembu lakho lezokwelapha.

Bangancoma ushintsho ohlelweni lwakho lokwelashwa. Noma bangazi ngohlelo losizo olungasiza ukumboza izindleko zokunakekelwa kwakho. Kwezinye izimo, bangakukhuthaza ukuthi ubhalise esivivinyweni somtholampilo esizokuvumela ukuthi ufinyelele kumuthi mahhala ngenkathi ubambe iqhaza ocwaningweni.

Ukuhlolwa kwemitholampilo

Ngaphezu kwemithi yokwelashwa kwama-immunotherapy evunyelwe ukwelapha i-melanoma, ososayensi njengamanje bafunda ezinye izindlela zokuhlola i-immunotherapy.

Abanye abacwaningi bakha futhi bahlole izinhlobo ezintsha zemithi yokuzivikela emzimbeni. Abanye bafunda ukuphepha nokusebenza kokuhlanganisa izinhlobo eziningi ze-immunotherapy. Abanye abacwaningi bazama ukukhomba amasu okufunda ukuthi yiziphi iziguli okungenzeka ukuthi zizuze kuziphi izindlela zokwelashwa.

Uma udokotela wakho ecabanga ukuthi ungazuza ngokuthola ukwelashwa kokuhlola noma ukubamba iqhaza ocwaningweni lwe-immunotherapy, bangakukhuthaza ukuthi ubhalise esivivinyweni somtholampilo.

Ngaphambi kokubhalisa kunoma isiphi isilingo, qiniseka ukuthi uyaziqonda izinzuzo nezingozi ezingaba khona.

Izinguquko zendlela yokuphila

Ukusiza ukusekela impilo yakho engokwenyama nengokwengqondo ngenkathi uthola i-immunotherapy noma ezinye izindlela zokwelashwa komdlavuza, udokotela wakho angakukhuthaza ukuthi wenze izinguquko ezithile endleleni ophila ngayo.

Isibonelo, bangakukhuthaza ukuthi:

• lungisa imikhuba yakho yokulala ukuze uthole ukuphumula okwengeziwe
• shintsha ukudla kwakho ukuze uthole izakhamzimba noma ama-calories amaningi
• shintsha imikhuba yakho yokuzivocavoca ukuze uthole umsebenzi owanele, ngaphandle kokukhokhisa umzimba wakho ngokweqile
• geza izandla zakho futhi unciphise ukuvezwa kwakho kubantu abagulayo ukunciphisa ubungozi bokutheleleka
• thuthukisa izindlela zokulawula ingcindezi nezokuphumula

Kwezinye izimo, ukulungisa imikhuba yakho yansuku zonke kungakusiza ukuba ubhekane nemiphumela emibi yokwelashwa. Isibonelo, ukuphumula ngokwengeziwe kungakusiza ukuphatha ukukhathala. Ukwenza ushintsho ekudleni kwakho kungakusiza ukuthi uphathe isicanucanu noma ukulahlekelwa isifiso sokudla.

Uma udinga usizo ukulungisa imikhuba yakho yokuphila noma ukulawula imiphumela emibi yokwelashwa, udokotela wakho angakudlulisela kuchwepheshe ukuze akusekele. Isibonelo, isazi sokudla singakusiza ulungise indlela odla ngayo.

Umbono

Umbono wakho ngomdlavuza we-melanoma uncike ezintweni eziningi, kufaka phakathi:

• impilo yakho yonke
• isigaba somdlavuza onaso
• usayizi, inombolo, kanye nendawo yamathumba emzimbeni wakho
• uhlobo lokwelashwa olutholayo
• umzimba wakho uphendula kanjani ekwelashweni

Udokotela wakho angakusiza ufunde kabanzi ngesimo sakho nangombono wesikhathi eside. Zingakusiza nokuthi uqonde izinketho zakho zokwelashwa, kufaka phakathi imiphumela ukwelashwa okungaba nayo kubude nekhwalithi yempilo yakho.