Faruwar cutar sankara a ƙarshe ta samo asali ne daga ƙayyadaddun kwayoyin halitta, wanda ke sa haɓakar ƙwayoyin jijiyoyi zuwa yanayin da ba a sarrafa su ba, kuma ƙwayoyin kansa sun fara rarraba kuma suna karuwa a cikin ƙima. A wasu kalmomi, ciwon daji cuta ce ta kwayoyin halitta. Duk da haka, abubuwan da ke waje kamar hawan jini, ƙarancin rigakafi, shan taba da sha, da rashin aiki na yau da kullum da hutawa sune abubuwan da ke haifar da kurakurai.
Abubuwan da suka shafi cutar kansa sune:
- shekaru
- barasa
- Carcinogen (aflatoxin)
- Ciwon mara
- Halayen cin abinci
- hormone
- Tsarin rigakafi
- Kwayoyin cututtuka (hepatitis B virus, Helicobacter pylori)
- kiba
- radiation
- haske
- taba
Bayan fiye da shekaru goma na ci gaba, gwajin kwayoyin cutar kansa ya zama buƙatu da gaggawa na adadin masu cutar kansa. Jagorar rahoton gwajin da aka bayar ta hanyar gwajin kwayoyin cutar tumor ya yi daidai da tsarin ci gaban ingantaccen magani, kuma ya shiga cikin dukkan bangarorin bincike da kuma kula da masu fama da cutar kansa, ta yadda majiyyata za su iya zabar magungunan da aka yi niyya don yin magani daidai, da guje wa karkata, da guje wa abubuwan da ba dole ba. illa masu daci.
Matsayi na yau da kullun na maganin cutar hanta
Ta hanyar rarrabe muhimman halaye na cutar hanta daga matakin kwayar halitta ne kawai za a iya ganewa da wuri tare da yanke hukunci game da ciwon ƙari kuma ya zama daidai, kuma ana iya amfani da ƙwayoyin ƙwayoyin ƙwayoyin ƙwayoyi don keɓancewa da kuma magance marasa lafiya daidai. Abubuwan da aka yarda da cutar kansar hanta sune kamar haka:
1.Sorafenib (Sorafenib, Dorjemi)
Sorafenib magani ne mai niyya tare da tasiri biyu. Isaya shine hana sabbin hanyoyin jini da ake buƙata don ciwace ciwace ciwace, kuma yana iya ƙaddamar da sunadaran da ke inganta ci gaban ƙwayoyin kansa. Babban maƙasudin sune VEGFR-1 / 2/3, RET, FLT3, BRAF da sauransu.
Sorafenib na iya hana yaduwar ƙwayoyin tumor kai tsaye, kuma yana iya yin aiki akan VEGFR da PDGFR don hana samuwar sabbin hanyoyin jini da yanke wadataccen abinci mai gina jiki na ƙwayoyin ƙari, ta haka ne zai hana ci gaban ƙari. Sorafenib ya dace da layin farko na maganin ciwon hanta mai ci gaba wanda ba za a iya sarrafa shi ba ko metastasized.
Sorafenib magani ne na baka, sau biyu a rana. Abubuwan da aka fi sani da wannan magani sun haɗa da gajiya na tafin hannu ko tafin kafa, kurji, rashi cin abinci, gudawa, hawan jini, ja, zafi, kumburi ko kumfa. M sakamako masu illa (ba nadiri) sun haɗa da matsaloli tare da gudan jini zuwa zuciya da kuma ɓarkewar ciki ko hanji.
2.regorafenib (Regofenib, Baivango)
Regefenib na iya toshe maganin angiogenesis, kuma zai iya amfani da sunadarai da yawa akan farfajiyar kansar don hana ci gaban ƙwayoyin kansa. Yana da mai hana cin hanci da rashawa da yawa wanda zai iya hana VEGFR-1, 2, 3, TIE-2, BRAF, KIT, RET, PDGFR da FGFR, kuma tsarinta yayi kama da sorafenib.
A ranar 12 ga Disamba, 2017, Hukumar Abinci da Magunguna ta Kasa (CFDA) ta ba da izinin maganin polykinase mai hana regorafenib ga marasa lafiya da ke fama da cutar sankarar hanta (HCC) wacce a baya ta samu maganin sorafenib. Itauke shi da baki sau ɗaya a rana don makonni 3 a jere, sannan hutawa na mako guda, sannan ci gaba zuwa zagaye na gaba.
Illolin dake tattare da mutane sun hada da gajiya, rashin cin abinci, cutar ciwon ƙafa (ja da haushin hannu da ƙafa), hawan jini, zazzabi, kamuwa da cuta, rage nauyi, gudawa da ciwon ciki. M sakamako mai cutarwa (wanda ba a sani ba) na iya haɗawa da cutar hanta mai tsanani, zub da jini mai tsanani, matsalolin kwararar jini, da kuma ɓarkewar ciki ko hanji.
3.lenvatinib (Levatinib, Le Weima)
Lenvatinib magani ne mai niyya da yawa. Babban maƙasudin levatinib ya haɗa da mai karɓar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta VEGFR1-3, mai karɓar haɓakar haɓakar fibroblast FGFR1-4, mai karɓar karɓa mai karɓa na platelet PDGFR- α, cKit, Ret et al. Yi aiki ta hana ciwace-ciwacen kafa sabbin jijiyoyin jini da ke buƙatar girma.
A watan Agustan wannan shekarar, Eisai (Eisai) da Merck (MSD) na lovastinib sun sami amincewar FDA ta Amurka don tallatawa. Leweima ya kasance cikin farkon layi na rashin ciwon hanta mai saurin ciwon hanta ta hanyar jagorar cutar hanta ta CSCO (2018 sigar), mafi yawan cututtukan cututtukan tumor da jagorar magani a China.
Ana gudanar da Lenvatinib a baki sau ɗaya kowace rana. Abubuwan da aka fi sani da wannan magani sune cututtukan red-footed redness, rash, rashin ci, zawo, hawan jini, haɗin gwiwa ko ciwon tsoka, rage nauyi, ciwon ciki ko kumburi. M sakamako mai cutarwa (ba a sani ba) na iya haɗawa da matsalolin zub da jini da asarar furotin a cikin fitsari.
4. Cabozantinib (Cabozantinib)
Cabozantinib (Cabozantinib) karamin kwayar cuta ce mai hana yaduwa ta hanyar Exelixis na Amurka, wanda zai iya kaiwa VEGFR, MET, NTRK, RET, AXL da KIT. XL184 ”.
A ranar 29 ga Mayu, 2018, FDA ta amince da Carbotinib don yin layi na biyu na ci gaba da cutar kansa na hanta. Amincewa yana dogara ne akan gwajin asibiti na Phase III CELESTIAL. Marasa lafiya da ke fama da cutar sanyin hanta wadanda suka sami ci gaba bayan sun yi jiyya tare da sorafenib sun inganta rayuwa gaba daya idan aka kwatanta da placebo. Ci gaban da ba shi da ci gaba da kuma saurin mayar da martani ya inganta sosai.
5.nivolumab (Navumab, Opdivo®)
Opdivo yana taimaka wa tsarin garkuwar jiki ya kai hari ga ƙwayoyin kansa ta hanyar yin niyya ta hanyar siginar salula ta PD-1 / PD-L1 (PD-1 da PD-L1 sunadaran da ke cikin ƙwayoyin rigakafi na jiki da wasu ƙwayoyin kansa). A cikin sharuddan layman: Ta hanyar toshe haɗin furotin PD-L1 zuwa ƙwayoyin kansa, ana hana kamannin ƙwayoyin cutar kansa, kuma ƙwayoyin rigakafi na jiki na iya ganewa da kawar da ƙwayoyin kansa.
A ranar 23 ga Satumba, 2017, bisa ga gwajin asibiti na Checkmate-040, FDA ta Amurka ta amince da Opdivo ga marasa lafiya da ke fama da ciwon hanta na hanta bayan gazawar jiyya na sorafenib (dojime): tasiri mai inganci 20%, yawan sarrafa cuta 64%.
6. larotrectinib (Larotinib, sunan kasuwanci Vitrakvi)
Larotrectinib (sanannen sanannen shine LOXO-101) ya amince da FDA a ranar 27 ga Nuwamba, 2018 don kula da manya da yara marasa lafiya tare da ci gaba na cikin gida ko ƙananan ƙwayoyin cuta tare da haɗin NTRK. Wannan maganin da aka yi niyya ba kawai yana da tasiri ba, amma har ma yana da faɗan-maganin rigakafin ciwon kansa, yana da tasiri ga ciwace-ciwace daban-daban! Muddin ka yi gwajin kwayar halitta kuma akwai NTRK1, NTRK2, ko NTRK3 gene fusion, za ka iya zaɓar wannan magani na maganin kansar kansa wanda ba ya rarrabe nau'o'in ƙari.
Yaya za a zabi gwajin kwayar cutar marasa lafiya na hanta?
Kwararru daga cibiyar sadarwa ta Global Oncologist Network sun gaya wa abokansu karara cewa gwajin kwayoyin cutar kansa da kuma nazarin jiyya na asibiti wani tsari ne mai tsauri da ke bukatar goyon bayan dakin gwaje-gwaje mai karfi, babban ingancin ingancin gwaji da kuma babban matakin kungiyar nazarin bayanai. Kyakkyawan gwajin gwajin kwayoyin halitta zai iya ceton rayukan masu ciwon daji, kuma rahoton binciken faci zai sa marasa lafiya su rasa damar jiyya. A halin yanzu, akwai cibiyoyin gwajin kwayoyin halitta da dama a kasuwa, kuma dole ne marasa lafiya su zabi kamfanonin gwajin kwayoyin halitta a hankali don tabbatar da daidaiton sakamakon gwajin.
Editocin masu zuwa za su gabatar da madaidaicin fasahar gwajin kwayar halitta guda biyu a Amurka!
1. Keris fasaha da yawa na nazarin kwayoyin
Fasahar binciken kwaskwarima mai tarin yawa game da tsarin kula da cutar kanjamau na Careris Cancer a cikin Amurka shine mafi kyawun zabi don gwajin kwayar cutar kanjamau, saboda ya haɗa da ba gwajin ƙirar DNA kawai ba har ma da RNA da furotin.
gwajin gwaji. Duk sauran kamfanonin gwajin kwayoyin basu da. Saboda nau'ikan dabarun bincike, fasahar nazarin kwayoyin-dandamali da yawa na iya nazarin bambance-bambancen cututtukan mara lafiya sosai kuma cikakke, kuma jagorancin magani da aka bayar ya fi ƙarfin iko.
Dangane da bayanan hukuma na Keruis, babban binciken ƙwayar cuta na marasa lafiya 1180 da suka shiga, bayan an gudanar da bincike ta hanyar kwayar halittar dandamali ta Keruis, marasa lafiya sun tsawanta rayuwa ta 422 kwanaki . Matsakaicin adadin magunguna ga marasa lafiya a ƙarƙashin umarni shine 3.2, kuma yawan magunguna ga marasa lafiya ba tare da jagora ba shine 4.2. Medicationsarin magunguna na nufin cewa marasa lafiya na iya buƙatar shan wahala fiye da illa da asarar tattalin arziki mara amfani. Abin da marasa lafiya ke tsammani shi ne, ban da jagorantar zaɓin magungunan da aka yi niyya, Kerrys na iya nazarin ko waɗanne magungunan ƙwayoyi ne suka dace da marasa lafiya. A zahiri, zaɓin magungunan ƙwayoyi kuma yana buƙatar jagora, kuma ba za a iya kofe su ba bisa ga jagororin maganin. Keris Multi-dandamali nazarin kwayoyin shine irin wannan cikakkiyar fasahar bincike don wadatar da marasa lafiya ingantattun hanyoyin dacewa.
Kulawa da yawa-tsarin nazarin kwayoyin yana jagorantar madaidaicin magani don rufe kusan dukkanin nau'ikan cutar kansa
Abubuwan da aka fi sani da nazarin kwayoyin Keruis kamar EGFR, ALK, ROS1, MET, mTOR, BRAF, HER2 da sauransu, da kuma immunotherapy hari PD-L1, TMB da MSI-H, rahoton gwajin zai iya jagorantar marasa lafiya don zaɓar. Maƙasudi Daidaitaccen magani na magunguna yana taimaka wa marasa lafiya su guji karkata hanya da guje wa illolin da ba dole ba. Ko da babu maƙasudin maye gurbi kuma babu damar zaɓar magungunan da aka yi niyya, Keruis kuma na iya jagorantar yin amfani da magungunan chemotherapy da magungunan hormone dangane da sakamakon bincike, kuma yana ba da damar shiga cikin sabbin gwaji na asibiti a Amurka.
2. GidauniyarOne®CDx
FoundationOne®CDx ya sami amincewa ne daga FDA a matsayin farkon samfurin samfuran cututtukan ƙwayoyin cuta. A matsayin kayan aikin bincike, ta taimaka wajen gano sakamakon binciken kimiya mara adadi, kuma ta tara adadi mai yawa a wannan lokacin. Gwajin gwajin na yanzu ya hada da kwayoyin 324 da alamomin kwayoyin guda biyu (MSI / TMB) waɗanda zasu iya hango fa'idar masu hana masu binciken kariya. Zai iya rufe dukkan ƙwayoyin cuta (banda sarcoma) kuma zai iya dacewa kai tsaye zuwa hanyoyin kwantar da hankali na 17 waɗanda FDA ta yarda da su!
A cikin kimantawa na asibiti na kwayoyin cutar kansa, fasahar da aka saba amfani da su sun hada da Sanger sequencing, mass spectrometry genotyping, fluorescence in situ hybridization (FISH) da immunohistochemical analysis (IHC). "Ganewar alamar alama guda ɗaya" kamar FISH , IHC da kuma ganowar hotspot mai yawa (hotspot panel) na iya samun nau'i ɗaya ko biyu kawai na rashin lafiyar kwayoyin halitta (kamar kawai maye gurbin tushe). Nazarin ya nuna cewa sabuwar fasahar jeri na gaba na gaba don cikakken gwajin cutar kansa na iya gano duk nau'ikan rashin daidaituwar kwayoyin halitta guda hudu (maye gurbin tushe; sakawa da gogewa; bambancin lambar kwafi da sake tsarawa), kuma ya fi na gargajiya, daidaitattun gwaje-gwaje.
