In recent years, the incidence of gynecological tumors has increased year by year, making the terms cervical cancer and ovarian cancer no longer unfamiliar to us. Cervical cancer is the most common gynecological malignant tumor. In addition, it is also the three major gynecological malignant tumors along with ovarian cancer and endometrial cancer. Gynecological ciwan kansa are harmful to women. Early detection and early diagnosis can often help treatment and improve the survival time of patients.
Ci gaba da sauri na maganin da aka yi niyya da immunotherapy ya inganta sosai yanayin masu fama da ciwon daji na gynecological. Editan zai duba ingantaccen ƙwayar mata da aka yi niyya da magungunan jiyya da magungunan rigakafi a gare ku.
Maganin ciwon daji na gynecologic
ovarian ciwon daji Tarurrukan ci gaba
② Mai hanawa PARP
Olaparib (Olapani, Lynparza), rucaparib (Rucapa, Rubraca) da niraparib (Nilapani, Zejula)
cutar sankarar mahaifa magungunan da aka yi niyya
Bevacizumab (Bevacizumab, Avastin)
Maganin ciwon daji na endometrial
Yi amfani da hormones ko magunguna masu toshe hormone don yaƙar ciwon daji. Magungunan magani sun haɗa da:
Ø Progesterone: medroxyprogesterone acetate da megestrol acetate
Ø Tamoxifen
Ø Luteinizing hormone-mai sakin hormone agonists: Goserelin (Norred®) da Leuprolide (Leuprolide®). Ana yin allurar waɗannan magungunan kowane wata 1-3
Ø Masu hana Aromatase: letrozole (Fronon®), anastrozole (Reninide®), exemestane (Anoxin®)
Uterine sarcoma Tarurrukan ci gaba
Ø Panzopinab (Votrient) magani ne da aka yi niyya wanda za'a iya amfani dashi don magance leiomyosarcoma wanda ya yadu ko ya koma bayan jiyya.
Ø Olaratumab (Lartruvo) tare da maganin chemotherapy doxorubicin don magance sarcoma mai laushi. Ana iya amfani dashi don magance sarcoma na mahaifa wanda baya amsawa ga wasu jiyya.
Gynecological tumor immunotherapy
Immunotherapy is a relatively new concept, not widely used like surgery, chemotherapy and radiotherapy. However, it has made great progress in improving the survival of patients with advanced lung cancer, melanoma, kidney cancer, Lymphoma na Hodgkin and so on. Only one drug is approved for gynecological tumor immunotherapy! But for two different situations, the star drug is pembrolizumab (Pembrolizumab, Keytruda).
Pembrolizumab (Keytruda) yana kai hari ga PD-1, wanda shine furotin akan ƙwayoyin T kuma yawanci yana taimakawa hana waɗannan sel daga kai hari ga sauran ƙwayoyin jikin. Ta hanyar toshe PD-1, waɗannan kwayoyi na iya haɓaka amsawar rigakafi ga ƙwayoyin cutar kansa, haifar da wasu ciwace-ciwacen ciwace-ciwace ko rage haɓakar su.
MSI-H Gynecologic Oncology
On May 24, 2017, the US FDA approved the PD-1 inhibitor pembrolizumab (Pembrolizumab, Keytruda) to treat solid tumor patients with microsatellite highly unstable (MSI-H) / mismatch repair defects (dMMR) The tumor types cover 15 different malignant tumors including liver cancer, maganin ciwon daji, lung cancer and cervical cancer, including various gynecological tumors. (Note: If MSI-H is detected, it does not matter whether it is early or late, you can benefit)
PD-L1 tabbatacce ciwon mahaifa
A watan Yuni na wannan shekara, FDA ta Amurka ta haɓaka amincewar pembrolizumab (Keytruda) don kula da ci-gaba na PD-L1-tabbataccen ciwon daji na mahaifa wanda cutar ta ci gaba a lokacin ko bayan chemotherapy. Amincewar ta bayyana tabbataccen PD-L1 azaman kansar mahaifa tare da ingantaccen ma'auni (CPS) ≥1 wanda ya wuce sakamakon gwajin da aka amince da FDA. Yana da kyau a faɗi cewa, a halin yanzu, Keytruda kuma shine farkon kuma kawai an amince da maganin anti-PD-1 don ci gaban kansar mahaifa.
Ana ba da maganin rigakafi a kowane mako 3 kuma ana ba da shi ta hanyar jiko (IV). A halin yanzu an jera shi a China kuma yana shiga inshorar likita. Marasa lafiya na cikin gida na iya zuwa asibiti na gida don tuntuɓar juna, ko kuma a kira Global Oncologist Network (400-626-9916) don ƙarin bayani kan maganin ciwon mahaifa na pembrolizumab.
Amincewar ta dogara ne akan bayanai daga majiyyata 98 da suka sake dawowa ko ciwon sankarar mahaifa a cikin gwaji na Mataki na II KEYNOTE-158. Wannan binciken na duniya, budewa, bazuwar bazuwar, mahara, da kuma binciken da yawa ya kimanta pembrolizumab a cikin kula da marasa lafiya da nau'ikan ciwace-ciwacen ci gaba da yawa, kuma waɗannan marasa lafiya sun sami ci gaba akan daidaitattun ka'idojin kulawa.
Tsakanin lokacin biyo baya shine watanni 11.7 (kewayon 0.6-22.7). Jimlar ƙimar tasiri (ORR) na 77 PD-L1 tabbatacce marasa lafiya (CPS ≥ 1) ya kasance 14.3%. Waɗannan marasa lafiya duk marasa lafiya ne da ke da cututtukan metastatic waɗanda suka karɓi ≥ 1 layin chemotherapy. ORR yana da cikakken ƙimar amsawa na 2.6% da ƙimar amsa juzu'i na 11.7%. Ba a kai tsawon lokacin mayar da martani ba (kewayon watanni 4.1 zuwa watanni 18.6 +), kuma 91% na masu amsa suna da tsawon lokacin amsawa na watanni 6 ko fiye.
Ga marasa lafiya tare da maganganun PD-L1 CPS <1, ba a bayar da rahoto ba.
"Ko da yake an sami ci gaba da yawa a cikin ciwon daji na gynecological, a baya da aka yi wa marasa lafiya da ciwon daji na mahaifa har yanzu ba su da sababbin hanyoyin magancewa," in ji Bradley Monk, wani masanin ilimin likitancin Arizona, darektan likita na Cibiyar Nazarin Gynecology ta Amirka da kuma farfesa a fannin mata masu ciki da mata. A cikin wata sanarwa.
Monk ya kara da cewa "Yin amincewa da Keytruda a cikin wannan nuni yana da mahimmancin labarai-a matsayin masanin ilimin cututtukan daji, yana da ban sha'awa don ganin zaɓin da ake buƙata sosai ga waɗannan marasa lafiya."
The histological classification of 77 patients with treatment response were: 92% squamous cell carcinoma, 6% adenocarcinoma, and 1% adenosquamous carcinoma. 95% of patients have metastases, and 20% are relapsed. The PD-L1 IHC 22C3 pharmDx kit was used to determine the PD-L1 status.
Marasa lafiya sun karɓi 200 MG pembrolizumab kowane mako 3 har zuwa watanni 24 ko kuma sun janye daga jiyya ba tare da bata lokaci ba, ko tabbacin ci gaban cutar ta rediyo, ko guba mara karɓuwa ko bisa ga shawarar mai binciken. Marasa lafiya tabbatacciya tare da ci gaban rediyo na iya ci gaba da jiyya har sai an tabbatar da ci gaba ta hanyar hoto na gaba. Ana kimanta ci gaban Tumor kowane mako 9 a cikin shekara ta farko, da kowane mako 12 bayan haka.
Mafi na kowa (≥10% na marasa lafiya) sun ba da rahoton abubuwan da suka faru (AEs) a duk matakan sun haɗa da gajiya (43%), zafi (22%), zazzabi (19%), edema na gefe (15%), da ciwon musculoskeletal (27). %)), Zawo / colitis (23%), ciwon ciki (22%), tashin zuciya (19%), amai (19%), maƙarƙashiya (14%), rage cin abinci (21%), zubar jini (19%). UTI (18%), kamuwa da cuta (16%), rash (17%), hypothyroidism (11%), ciwon kai (11%) da dyspnea (10%).
Mafi yawan 3/4 AEs sun hada da UTI (6%), zubar jini (5%), ciwon musculoskeletal (5%), gajiya (5%), kamuwa da cuta (4.1%), ciwon ciki (3.1%), zafi (2). )%), Kumburi na gefe (2%), rash (2%), ciwon kai (2%), zawo / colitis (2%), amai (1%), dyspnea (1%) da zazzabi (1%).
Kashe maganin da ke da alaka da AE ya faru a cikin 8% na marasa lafiya. AE mai tsanani ya faru a cikin 39% na marasa lafiya, wanda ya fi kowa shine anemia (7%), fistula (4.1%), zubar da jini (4.1%), da kamuwa da cuta (sai UTI; 4.1%).
Yarda da ƙwayar cuta ta gynecological immunotherapy babu shakka zai ƙara bambaro mai ceton rai, ƙarin zaɓin magani, da ƙarin bege na rayuwa ga marasa lafiya waɗanda ke da juriya ga chemotherapy, maganin hormone, da maganin da aka yi niyya. Daga sama, mun ga cewa gynecological tumor immunotherapy bai dace da duk marasa lafiya ba. Kafin jiyya, dole ne a gwada alamomi guda biyu: ɗaya MSI kuma ɗayan shine PD-L1. Marasa lafiya waɗanda suka cika ka'idodin sun fi dacewa.
Kodayake an riga an sayar da pembrolizumab a China, wasu marasa lafiya na iya jin cewa farashin wannan magani yana da tsada. Idan kana son adana farashin gwajin kwayoyin halitta, gwada pembrolizumab a makance. Wannan hanya kuma ba ta da kyau, amma yawanci Idan ba a ba da shawarar wannan ba, maganin pembrolizumab da kansa zai haifar da wasu sakamako masu illa kuma yana iya yin mummunan tasiri akan maganin mara lafiya.
Idan fa'idar ba za a iya tabbatar da ita ba, ana iya fin karfinta kuma ta shafi yanayin.
For cancer friends whose survival period is not optimistic, the doctor ‘s estimate may be less than 6 months, and the economic conditions are not good. In this case, if you take half a month to wait for an uncertain result, it seems too risky, so It is better to conduct a blind test directly, use the money on the blade, and select the most probable one to try, commonly known as “Chuangyun”.
Tabbas gwajin makafin shima yana da nasa nakasu. Kafin babu gwajin kwayoyin halitta, magani ya dogara ne akan "zato", kuma tasirin yana dogara ne akan "addu'a".
