Mishonga inogamuchirwa neASCO kubva muna 2005 kusvika muna 2014
Kubva ASCO yakaburitsa mushumo wayo wekutanga wekiriniki wekufambira mberi kwegomarara muna 2005, yakaona kufambira mberi kwakasimba uye kwakasimba mumunda weoncology mumakore gumi apfuura.
Mumakore gumi apfuura, anopfuura makumi matanhatu emishonga inorwisa bundu yakabvumidzwa neFDA (Mufananidzo 10). Nekunzwisisa kwakadzika kwe tumor biology, masayendisiti akagadzira nhevedzano yemishonga mitsva yakanangana nemamolekyulu, uye kuuya kwavo kwachinja nezviuru. Mamiriro emakumi ezviuru evarwere vekenza avo vanonetsa kurapa.
Such new drugs can target specific molecules or molecular clusters necessary for tumarara cell growth, survival or spread.
Makore gumi apfuura, maNational Institutes of Health akatanga chirongwa cheTCGA, icho chakave chekutanga uye chakakura kwazvo muzvirongwa zvakadaro. Parizvino, iyo TCGA yekutsvagisa network yakaratidza yakazara mamorekuru mepu gumi gumi dzakasiyana mhando dzekenza.
Nhasi, TCGA uye mamwe epamusoro-throughput ekuteedzera mapurojekiti anoenderera achiongorora ruzivo rwakakosha rwunobatsira kuvandudza kufungidzira kwevarwere kuburikidza nhevedzano yenzira. Zvinogoneka kuti varwere vasarudze yakakodzera nzira yekurapa. Chidzidzo chacho chakawanawo mutsva mutyairi wekenza geni zvisizvo. Aya majini anogona kuve tarisiro yemishonga mitsva.
Mushure memakumi emakore ekusimudzira kwakadzikama, munda weantibody immunotherapy has finally ushered in the long-awaited major success in recent years. It first occurred in the treatment of advanced melanoma, followed by a series of other cancer types, including lung cancer. Common types have also made progress.
Huwandu hwevarwere vakamboshaya kurapwa kwakaringana vakapona kwenguva yakareba mushure mekurapwa nemishonga mitsva. Imwe ongororo yenguva refu-refu yakaratidza kuti antibody immunotherapy ichiri nemhedzisiro pakukura kwemarara mushure memakore mazhinji ekurapwa.
Imwe mhando yemununotherapy yakazvipira kugadzirisa zvekare maseru emuviri wayo kurwisa tumarara maseru. Inoitawo zvakanaka kune mamwe maronda eropa uye akateedzana mamota akaomarara.
wokutanga jekiseni regomarara mumakore gumi apfuura zvakare yakaburitswa (gomarara rechibereko Gardasil vaccine). Zviyedzo zvekuongorora dzimwe mhando dzemajekiseni egomarara zviri kuitikawo.
Finally, large-scale screening studies have brought new and important evidence that it can advance screening practices for some common cancers such as lung cancer, breast cancer, and Kenza yeprotate.
Kukurumidza kukurumidza kweakanangwa kurapwa mukenza kurapwa
Mumakore gumi apfuura, takaona kuwedzera kwakasimba uye nekukurumidza kwenhamba yemishonga mitsva yakanangwa yekurapa yakabvumidzwa neFDA, inopfuura nekure kumhanya kwekuvandudza kwemishonga mitsva yechemotherapy (Mufananidzo 2).
Munguva iyi, angangoita makumi mana emishonga mitsva yakanangwa yakatenderwa, mazhinji acho akachinja echinyakare kurapwa modhi uye nekuvandudza zvakanyanya kufungidzira kwevarwere vazhinji vegomarara.
Isu tinotanga taunza anti-angiogenesis inhibitors, inova kirasi yemishonga yakagadzirirwa kudzora neovascularization yemamota uye ave marapiro akabudirira kune mazhinji epamberi uye anorwisa kenza.
The first drug approved by the FDA is bevacizumab, which was approved for advanced colorectal cancer in 2004 and has since been used in certain lung, kidney, ovarian, and brain tumors.
Subsequently, other angiogenesis inhibitor drugs such as axitinib, carbotinib, pazopanib, rigefenib, sorafenib, sunitinib, vandetanib, and abecept were successively Approved for the treatment of advanced kidney cancer, pancreatic cancer, colorectal cancer, thyroid cancer, and gastrointestinal stromal tumors and sarcomas.
EGFR inhibitors: kunanga nzira dzakakosha dzekusaina
Tumota uye Midziyo yeRopa
Rimwe boka hombe remishonga yakanangwa rakagadzirirwa kukanganisa nzira dzinonetsa dzekuratidzira mumaseru, kunyanya network yekuratidzira iyo inodzora kukura kwemasero ekenza. Imwe yeiyi nzira inodzorwa neEGFR protein.
The first EGFR drug was gefitinib, which was approved for the treatment of NSCLC in 2003. Two years later, the FDA approved the second EGFR drug cetuximab for the treatment of advanced kenza yakajeka, and another similar drug panitumumab was also approved in 2006.
Zvisinei, muna 2008, tsvakurudzo itsva yakaratidza kuti colorectal cancer varwere vane KRAS mutations vakatanga kuramba cetuximab uye panitumumab. Uku kuwanikwa kunoda kuongororwa kwese kweKRAS geni shanduko kuona kuti varwere vanogona kubatsirwa kubva pane maviri ekurapa ekurapa, uku vachidzivirira vamwe varwere kubva kune yakaipa mhedzisiro yekurapa kusingabatsiri.
In 2004 and 2005, the FDA approved the EGFR inhibitor erlotinib for the treatment of NSCLC and advanced pancreatic cancer. Recently, in 2013, the US FDA approved afatinib for the treatment of advanced NSCLC patients with specific mutations in the EGFR gene. Other EGFR targeted drugs are undergoing clinical trials.
New HER2 therapy brings continuous breakthrough in kenza yebonde mabatiro
Anenge makore gumi nemashanu apfuura, masayendisiti akawana kurapwa kwekutanga kwebundu tishu iyo inowandisa epidermal kukura factor receptor 15 (HER2). Inenge 2% kusvika 15% yevarwere vekenza yemazamu vanotakura zviri pamusoro apa genetic abnormalities (HER20-positive cancer). Zvakafanana neEGFR yemhuri imwechete, HER2 inogonawo kukurudzira kukura kwekenza masero. Kubva ipapo, mishonga ina yakanangwa neHER2 yakazvarwa, zvese izvi zvinogona kuvandudza kupona kwevarwere vane HER2-positive cancer cancer.
Yekutanga HER2 mushonga, trastuzumab, kana ikashandiswa pamwe chete nemakemikari anogona kuvandudza zvakanyanya kupona kwevakadzi vane advanced HER2-positive kenza yemazamu. Muna 2006, trastuzumab yakagamuchirwa kune varwere vane kenza yepazamu yekutanga yeHER2-kuitira kudzikisira njodzi yekudzokazve mushure mekuvhiyiwa.
Munguva pfupi yapfuura, chidzidzo chakakosha chakawana kuti kurova kwakapokana neHER2 kwaive kwakanyanya kushanda kupfuura trastuzumab monotherapy, izvo zvakatungamira mukubvumidzwa kweDAA kwechipiri HER2 mushonga Pertuzumab pamwe chete netrastuzumab muna 2012 Monoclonal antibody inoshandiswa mune varwere vane yakakwira HER2-yakanaka kenza yemazamu. , uye ndokubvumidzwa kurapwa kwechirwere chekutanga muna 2013.
Mugore rimwe chete, trastuzumab-emtansine (T-DM1) (trastuzumab pamwe ne chemotherapeutic drug) yakabvumidzwawo. Musanganiswa wekurapa uyu haungoshanda chete kupfuura kurapwa kwemushonga mumwe chete, asi zvakare unobvumidza mushonga kuti unyatsonongedzwa kumaseru ekenza yemazamu, nekudaro ichideredza mhedzisiro yakaipa kumaseru ane hutano. Kune HER2-yakanaka kenza yemazamu iyo yakadzikira mushure mekurapwa kwakawanda kwapfuura, iyi ndiyo nzira yekurapa yakakwana.
Yechina HER2 mushonga, lapatinib, yakagamuchirwa muna 2007. Kana ikashandiswa pamwe chete ne aromatase inhibitor zvinodhaka, inogona kubata zvine mutsindo HER2-inovhenekera uye mahormone receptor-yakanaka / HER2-yakanaka metastatic kenza yemazamu.
Zvinodhaka zvinotarisa akawanda mamorekuru nzira: anovimbisa tarisiro
Researchers continue to find that many cancer drugs can block multiple molecular targets or pathways at the same time, which makes them a more effective anti-cancer weapon. For example, vandetanib (approved for the treatment of chirwere chetachiona in 2011) can Block EGFR, VEGFR (protein involved in tumor blood vessel growth) and RET.
Iyo yakajeka kenza kenza zvinodhaka gefitinib (inogamuchirwa muna 2012) inovhara 6 dzakasiyana nzira dzekenza: VEGFR1-3, TIE2, PDGFR, FGFR, KIT, uye RET.
Zvinangwa zvitsva uye mishonga mitsva pakurapa kenza
Chinobudirira
ts yekugadzirwa kwemishonga mitsva inokwezva zvakanyanya. Muna 2013 na2014, iyo FDA yakabvumidza Trametinib naDalafenib, mishonga miviri inogona kushandiswa pakurapa chaiyo mutant melanoma yeBRAF gene, iyo inodzora nzira yeMEK.
Crizotinib (approved in 2013) can target kenza yemapapu and childhood cancer with ALK gene mutation. Tisirolimus (approved in 2007) and everolimus (approved in 2012) block the mTOR pathway, which can control the growth of several cancers, including breast cancer, pancreatic cancer, and kidney cancer.
Everolimus ndiyo yekutanga inoshanda yakanangwa mishonga yeHER2-isina kenza yemazamu, iyi mhando inowanzoita yakawanda yekenza yemazamu. Everolimus inosanganiswa nearomatase inhibitor mishonga inogamuchirwa yehormone receptor yakanaka uye HER2 yakaipa postmenopausal yepamusoro kenza yemazamu varwere.
Nilotinib (inogamuchirwa muna 2007) uye dasatinib (inogamuchirwa muna 2010) inogona kunanga BCR-ABL, puroteni yakanowanikwa mune mamwe marudzi eleukemia.
Kugamuchirwa kunguva ye immunotherapy
Masayendisiti akaziva kuti immune system isimba rakasimba kurwisa kenza makore zana apfuura. Asi pakanga pasiri kutosvika makore gumi apfuura kuti immunotherapy yakatanga kunyatso shandura kurapwa kwekenza. Kufambira mberi kwakaitwa munzira dzinoverengeka kubva pamushonga wemumuromo kuenda kumasero-akavakirwa marongero akagadzirirwa murwere mumwe nemumwe.
Simbisa immune system kurwisa gomarara
T maseru anoita basa rakakosha pakurwisa gomarara. Muna 2011, iyo FDA yakabvumira ipilimumab senzira yekurapa kwemelanoma. Ipilimumab imushonga wemuviri unonongedza iyo CTLA-4 protein yeT maseru, ayo anogona kutadzisa kuuraya mhedzisiro yeT masero.
Mumakiriniki ekuedzwa, varwere vanozoona kukurumidza uye kuri pachena bundu regression, uye ivo vacharamba vachibatsirwa mushure menguva yakareba mushure mekurapwa kwapera (kune vamwe varwere zvinogona kugara kwemakore akati wandei).
Kubva ipapo, mamwe anonzi immune checkpoint inhibitor zvinodhaka akagadzirwa, kunyanya mamwe madhiragi anogona kunanga iyo PD-1 / PD-L1 nzira, iyo inobatsira mapundu kutiza immune system.
Iyo FDA yakapa iyo PD-1 blocker zvinodhaka nivolumab uye MK-3475 yekubudirira kwemazita ezvekurapa. Mumakiriniki ekutanga emakiriniki ekutanga pane melanoma, ese ari maviri aratidzira kushanda kusingaenzaniswi kwakanaka (nivolumab inogona zvakare kushandiswa nemazvo kenza yeitsvo Uye kurapwa kwemukenza wemapapu).
MunaGunyana 2014, Mk-3475 (pembrolizumab) yakava yekutanga PD-1 yakanangwa mushonga unobvumidzwa neFDA. PD-1 yakanangwa mushonga MPDL3280A yakaratidzawo mhedzisiro inopesana neyepamberi melanoma mumakiriniki miedzo.
Zvidzidzo zvenguva pfupi zvinoratidza kuti kushandiswa kwakabatana kweakasiyana checkpoint inhibitor madhiragi kana musanganiswa wemishonga inogadziriswa immune yakadai se interferon, interleukin uye imwe yekutarisa inhibitor zvinodhaka zvinogona kuwedzera kuvandudza murwere.
Patients and vakapukunyuka have significantly improved quality of life
Mumakore gumi apfuura, tsvagiridzo yakawana nhevedzano yemishonga mitsva inogona kusimudzira hupenyu hwevarwere padanho rega kubva kubva pakuongororwa kusvika pakurarama. Uye zvakare, kusimbisa kubatanidzwa kwekutanga kurapwa kwekurapa uye kurapa kunoshanda kuchabatsira varwere vazhinji, kunyanya kusimudzira varwere vemberi kuti vararame hupenyu huri nani.
Bvisa zvakashata zvine chekuita nekenza
Maitiro matsva anoitirwa kudzora mhedzisiro inogona kuvandudza zvakanyanya hupenyu hwevarwere, panguva uye mushure mekurapwa. Semuenzaniso, zvidzidzo zviviri zvakazvimirira zvakaratidza kuti antidepressant duloxetine uye antipsychotic olanzapine mishonga inoshanda kudzivirira mbiri dzakajairika senge chemotherapy peripheral neuropathy uye kuda kurutsa.
Chimwe chidzidzo chakawana kurapwa kwezviratidzo zvakajairika izvo zvisina kukwezva kutarisisa kwakakwana-kushushikana uye kurwadziwa. Hwakawanda uye hwakawanda humbowo hunosimbisa kushanda kwenzira dzisiri dzekurapa senge kugadzirira uye iyo yoga kusimudzira hutano hwepanyama uye hwepfungwa hwevarwere nevanopona. Zvinogona kubatsirwa zvinosanganisira kudzikisira kuneta uye kurwadziwa, kuvandudza hupenyu hwehupenyu, uye kudzikisa kushandiswa kwemushonga.
Kubatanidza kurapwa kwekenza nekutarisira kwekutanga kurapa
Muedzo wakakosha wekiriniki muna 2010 wakasimbisa kuti kusangana kwekutanga kurapwa kunorapa panguva yekurapa kunogona kuvandudza zvakanyanya hupenyu uye kuwedzera kurarama kwevarwere vane gomarara repamberi remapapu kana ichienzaniswa neyekurapa kumwe chete. Uye zvakare, varwere vakagashira kwekutanga kurapwa kwekurapa havaite kuti vawane yakanyanya-yakasimba kushingairira kuchengetedza sekumutsidzira pakupera kwehupenyu.
Chidzidzo chacho chakakonzera mutsva wekutarisirwa kwevarwere vemberi. Chidzidzo ichi chakataura zvakare kurudziro yemienzaniso yenguva pfupi yakapihwa neASCO muna2012: Chero murwere ane chirwere checancer yemastastatic kana mutoro wakakura wechiratidzo anogona kuperekedzwa nekurapa kwekurapa mune ekutanga kurapwa kwekenza.
Zvinowanzoitika zvinodhaka zvinoderedza njodzi yekenza
A large number of clinical trials have shown that some commonly used drugs may have important effects on cancer prevention. For example, analysis of data from nearly 50 epidemiological studies shows that oral contraceptives can reduce the risk of ovarian cancer by 20% every 5 years. This reduction effect persists within 30 years of termination of the drug.
Imwe tsvagiridzo yakawana kuti kutora aspirin zuva nezuva kunogona kuderedza njodzi yegomarara remukati. Nekudaro, nekuda kwekubuda ropa mudumbu uye dzimwe njodzi, hazvikurudzirwe kugara uchishandisa aspirin senzira yekudzivirira kenza. Nhanho inotevera yechidzidzo ichaongorora zvakare anti-kuzvimba mishonga mukudzivirira cancer uye Basa rekurapa.
