Kuitika kwegomarara kunopedzisira kwakonzerwa nekusakwana kwemajini, izvo zvinoita kuti kukura kwemaseru anoshanduka kuita isingadzoreki, uye maseru egomarara anotanga kupatsanurwa uye kuwedzera kukosha kusingaperi. Mune mamwe mazwi, kenza chirwere chemajini. Zvisinei, zvinhu zvekunze zvakadai sehupenyu hwepamusoro-soro, kusadzivirirwa kwakaderera, kusvuta uye kunwa, uye kushanda kusina kujairika uye kuzorora ndizvo zvikonzero zvekukanganisa kwemajini.
Zviitiko zvine chekuita nekenza ndezvi:
- zera
- doro
- Carcinogen (aflatoxin)
- Kuzvimba kusingaperi
- Madyiro
- hormone
- Immunosuppressive
- Zvirwere zvinotapukira (hepatitis B virus, Helicobacter pylori)
- kuneta
- radiation
- kuvhenekerwa
- fodya
Mushure meanopfuura makore gumi ebudiriro, cancer genetic test yave kudiwa kwekukurumidza kwenhamba huru yevarwere vegomarara. Rondedzero yeredhiyo inopihwa ne tumor genetic test inonyatso enderana nepfungwa yekuvandudza yemishonga chaiyo, uye yakapinda mune ese maficha ekuongororwa uye kurapwa kwevarwere vegomarara, kuitira kuti varwere vasarudze mishonga yakanangwa yekurapwa chaiko, kudzivirira kutsauka, uye kudzivirira zvisina basa. maside effects anovava.
Ikozvino mamiriro ekurapa kwakanangwa nekenza yechiropa
Chete nekuisa hunhu hwakakosha hwegomarara rechiropa kubva padanho remamorekuru kunogona kutanga kuongororwa uye kufungidzira kutonga kwebundu kuve zvine musoro uye kwakaringana, uye mishonga yakanangwa nemamolecular inogona kushandiswa kugadzirisa uye kurapa varwere nemazvo. Mishonga yakanangana negomarara rechiropa yakatenderwa ndeiyi:
1.Sorafenib (Sorafenib, Dorjemi)
Sorafenib chirwere chakanangwa chine miviri mhedzisiro. Imwe ndeyekudzivirira mitsipa yeropa mitsva inodikanwa kuti isimbe kukura, uye inogona zvakare kunongedza mapuroteni anosimudzira kukura kwemasero ekenza. Izvo zvinangwa zvikuru ndeye VEGFR-1/2/3, RET, FLT3, BRAF zvichingodaro.
Sorafenib inogona kudzivisa zvakananga kupararira kwemasero emarara, uye inogonawo kuita paVEGFR uye PDGFR kudzivisa kuumbwa kwetsinga itsva dzeropa uye kubvisa kudya kunovaka muviri kwemasero emarara, nokudaro kuderedza kukura kwechirwere. Sorafenib inokodzera mutsara wekutanga kurapwa kwekenza yechiropa yepamusoro iyo isingagone kuvhiyiwa kana metastasized.
Sorafenib imishonga yemuromo, kaviri pazuva. Mhedzisiro inowanzoitika yemushonga iyi inosanganisira kuneta kwemichindwe kana soles, kuputika, kurasikirwa nechido, manyoka, kuwedzerwa kweropa, kutsvuka, kurwadziwa, kuzvimba kana blister. Yakakomba mhedzisiro mhedzisiro (zvisingawanzo) inosanganisira matambudziko neropa kuyerera kusvika pamoyo uye kupora kwemudumbu kana ura.
2.regorafenib (Regofenib, Baivango)
Regefenib inogona kuvhara bundu angiogenesis, uye inogona zvakare kunongedza mapuroteni akati wandei pamusoro pecancer maseru kudzivirira kukura kwemasero ekenza. Iyo yemuromo yakawanda-yakanangwa kinase inhibitor iyo inogona kutadzisa VEGFR-1, 2, 3, TIE-2, BRAF, KIT, RET, PDGFR uye FGFR, uye chimiro chayo chakafanana nesorafenib.
Musi waZvita 12, 2017, iyo State Chikafu neDrug Administration (CFDA) yakabvumidza iyo yemuromo polykinase inhibitor regorafenib yevarwere vane hepatocellular carcinoma (HCC) avo vakambogamuchira kurapwa kwe sorafenib. Tora muromo nemuromo kamwe pazuva pazuva kwemavhiki matatu akateedzana, wozorora kwevhiki, wobva waenderera kumberi kutenderera.
Zvakajairika mhedzisiro zvinosanganisira kuneta, kurasikirwa nenzara, ruoko-tsoka syndrome (kutsvuka uye kutsamwa kwemaoko nemakumbo), kuwedzerwa kweropa, kupisa muviri, hutachiona, kuonda, manyoka uye kurwadziwa nemudumbu. Matambudziko akakomba (asina kujairika) anogona kusanganisira kukuvara kwechiropa kwakanyanya, kubuda ropa kwakanyanya, matambudziko eropa kuyerera, uye kupera kwemudumbu kana ura.
3.lenvatinib (Levatinib, Le Weima)
Lenvatinib imishonga yakanangwa yakawanda. Izvo zvinangwa zvikuru zvelevatinib zvinosanganisira vascular endothelial grow factor receptor VEGFR1-3, fibroblast yekukura factor receptor FGFR1-4, platelet-yakatorwa yekukura factor receptor PDGFR- α, cKit, Ret et al. Shanda nekudzivirira mamota kubva pakuumba tsinga dzeropa nyowani dzinoda kukura.
Muna Nyamavhuvhu gore rino, Eisai (Eisai) naMerck (MSD) we lovastinib vakabvumidzwa neUS FDA kushambadza. Leweima akaverengerwa pakurapa kwekutanga-kenza yechiropa isina kuvhiya neCSCO chiropa gwara gwara (2018 vhezheni), iro rine chiremera kwazvo bundu rekuongorora uye gwara rekurapa muChina.
Lenvatinib inoitwa nemuromo kamwe chete zuva nezuva. Mhedzisiro yakajairika yemushonga uyu ndeyekutsvuka-tsoka tsoka yemapapu, kuputika, kushaiwa kudya, manyoka, kuwedzerwa kweropa, kurwadza kwemajoini kana kwemhasuru, kuonda, kurwadziwa mudumbu kana blister. Matambudziko akakomba (zvisingawanzo) anogona kusanganisira matambudziko ekubuda ropa uye kurasikirwa kweprotein mumuti.
4. Cabozantinib (Cabozantinib)
Cabozantinib (Cabozantinib) idiki mamorekuru akawanda-akananga inhibitor akagadzirwa neExelixis yeUnited States, iyo inogona kunongedza VEGFR, MET, NTRK, RET, AXL uye KIT. XL184 ”.
Musi waMay 29, 2018, FDA yakabvumidza Carbotinib yechipiri-mutsara kurapwa kwekenza yechiropa yakakwira. Kubvumidzwa kwakavakirwa paChikamu chechitatu chekiriniki yekuyedza CELESTIAL. Varwere vane advanced hepatocellular carcinoma avo vakafambira mberi mushure mekurapwa ne sorafenib vakagadzirisa zvakanyanya kupona kwese zvichienzaniswa ne placebo. Kufambira mberi-kwemahara kupona uye chinangwa chekupindura mwero chakavandudza zvakanyanya.
5.nivolumab (Navumab, Opdivo®)
Opdivo inobatsira immune system kurwisa cancer maseru nekunanga iyo PD-1 / PD-L1 cell signing nzira (PD-1 uye PD-L1 mapuroteni aripo mumasero emuviri ekudzivirira uye mamwe maseru egomarara). Mukutaura kwe layman: Nekuvhara kusungwa kwePD-L1 protein kumasero egomarara, kuvharika kwemasero egomarara kunodzivirirwa, uye masero emuviri ekudzivirira anogona kuziva nekubvisa maseru egomarara.
Musi waSeptember 23, 2017, maererano neCheckmate-040 kiriniki yekuyedzwa, iyo US FDA yakabvumidza Opdivo yevarwere vane kenza yechiropa yakakwira mushure mekurapa kutadza kwe sorafenib (dojime): chiyero chinoshanda 20%, chirwere chekudzivirira mwero 64%.
6. larotrectinib (Larotinib, zita rekutengeserana Vitrakvi)
Larotrectinib (zita rinonyanya kuzivikanwa rinogona kunge riri LOXO-101) rakabvumidzwa neDFA musi waNovember 27, 2018 yekurapwa kwevakuru nevarwere vevana vane mamota akasimba emuno kana emastastatic ane NTRK gene fusion. Ichi chakanangwa chinodhaka hachina kungoshanda chete, asi zvakare chakapatsanurwa-chinopesana nekenza mushonga, inoshanda kune akawanda akasiyana mamota! Chero bedzi iwe ukave nekuongororwa kwemajini uye paine NTRK1, NTRK2, kana NTRK3 gene fusion, unogona kusarudza iyi inoratidzira inorwisa gomarara mushonga usingasiyanise mamota emhando.
Nzira yekusarudza sei majini ekuongorora varwere vegomarara rechiropa?
Nyanzvi dzinobva kuGlobal Oncologist Network dzakaudza shamwari dzavo zvakajeka kuti kenza genetic test uye kuongororwa kwekiriniki kurapwa chirongwa chakarongeka chinoda kutsigirwa kwakasimba kwerabhoritari, chiyero chepamusoro chekuongorora kwemhando uye chikamu chepamusoro cheboka rekuongorora data. Iyo yakanaka genetic test ongororo inogona kuchengetedza hupenyu hwevarwere vegomarara, uye chigamba chekuongorora chishumo chichaita kuti varwere varasikirwe nemukana wekurapwa. Parizvino, kune akawanda emageneti ekuongorora genetic pamusika, uye varwere vanofanirwa kunyatsosarudza makambani ekuongorora ma genetic kuti vaone chokwadi chemhedzisiro yebvunzo.
Vapepeti vanotevera vachazivisa maviri chaiwo chaiwo ekuyedza matekinoroji muUnited States!
1. Keris yakawanda-chikuva mamorekuru ongororo tekinoroji
Iyo yakawanda-chikuva mamorekuru ongororo tekinoroji yeCareris Cancer Precision Therapy yeCareris Hupenyu Sayenzi muUnited States ndiyo sarudzo yakasarudzika yekenza murwere kuongororwa kwemajini, nekuti inosanganisira kwete chete DNA-chikamu chemageneti kuyedza asiwo RNA uye mapuroteni-ane hukama mo
lecular kuyedza. Mamwe ese makambani ekuongorora majini haana. Nekuda kwemhando dzakasiyana dzehunyanzvi hwekuongorora, akawanda-mapuratifomu mamorekuru ekuongorora tekinoroji anogona kuongorora musiyano wemota yemurwere zvakanzwisisika uye zvinonzwisisika, uye nhungamiro yemushonga yakapihwa ine mvumo.
Zvinoenderana nedhata repamutemo reKeruis, rakakura rakasimba bundu kudzidza kwevarwere zana nemakumi masere vakanyoresa, mushure mekutungamirwa neKeruis yakawanda-chikuva mamorekuru ongororo, varwere vakagara kwenguva refu Mazuva mashanu . Ivhareji nhamba yemishonga yevarwere vari pasi pekurairwa ndeye 3.2, uye huwandu hwemishonga yevarwere vasina hutungamiriri ndi4.2. Mimwe mishonga inoreva kuti varwere vangangoda kutambura mamwe mhedzisiro uye kurasikirwa zvisina kufanira kwehupfumi. Izvo izvo varwere vasingafungidzire ndezvekuti, pamusoro pekutungamira kusarudzwa kwemishonga yakanangwa, Kerrys anokwanisa zvakare kuongorora kuti ndeapi makemikari ekurapa akakodzera varwere. Muchokwadi, kusarudzwa kwemakemikari ekurapa anodawo hutungamiriri, uye haugone kuteedzerwa zvinoenderana nemazano ekurapa. Keris yakawanda-chikuva mamorekuru ongororo iyi yakazara yakazara nzwisisika yekuongorora tekinoroji yekupa varwere nzira dzakanyatsonaka uye dzakakodzera marapirwo.
Mabasa akawanda-epuratifomu mamorekuru ekuongorora magwara chaiwo ekurapa kufukidza angangoita ese marudzi ekenza
Zvinangwa zvakanyanya zveKeruis molecular analysis yakadai seEGFR, ALK , ROS1 , MET , mTOR , BRAF , HER2 zvichingodaro, pamwe chete nezvinangwa zve immunotherapy PD-L1 , TMB uye MSI-H , mushumo wekuedza unogona kutungamira varwere kuti vasarudze. zvinangwa Kunyatsorapwa kwemishonga kunobatsira varwere kuti vadzivise kutsauka uye kudzivirira zvisingakodzeri mhedzisiro. Kunyange kana pasina chinangwa chekuchinja uye pasina mukana wekusarudza zvinodhaka zvakanangwa, Keruis anogonawo kutungamirira kushandiswa kwemishonga yechemotherapy nemishonga yehomoni zvichienderana nemigumisiro yekuongorora, uye kupawo mukana wekutora chikamu mune zvitsva zvekliniki miedzo muUnited States.
2. NheyoOne®CDx
FoundationOne®CDx yakagamuchirwa neDFA seyekutanga pan-bundu mhando inosangana yekuongorora chigadzirwa. Sechishandiso chekutsvaga, chakabatsira kuwanikwa kwemishumo yakawanda yekutsvagisa kwesainzi, uye yakaunganidza huwandu hwakawanda hwedata panguva iyi. Ikozvino bvunzo kufukidza inosanganisira 324 magene uye maviri mamorekuru mamaki (MSI / TMB) ayo anogona kufanotaura kushanda kwe immune immune pooti inhibitors. Inogona kuvhara mamota ese akasimba (kunze kwesarcoma) uye inogona kuenderana nematanho gumi nemanomwe ekurapwa anotenderwa neDFA!
Mukuongorora kwekiriniki kwemajini egomarara, maitiro anowanzoshandiswa anosanganisira Sanger sequencing, mass spectrometry genotyping, fluorescence in situ hybridization (FISH) uye immunohistochemical analysis (IHC). "Standard single marker monitoring" yakadai seFISH, IHC uye multi-gene hotspot diagnosis ( hotspot panel) inogona kungowana imwe chete kana maviri mhando yekliniki yakakosha yemajini abnormalities (sekungotsiva kwekutanga). Zvidzidzo zvakaratidza kuti ichangoburwa yakazara-inotevera-chizvarwa kutevedzana tekinoroji yegomarara yakazara genetic test inogona kuona ese mana emhando dzemajini abnormalities (base kutsiva; kuisa uye kudzima; kopi nhamba kusiyanisa uye kurongazve), uye yakarurama kupfuura yechinyakare, yakajairwa bvunzo.
