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 tumor are harmful to women. Early detection and early diagnosis can often help treatment and improve the survival time of patients.
Iko kukurumidza kufambira mberi kwechinangwa chekurapa uye immunotherapy yakavandudza zvakanyanya mamiriro evarwere vegomarara revakadzi. Mupepeti anotarisa kune yakatenderwa gynecological bundu yakanangwa kurapa mishonga uye immunotherapy mishonga yako.
Gynecologic kenza yakanangwa kurapwa
Kenza yeOvarian yakanangwa kurapwa
① Bevacizumab
②PARP inhibitor
Olaparib (Olapani, Lynparza), rucaparib (Rucapa, Rubraca) uye niraparib (Nilapani, Zejula)
Kenza yemuromo wechibereko yakanangana nemishonga yekurapa
Bevacizumab (Bevacizumab, Avastin)
Kenza yeEndometrial yakanangwa kurapwa
Shandisa mahormone kana mahormone anovharira mishonga kurwisa cancer. Mishonga yekurapa inosanganisira:
Ø Progesterone: medroxyprogesterone acetate uye megestrol acetate
Amo Tamoxifen
Ø Luteinizing hormone-inosunungura mahormone agonists: Goserelin (Norred®) uye Leuprolide (Leuprolide®). Iyi mishonga inobayiwa mwedzi imwe neimwe 1-3
Ø Aromatase inhibitors: letrozole (Fronon®), anastrozole (Reninide®), exemestane (Anoxin®)
Uterine sarcoma yakanangwa kurapwa
Anz Panzopinab (Votrient) chirwere chakanangwa chinogona kushandiswa kurapa leiomyosarcoma yakapararira kana kudzoka mushure mekurapwa.
Ø Olaratumab (Lartruvo) yakasanganiswa nechemotherapy drug doxorubicin kurapa nyoro nyoro sarcoma. Inogona kushandiswa kurapa uterine sarcoma iyo isingapinduri kune mamwe marapirwo.
Gynecological bundu immunotherapy
Immunotherapy ipfungwa nyowani, isingashandiswe zvakanyanya sekuvhiya, chemotherapy uye radiotherapy. Nekudaro, yakafambira mberi zvikuru mukuvandudza kupona kwevarwere vane cancer yemapapu, melanoma, kenza yeitsvo, Hodgkin's lymphoma zvichingodaro. Mushonga mumwe chete unotenderwa kune gynecological tumor immunotherapy! Asi kune maviri akasiyana mamiriro, nyeredzi mushonga ndeye pembrolizumab (Pembrolizumab, Keytruda).
Pembrolizumab (Keytruda) inotarisa PD-1, inova puroteni pamasero eT uye inowanzobatsira kudzivirira masero aya kubva pakurwisa mamwe masero mumuviri. Nekuvhara PD-1, mishonga iyi inogona kukwidziridza mhinduro yekudzivirira kumasero egomarara, zvichiita kuti mamwe mamota adzike kana kunonoka kukura.
MSI-H Gynecologic Oncology
Musi wa24 Chivabvu 2017, iyo US FDA yakabvumidza iyo PD-1 inhibitor pembrolizumab (Pembrolizumab, Keytruda) kurapa yakasimba bundu varwere vane microsatellite isina kugadzikana zvakanyanya (MSI-H) / kusawirirana kugadzirisa kuremara (dMMR) Mhando dzebundu dzinovhara gumi nemashanu akasiyana mamota akashata. zvinosanganisira gomarara rechiropa, gomarara remukati, kenza yemapapu negomarara remuchibereko, kusanganisira mamota akasiyana echikadzi. (Cherechedza: Kana MSI-H ikaonekwa, hazvina basa kuti inokurumidza kana kunonoka, unogona kubatsirwa)
PD-L1 gomarara remuromo wechibereko
Muna Chikumi gore rino, iyo US FDA yakakurudzira kubvumidzwa kwepembrolizumab (Keytruda) yekurapa kwepamberi PD-L1-inovhenekera varwere vegomarara remuromo wechibereko vane chirwere chakafambira mberi panguva kana mushure memakemikari. Kubvumidzwa kunotsanangura PD-L1 yakanaka sekenza yemuromo wechibereko pamwe neakaenzana akanaka mamaki (CPS) -1 iyo yakapasa mhedzisiro yeDAA yakabvumidzwa bvunzo. Izvo zvakakosha kuti utaure kuti, kubva ikozvino, Keytruda ndiyewo wekutanga uye chete wakabvumidzwa anti-PD-1 kurapa kwechirwere chembere chechibereko.
Iyo immunotherapy mushonga unopihwa yega yega mavhiki matatu uye unopihwa neiyo intravenous (IV) infusion. Iko parizvino yakanyorwa muChina uye inopinda inishuwarenzi yekurapa. Varwere mudzimba vanogona kuenda kuchipatara chemuno kunobvunzwa, kana kufonera iyo Global Oncologist Network (3-400-626) kuti uwane ruzivo rwakadzama nezvecancer cancer pembrolizumab kurapwa.
Kubvumidzwa kwaive kwakavakirwa pane data kubva kuvarwere ve98 vane kenza yemukondombera yakadzokororwa kana metastatic muPaseti II KEYNOTE-158 kutongwa. Ichi chepasirese, chakavhurika, chisingaite, yakawanda, uye multicenter kudzidza kwakayedza pembrolizumab mukurapa kwevarwere vane akawanda marudzi emhando yepamusoro mamota, uye varwere ava vafambira mberi pane zvakajairika kurapwa maprotocol.
Nguva yepakati yekutevera yaive 11.7 mwedzi (renji 0.6-22.7). Iyo yakazara inoshanda mwero (ORR) ye77 PD-L1 yakanaka varwere (CPS-1) yaive 14.3%. Ava varwere vese vaive varwere vane metastatic chirwere avo vakagamuchira ≥ 1 mutsara wekemotherapy. Iyo ORR ine yakakwana yekupindura mwero we2.6% uye chikamu chekupindura chiyero che11.7%. Nguva yekupindurwa yepakati haina kusvika (renji 4.1 mwedzi kusvika 18.6 + mwedzi), uye 91% yevakapindura vane nguva yekupindura yemwedzi mitanhatu kana kupfuura.
Kune varwere vane PD-L1 expression CPS <1, hapana mhinduro yakataurwa.
"Kunyangwe paine kufambira mberi kwakawanda mukenza yemadzimai, vakamborapwa varwere vane gomarara repamuromo wechibereko vachiri kushaya nzira itsva dzekurapa," akadaro Bradley Monk, Arizona oncologist, director wezvekurapa weAmerican Gynecology Research oncology Program uye purofesa wezvekuzvara uye gynecology. Mune chirevo,
"Kubvumidzwa kwaKtrtruda muchiratidzo ichi kwakakosha nhau-seanachiremba, zvinofadza kuona sarudzo inodiwa kwazvo kuvarwere ava," Monk akawedzera.
The histological classification yevarwere makumi manomwe nevanomwe vane mhinduro yekurapa yaive: 77% squamous cell carcinoma, 92% adenocarcinoma, uye 6% adenosquamous carcinoma. 1% yevarwere vane metastases, uye 95% vanodzoka zvakare. Iyo PD-L20 IHC 1C22 pharmDx kit yakashandiswa kuona mamiriro ePD-L3.
Varwere vakagamuchira 200 mg pembrolizumab masvondo ese e3 kusvika pamwedzi makumi maviri nemana kana kuti vakasiya kurapwa nekukasira, kana kusimbiswa kweradiology yekuwedzera kwechirwere, kana chepfu isingagamuchirwe kana zvichibva pasarudzo yemupfuri. Vanachiremba vakadzikama vane radiology kufambira mberi vanogona kuenderera mberi nekurapwa kusvikira kufambira mberi kusimbiswa nemifananidzo inotevera. Kumhanyisa kufambira mberi kwakaongororwa vhiki dzese pfumbamwe mugore rekutanga, uye vhiki dzese gumi nemaviri zvichizotevera.
Iyo inowanzozivikanwa (≥10% yevarwere) yakashuma zviitiko zvakashata (AEs) pamatanho ese aisanganisira kuneta (43%), kurwadziwa (22%), fever (19%), peripheral edema (15%), uye musculoskeletal pain (27 %)), Dhairrhea / colitis (23%), kurwadziwa kwepamuviri (22%), kuda kurutsa (19%), kurutsa (19%), kuzvimbirwa (14%), kuderera kwechido (21%), kubuda ropa (19%), UTI (18%), hutachiona (16%), mapundu (17%), hypothyroidism (11%), musoro (11%) uye dyspnea (10%).
Giredhi rakajairika 3/4 AEs rinosanganisira UTI (6%), kubuda ropa (5%), kurwadziwa musculoskeletal (5%), kuneta (5%), hutachiona (4.1%), kurwadziwa mumimba (3.1%), kurwadziwa (2%) )%), Peripheral edema (2%), mapundu (2%), musoro (2%), manyoka / colitis (2%), kurutsa (1%), dyspnea (1%) nefivhiri (1%)).
Kuregedza kurapwa kwakanangana neAE kwakaitika mu8% yevarwere. MaEEs akasimba akaitika mu39% yevarwere, yakanyanya kuve anemia (7%), fistula (4.1%), kubuda ropa (4.1%), uye hutachiona (kunze kwe UTI; 4.1%).
Kubvumidzwa kwe gynecological tumor immunotherapy pasina mubvunzo kuchawedzera huswa hunoponesa hupenyu, imwe imwe nzira yekurapa, uye imwezve tariro yekupona kune varwere vasingadi chemotherapy, hormone therapy, uye yakanangwa kurapa. Kubva pane zviri pamusoro, tinoona kuti gynecological tumor immunotherapy haina kukodzera kuvarwere vose. Usati warapwa, mabundu mavanga maviri anofanirwa kuongororwa: imwe iMSI uye imwe yacho PD-L1. Varwere vanozadzisa zviyero vanonyanya kukodzera.
Kunyangwe pembrolizumab yatotengeswa kuChina, vamwe varwere vanganzwa kuti mutengo wemushonga uyu wakadhura. Kana iwe uchida kuchengetedza mutengo wekuongororwa kwemajini, bofu edza pembrolizumab. Iyi nzira hainawo kuipa, asi kazhinji Kana izvi zvisingakurudzirwe, kurapwa kwepembrolizumab pachayo kunokonzera mamwe maside effects uye kunogona kuve nemhedzisiro yakaipa pakurapwa kwemurwere.
Kana iyo bhenefiti isingakwanise kuvimbiswa, inogona kupfuudzwa uye kukanganisa mamiriro acho.
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”.
Zvechokwadi, bvunzo yebofu inewo zvikanganiso zvayo. Pasati pave pasina genetic test, mushonga wacho unoenderana ne "kufungidzira", uye mhedzisiro yacho iri kutsamira pa "kunamata".
