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 burooyinka are harmful to women. Early detection and early diagnosis can often help treatment and improve the survival time of patients.
Horumarka degdegga ah ee daaweynta la beegsanayo iyo immunotherapy ayaa si weyn u hagaajiyay xaaladda bukaannada kansarka dumarka. Tifaftiraha ayaa fiirin doona daawooyinka daaweynta bartilmaameedka burada dumarka ee la ansixiyay iyo daawooyinka tallaalka immunotherapy.
Kansarka dumarka ku dhaca ee lagu daweeyo
Kansarka qoorta daaweynta la beegsaday
Daawada ②PARP
Olaparib (Olapani, Lynparza), rucaparib (Rucapa, Rubraca) iyo niraparib (Nilapani, Zejula)
kansarka ilmo dawooyinka daawaynta ee la beegsaday
Bevacizumab (Bevacizumab, Avastin)
Cudurka kansarka 'endometriatric therapy therapy'
U isticmaal hormoonnada ama daawooyinka horjoogsada hormoonka si aad ula dagaallanto kansarka. Daawooyinka daaweynta waxaa ka mid ah:
Ges Progesterone: medroxyprogesterone acetate iyo megestrol acetate
Amo Tamoxifen
Luteinizing hormone-sii deynta agonists: Goserelin (Norred®) iyo Leuprolide (Leuprolide®). Daawooyinkan waxaa la isku duraa 1-3-dii biloodba mar
Itors Aromatase inhibitors: letrozole (Fronon®), anastrozole (Reninide®), tusaale (Anoxin®)
Uterineine sarcoma daaweynta la beegsaday
Zo Panzopinab (Votrient) waa daaweyn la bartilmaameedsaday oo loo isticmaali karo in lagu daaweeyo leiomyosarcoma oo ku faafay ama ku soo noqotay daaweynta ka dib.
Ø Olaratumab (Lartruvo) oo lagu daray dawada kiimikaad ee doxorubicin si loogu daweeyo sarcoma unug jilicsan. Waxa loo isticmaali karaa in lagu daaweeyo sarcoma uterineine-ka oo aan ka jawaabin daawaynta kale.
Immunotherapy burooyinka cudurada haweenka
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, Xuubka '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) waxay beegsataa PD-1, taas oo ah borotiin ku jira unugyada T waxayna caadi ahaan ka caawisaa ka hortagga unugyadan inay weeraraan unugyada kale ee jirka. Marka la xannibo PD-1, daawooyinkani waxay kor u qaadi karaan jawaabta difaaca unugyada kansarka, taasoo keenta burooyinka qaar inay yaraadaan ama hoos u dhigaan korriimadooda.
MSI-H Cudurka Haweenka
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, kansarka mindhicirka, 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 kansarka xubinta taranka dumarka
Bishii Juun ee sannadkan, US FDA waxay dardargelisay oggolaanshaha pembrolizumab (Keytruda) ee daaweynta bukaan-socodka kansarka ilmo-galeenka ee PD-L1-positive oo cudurkoodu sii socday intii lagu jiray ama ka dib daaweynta kemotherabi. Ansixinta waxay qeexaysaa PD-L1 inay tahay mid ku habboon kansarka ilmo-galeenka oo leh dhibco isku-dhafan oo isku-dhafan (CPS) that1 oo ka gudubtay natiijooyinka baaritaanka ee FDA. Waxaa xusid mudan in, ilaa imika, Keytruda sidoo kale ay tahay dawada ugu horeysa oo kaliya ee la oggol yahay daaweynta anti-PD-1 ee kansarka xubinta taranka dumarka.
Daawada difaaca jirka waxaa la bixiyaa 3dii asbuucba mar waxaana bixiya faleebada xididka (IV). Waxay hadda ku qoran tahay Shiinaha waxayna galeysaa caymiska caafimaadka. Bukaannada gudaha waxay aadi karaan isbitaalka maxalliga ah si ay ula tashadaan, ama waxay u wacaan Shabakadda Caalamiga ah ee Oncologist (400-626-9916) si aad u hesho macluumaad faahfaahsan oo ku saabsan daaweynta kansarka ilmogaleenka pembrolizumab.
Ansixinta waxay ku saleysneyd xog laga helay 98 bukaan oo qaba cudurka kansarka xubinta taranka dumarka ee soo noqnoqda ama tijaabada ah ee wejiga II KEYNOTE-158. Daraasaddan caalamiga ah, furan, aan kala sooc lahayn, tiro badan, iyo daraasado badan ayaa lagu qiimeeyay pembrolizumab ee daaweynta bukaanada qaba noocyo badan oo burooyin adag oo adag, bukaanadani waxay horumar ka sameeyeen nidaamyada daaweynta caadiga ah.
Waqtiga dabagalka ee dhexdhexaadku wuxuu ahaa 11.7 bilood (inta udhaxeysa 0.6-22.7). Wadarta heerka wax ku oolka ah (ORR) ee 77 PD-L1 bukaanada togan (CPS ≥ 1) waxay ahayd 14.3%. Bukaanadan dhammaantood waxay ahaayeen bukaanno qaba cudurka metastatic ee helay line 1 sadarka kiimoteraabiga. ORR waxay leedahay jawaab celin dhameystiran oo ah 2.6% iyo qeyb jawaab celin ah 11.7%. Muddada jawaabta dhexdhexaadka lama gaarin (inta udhaxeysa 4.1 bilood ilaa 18.6 + bilood), iyo 91% jawaab bixiyaasha waxay lahaayeen jawaab celin ah 6 bilood ama kabadan.
Bukaannada qaba muujinta PD-L1 CPS <1, wax jawaab ah lama soo sheegin.
"In kasta oo ay jireen horumarro badan oo kansarka dumarka ah, haddana bukaanno horay loo daweeyay oo qaba kansarka ilmo galeenka oo aad u sarreeya ayaa wali haysan fursado daaweyn oo cusub," ayuu yiri Bradley Monk, oo ah dhakhtarka kansarka ee Arizona, oo ah agaasimaha caafimaadka ee Barnaamijka Cilmi-baarista Cudurka Haweenka ee Maraykanka iyo borofisar ku takhasusay cudurada haweenka iyo haweenka. Hadal qoraal ah,
"Ansixinta Keytruda ee tilmaamahan waa mid muhiim u ah warka-dhaqtarka kansarka, waa wax lagu farxo in la arko xulasho aad loogu baahan yahay bukaanadan," Monk ayaa raaciyay.
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.
Bukaanku waxay heleen 200 mg pembrolizumab 3dii usbuucba mar ilaa 24 bilood ama ay iskaga baxaan daaweynta si iskood ah, ama xaqiijinta shucaaca ee horumarka cudurka, ama sun aan la aqbali karin ama ku saleysan go'aanka baaraha. Bukaannada caafimaad ahaan deggan ee leh horumarka shucaaca ayaa sii wadi kara daaweynta illaa horumarka laga xaqiijinayo sawirka soo socda. Horumarka Burooyinka waxaa laqiimeyn jiray 9-kii asbuucba sanadka ugu horeeya, iyo 12-kii usbuucba kadib.
Kuwa ugu caansan (≥10% ee bukaanada) waxay soo sheegeen dhacdooyin xun (AEs) dhammaan heerarka oo dhan waxaa kamid ahaa daal (43%), xanuun (22%), qandho (19%), barar durugsan (15%), iyo muruq xanuun (27 %)), Shuban / colitis (23%), calool xanuun (22%), lallabo (19%), matag (19%), calool istaag (14%), rabitaanka cuntada oo yaraaday (21%), dhiigbax (19%), UTI (18%), infekshin (16%), finan (17%), hypothyroidism (11%), madax xanuun (11%) iyo dyspnea (10%).
Fasalka ugu badan ee 3/4 AEs waxaa ka mid ah UTI (6%), dhiigbax (5%), muruq xanuun (5%), daal (5%), infekshin (4.1%), calool xanuun (3.1%), xanuun (2 )%), Barar durugsan (2%), finan (2%), madax xanuun (2%), shuban / colitis (2%), matag (1%), dyspnea (1%) iyo qandho (1%).
Joojinta daaweynta ee la xiriirta AE waxay ka dhacday 8% bukaannada. AEs daran ayaa ku dhacay 39% bukaanada, kuwa ugu badan ayaa ah dhiig yaraan (7%), fistula (4.1%), dhiigbax (4.1%), iyo infekshin (marka laga reebo UTI; 4.1%).
Oggolaanshaha difaaca jirka ee buro-haweenka ayaa shaki la'aan ku dari doona hal caws oo nafo lagu badbaadinayo, hal doorasho daaweyn oo kale, iyo hal rajo oo dheeraad ah oo loogu talagalay badbaadada bukaanada u adkaysta daaweynta kemotherabi, daawaynta hoormoonka, iyo daaweynta la beegsaday. Inta kor ku xusan, waxaan aragnaa in tallaalka difaaca jirka ee buro-haweenku aanu ku habboonayn dhammaan bukaannada. Daaweynta ka hor, laba calaamadood oo burooyinka waa in la tijaabiyaa: mid waa MSI kan kalena waa PD-L1. Bukaannada buuxiya heerarka ayaa aad ugu habboon.
Inkasta oo pembrolizumab horeba loogu suuq geeyey Shiinaha, bukaannada qaar ayaa laga yaabaa inay dareemaan in qiimaha dawadani tahay mid qaali ah. Haddii aad rabto inaad badbaadiso kharashka baaritaanka hidda-socodka, si indho la'aan ah u tijaabi pembrolizumab. Habkani sidoo kale ma xuma, laakiin badanaa waa haddii aan tan lagu talin, daawaynta pembrolizumab lafteedu waxay keeni doontaa qaar ka mid ah waxyeelooyinka waxaana laga yaabaa inay saameyn xun ku yeelato daaweynta bukaanka.
Haddii dheefta aan la damaanad qaadi karin, way ka miisaan badnaan kartaa oo waxay saameyn ku yeelan doontaa xaaladda.
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”.
Dabcan, imtixaanka indho la'aanta sidoo kale wuxuu leeyahay cillado u gaar ah. Ka hor inta aan la helin baaritaanka hidda-socodka, daawadu waxay asal ahaan ku xiran tahay "male-awaalka", saameyntuna waxay asal ahaan ku tiirsan tahay "ducada".
