So'nggi yillarda ginekologik o'smalar bilan kasallanish yil sayin ortib bormoqda, bu esa bachadon bo'yni saratoni va tuxumdon saratoni atamalarini biz uchun begona emas. Bachadon bo'yni saratoni eng keng tarqalgan ginekologik xavfli o'sma hisoblanadi. Bundan tashqari, bu tuxumdon saratoni va endometrium saratoni bilan birga uchta asosiy ginekologik malign o'smadir. Ginekologik shishlar ayollar uchun zararli. Erta aniqlash va erta tashxis ko'pincha davolanishga yordam beradi va bemorlarning omon qolish vaqtini yaxshilaydi.
The rapid progress of targeted therapy and immunotherapy has greatly improved the condition of gynecological cancer patients. The editor will take a look at the approved gynecological tumor targeted therapy drugs and immunotherapy drugs for you.
Ginekologik saratonni davolash
Tuxumdon saratoniga qaratilgan terapiya
① Bevasizumab
②PARP inhibitori
Olaparib (Olapani, Lynparza), rukaparib (Rucapa, Rubraca) va niraparib (Nilapani, Zejula)
Bachadon bo'yni saratoni uchun mo'ljallangan terapiya preparatlari
Bevacizumab (Bevacizumab, Avastin)
Endometriyal saratonni davolash
Saratonga qarshi kurashish uchun gormonlar yoki gormonlarni blokirovka qiluvchi dorilarni qo'llang. Davolash dorilariga quyidagilar kiradi:
Ø Progesteron: medroksiprogesteron asetat va megestrol asetat
Ø Tamoksifen
Ø Luteinlashtiruvchi gormonlarni chiqaruvchi gormon agonistlari: Goserelin (Norred®) va Leuprolide (Leuprolide®). Ushbu dorilar 1-3 oyda bir marta AOK qilinadi
Ø Aromataza inhibitörleri: letrozol (Fronon®), anastrozol (Reninide®), eksemestan (Anoxin®)
Bachadon sarkomasi uchun mo'ljallangan terapiya
Ø Panzopinab (Votrient) - davolashdan so'ng tarqalgan yoki qayt qilgan leyomiyosarkomani davolash uchun ishlatilishi mumkin bo'lgan maqsadli terapiya.
Ø Olaratumab (Lartruvo) combined with the chemotherapy drug doxorubicin to treat soft tissue sarcoma. It can be used to treat uterine sarcoma that does not respond to other treatments.
Ginekologik o'smaning immunoterapiyasi
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, Hodgkin’s lymphoma 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) targets PD-1, which is a protein on T cells and usually helps prevent these cells from attacking other cells in the body. By blocking PD-1, these drugs can enhance the immune response to cancer cells, causing some tumors to shrink or slow their growth.
MSI-H ginekologik onkologiya
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, colorectal cancer, 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 ijobiy bachadon bo'yni saratoni
Joriy yilning iyun oyida AQShning FDA kasalligi kimyoviy terapiya paytida yoki undan keyin rivojlangan PD-L1-pozitiv serviks saraton kasalligini davolash uchun pembrolizumabni (Keytruda) tasdiqlashni tezlashtirdi. Tasdiqlash PD-L1-ni muskullar saratoni sifatida ijobiy FDA tomonidan tasdiqlangan test natijalaridan o'tgan qo'shma musbat ball (CPS) -1 bilan belgilaydi. Shuni eslatib o'tish joizki, hozirgi kundan boshlab Keytruda ham rivojlangan bachadon bo'yni saratoni uchun birinchi va yagona tasdiqlangan anti-PD-1 terapiyasidir.
Immunoterapiya preparati har 3 haftada yuboriladi va tomir ichiga (IV) infuziya bilan yuboriladi. Ayni paytda u Xitoyda ro'yxatga olingan va tibbiy sug'urtaga kiritilgan. Uy ichidagi bemorlar maslahat olish uchun mahalliy kasalxonaga murojaat qilishlari yoki bachadon bo'yni saratonini pembrolizumab davolash bo'yicha batafsil ma'lumot olish uchun Global Onkologlar Tarmog'iga (400-626-9916) qo'ng'iroq qilishlari mumkin.
Tasdiqlash II bosqich KEYNOTE-98 sinovida bachadon bo'yni relapsli yoki metastatik saraton kasalligiga chalingan 158 bemor ma'lumotlariga asoslangan. Ushbu global, ochiq, tasodifiy bo'lmagan, ko'p va ko'p markazli tadqiqot pembrolizumabni bir necha turdagi rivojlangan qattiq o'smalari bo'lgan bemorlarni davolashda baholadi va ushbu bemorlar standart davolash protokollari bo'yicha muvaffaqiyatlarga erishdilar.
O'rtacha kuzatuv vaqti 11.7 oyni tashkil etdi (0.6-22.7 oralig'i). 77 PD-L1 musbat bemorlarining (CPS ≥ 1) umumiy samarali darajasi (ORR) 14.3% ni tashkil etdi. Ushbu bemorlarning barchasi metastatik kasallikka chalingan bemorlar bo'lib, ular x1 terapiya liniyasini olganlar. ORR to'liq javob darajasi 2.6% va qisman javob darajasi 11.7% ni tashkil qiladi. O'rtacha javob davomiyligiga erishilmadi (4.1 oydan 18.6 + oygacha) va respondentlarning 91 foizida 6 oy yoki undan ko'proq vaqt davom etgan.
PD-L1 ekspresiyasi CPS <1 bo'lgan bemorlar uchun javob berilmagan.
"Ginekologik saraton kasalligida ko'plab yutuqlarga erishilgan bo'lsa-da, ilgari davolangan bachadon bo'yni saratoni bilan og'rigan bemorlar hali ham yangi davolash usullariga ega emaslar", deydi Bredli Monk, Arizona onkologi, Amerika Ginekologiya tadqiqotlari onkologiya dasturining tibbiy direktori va akusherlik va ginekologiya professori. Bayonotda,
"Keytrudaning ushbu ko'rsatkichni ma'qullashi onkolog sifatida muhim yangilik bo'lib, ushbu bemorlar uchun juda kerakli tanlovni ko'rish juda hayajonli", - deya qo'shimcha qildi Monk.
Davolashga javob bergan 77 bemorning gistologik tasnifi: 92% skuamoz hujayrali karsinoma, 6% adenokarsinoma va 1% adenoskuamoz karsinoma. Bemorlarning 95 foizida metastazlar, 20 foizida esa qaytalanish kuzatiladi. PD-L1 holatini aniqlash uchun PD-L22 IHC 3C1 pharmDx to'plami ishlatilgan.
Bemorlarga 200 haftagacha har 3 haftada 24 mg pembrolizumab qabul qilingan yoki o'z-o'zidan davolanishdan voz kechgan yoki kasallikning avj olganligini yoki qabul qilinmaydigan toksikligini radiologik tasdiqlagan yoki tergovchining qarori asosida. Radiologik progresiyaga ega klinik jihatdan barqaror bemorlar davolanishni keyingi ko'rish orqali tasdiqlangunga qadar davom ettirishlari mumkin. Shish o'sishi birinchi yilda har 9 haftada va undan keyin har 12 haftada baholandi.
Eng tez-tez uchraydigan (bemorlarning )10%) barcha darajadagi nojo'ya hodisalarni (AE) charchoq (43%), og'riq (22%), isitma (19%), periferik shish (15%) va mushak-skeletlari topildi og'riq (27). %)), Diareya / kolit (23%), qorin og'rig'i (22%), ko'ngil aynish (19%), qusish (19%), ich qotish (14%), ishtahaning pasayishi (21%), qon ketish (19%), UTI (18%), infektsiya (16%), toshma (17%), gipotireoz (11%), bosh og'rig'i (11%) va nafas qisilishi (10%).
Eng keng tarqalgan 3/4 AE darajalariga UTI (6%), qon ketish (5%), mushak-skelet tizimidagi og'riqlar (5%), charchoq (5%), infektsiya (4.1%), qorin og'rig'i (3.1%), og'riq (2) kiradi. )), Periferik shish (2%), toshma (2%), bosh og'rig'i (2%), diareya / kolit (2%), qusish (1%), nafas qisilishi (1%) va isitma (1%)).
AE bilan bog'liq davolanishni to'xtatish bemorlarning 8 foizida sodir bo'lgan. Kuchli AE kasalligi bemorlarning 39 foizida ro'y berdi, eng ko'p tarqalgani kamqonlik (7%), fistula (4.1%), qon ketish (4.1%) va infektsiya (UTIdan tashqari; 4.1%).
The approval of gynecological tumor immunotherapy will undoubtedly add one life-saving straw, one more treatment option, and one more hope for survival for patients who are resistant to chemotherapy, hormone therapy, and targeted therapy. From the above, we see that gynecological tumor immunotherapy is not suitable for all patients. Before treatment, two tumor markers must be tested: one is MSI and the other is PD-L1. Patients who meet the standards are more suitable.
Although pembrolizumab is already marketed in China, some patients may feel that the price of this drug is relatively expensive. If you want to save the cost of genetic testing, blindly test pembrolizumab. This method is also not bad, but it is usually If this is not recommended, pembrolizumab treatment itself will cause some side effects and may have some negative effects on the patient’s treatment.
Agar imtiyozni kafolatlash imkoni bo'lmasa, u og'irroq bo'lishi va vaziyatga ta'sir qilishi mumkin.
Omon qolish muddati optimistik bo'lmagan saraton kasalligiga chalingan do'stlar uchun shifokorning taxminiy bahosi 6 oydan kam bo'lishi mumkin va iqtisodiy sharoitlar yaxshi emas. Bunday holatda, agar siz noaniq natijani kutish uchun yarim oy vaqt sarflasangiz, bu juda xavfli bo'lib tuyuladi, shuning uchun to'g'ridan-to'g'ri ko'r-ko'rona testni o'tkazib, pichoqdagi pulni ishlatib, sinab ko'rish uchun eng ehtimolini tanlaganingiz ma'qul, odatda "Chuangyun" nomi bilan tanilgan.
Of course, the blind test also has its own shortcomings. Before there is no genetic test, the medication basically depends on “guessing”, and the effect is basically relying on “praying”.
