Izidakamizwa zomdlavuza wesisu ngo-2020

Umdlavuza wesisu uyakhula

Umdlavuza we-gastric uhlala ungomunye womdlavuza ojwayelekile futhi obulalayo emhlabeni wonke, ikakhulukazi kwabesilisa asebekhulile. Ngokuya ngemininingwane ye-GLOBOCAN 2018, umdlavuza wesisu yi-5^th I-neoplasm ejwayelekile kakhulu ne-3^rd umdlavuza obulala kakhulu, nokufa okulinganiselwa ku-783,000 ngonyaka we-2018. Izifo zomdlavuza wesisu nokufa kwehluka kakhulu esifundeni futhi kuncike kakhulu ekudleni futhi Helicobacter pylori ukutheleleka. Ngenkathi ungena ekuvikeleni nasekwelapheni H. pylori ukutheleleka kunciphise izehlakalo zomdlavuza wesisu, futhi kube nomthelela ekwandeni kwesifo somdlavuza we-cardia esiswini, uhlobo oluncane lwe-neoplasm olukhule kasikhombisa emashumini eminyaka adlule. Ukuqondwa okungcono kwe-etiology kanye nezici zobungozi zalesi sifo kungasiza ukufinyelela ekuvumelaneni ekusondeleni H. pylori ukutheleleka. Ukushintsha ukudla, ukuyeka ukubhema, nokuzivocavoca kunesithembiso ekuvimbeleni umdlavuza wesisu, kuyilapho ukuhlolwa kofuzo kunika amandla ukuxilonga ngaphambi kwesikhathi futhi ngaleyo ndlela ukusinda okukhulu.

Kunemishanguzo emisha yomdlavuza wesisu ngo-2020. Kunezigameko eziphezulu zomdlavuza wesisu emhlabeni nokukhula kwawo minyaka yonke. Izinga lokutholwa kweziguli ezinomdlavuza wokuqala esiswini lingama-5% -10% kuphela. Iziguli eziningi zitholakala zisesigabeni esiphakathi noma sekwephuzile ngoba isigaba sokuqala somdlavuza wesisu asisona isibonakaliso esisobala.

Nokho, umdlavuza wesisu awusona isifo esingelapheki. Ngokuthuthuka okusheshayo kokwelashwa okuhlosiwe kanye ne-immunotherapy, iziguli ezinomdlavuza wesisu ezifuna ukuzuza ukusinda isikhathi eside akuseyona inkinga. Ngaphezu kokuhlinzwa kanye ne-radiotherapy, ukwelashwa kwezidakamizwa kuhlanganisa i-chemotherapy, ukwelashwa okuhlosiwe, kanye ne-immunotherapy.

Izidakamizwa zeChemotherapy zomdlavuza wesisu

I-Chemotherapy ingasetshenziselwa ukwelapha umdlavuza wesisu ngezindlela ezahlukene:

Izidakamizwa eziningi ze-chemotherapy zingasetshenziswa ukwelapha umdlavuza wesisu, kufaka phakathi:

I-5-FU (i-fluorouracil) ivame ukuhlanganiswa ne-formyltetrahydrofolate (folate)

I-6-Capecitabine (Xeloda®)

I-Carboplatin

Cisplatin

I-Docetaxel (Tassodi®)

I-Epirubicin (Ellence ®)

I-Irinotecan (Capto®)

I-Oxaliplatin (Losadine®)

I-Paclitaxel (Taxol®)

Imithi yokwelapha umdlavuza wesisu imvamisa inikezwa ngenhlanganisela yezidakamizwa, okuhlanganisa:

I-ECF (epirubicin, cisplatin ne-5-FU) inganikezwa ngaphambi kokuhlinzwa nangemva kokuhlinzwa

I-Docetaxel noma i-paclitaxel kanye ne-5-FU noma i-capecitabine, kuhlanganiswe ne-radiotherapy njengokwelashwa kwangaphambi kokusebenza

I-Cisplatin kanye ne-5-FU noma i-capecitabine, kuhlanganiswe ne-radiotherapy njengokwelashwa kwangaphambi kokusebenza

I-Paclitaxel ne-carboplatin kuhlanganiswe i-radiotherapy njengokwelashwa ngaphambi kokuhlinzwa

Izidakamizwa ezibhekiswe kumdlavuza wesisu

HER2

Cishe u-20% weziguli uveza amaprotheni e-HER2 akhuthaza ukukhula komdlavuza, futhi ama-inhibitors aqondise i-Her 2 protein ivimbela ukukhula kwe-epidermal factor ukuthi inamathele ku-Her2 ngokuzinamathisela ku-Her2, ngaleyo ndlela ivimbe ukukhula kwamangqamuzana omdlavuza. Ingelashwa njengomuthi owodwa, noma ihlanganiswe nemithi embalwa eqondiswe elwa ne-HER2, noma ihlanganiswe nemithi yokwelapha ngamakhemikhali.

I-Trastuzumab (trastuzumab, Herceptin)

I-Trastuzumab (i-Herceptin) i-anti-monoclonal antibody yomuntu ehlose iphrotheni ye-HER2. I-Chemotherapy ene-trastuzumab ingasiza iziguli ezinomdlavuza ophakeme we-HER2-gastric zibe nempilo ende ukwedlula i-chemotherapy iyodwa.

I-Ontruzant (trastuzumab-dttb)

NgoJanuwari 18, 2019, i-FDA yase-US igunyaze i-Samsung Bioepis 'Ontruzant (trastuzumab-dttb), i-biosimilar ye-trastuzumab (trastuzumab) yokwelapha umdlavuza webele we-HER2 Positive kanye nomdlavuza wesisu ogqame kakhulu we-HER2.

Ithiphu: Ngaphambi kokusebenzisa lesi sidakamizwa, sicela uhlele ukuhlolwa ukuze unqume ukubonakaliswa kweprotheni ye-HER2. Ungashayela ku-400-626-9916 ukubonisana ngokuhlolwa kofuzo.

I-VEGFR

Njengoba umzimba ukhula futhi ukhula, wenza imithambo yegazi emisha inikeze igazi kuwo wonke amaseli, inqubo ebizwa nge-angiogenesis. Lapho imithambo yegazi emisha ihlinzeka ngomoya-mpilo nezakhi zomzimba kumaseli omdlavuza, asiza ukukhula nokusabalala kwamangqamuzana omdlavuza.

Ama-angiogenesis inhibitors asiza ukuvimbela noma anciphise ukukhula noma ukusabalala kwezimila ngokuvimbela izicubu ekwenzeni imithambo yegazi emisha, okwenza ukuthi izimila zife noma ziyeke ukukhula ngoba azikwazi ukuthola i-oxygen nezakhamzimba ezizidingayo. Ama-inhibitors asebenza ngokuvimba ama-vascular endothelial growth factor (VEGF) receptors kumaseli womdlavuza.

I-Ramucirumab (Remolucumab, Cyramza®)

I-Ramucirumab i-anti-monoclonal antibody ebophezela kwi-VEGF receptor futhi ingasiza ekunciphiseni noma ekunqandeni ukukhula nokusabalala komdlavuza. Ngo-2014, lesi sidakamizwa savunyelwa ukwelashwa komdlavuza wesisu kanye nomdlavuza we-gastroesophageal junction, kepha okwamanje awutholakali eChina.

I-immunotherapy yomdlavuza wesisu

I-Immunotherapy ihlose ukuthuthukisa amandla emvelo amasosha omzimba okulwa nomdlavuza. I-Immunotherapy ayiqondisi ngqo kumaseli omdlavuza emzimbeni womuntu, kepha iqeqesha amasosha omzimba omuntu womuntu ukuthi abone amangqamuzana omdlavuza futhi awakhe bese ewabulala.

I-Pembrolizumab (Pembrolizumab, Keytruda)

I-FDA igunyaza i-pembrolizumab ezigulini ezinomdlavuza wesisu othuthukile ezithole okungenani ukwelashwa oku-2 (okuhlanganisa nokwelashwa ngamakhemikhali) ukuze zelashwe iziguli ezine-adenocarcinoma yesimila esithuthukile endaweni noma esine-metastatic noma i-gastroesophageal (GEJ) i-adenocarcinoma, ene-tumor expression PD-L1 [Comprehensive Positive Score (CPS) ≥1], kunqunywa ukuhlolwa okugunyazwe i-FDA. Ithuthuke ngemva kwemigqa emibili noma ngaphezulu ye-chemotherapy ehlanganisa i-fluoropyrimidine ne-platinum, noma i-HER2 / neu yokwelapha okuhlosiwe. Ngaphezu kwalokho, imiphumela yokuhlolwa kofuzo ye-MSI-H iyasebenza nasezigulini ezinomdlavuza wesisu.