Into ekufuneka uyazi malunga nokuvavanywa kwemfuzo yomhlaza wemiphunga

Umxholo

• Yintoni utshintsho lwemfuza?
• Zingaphi iindidi zeNSCLC ezikhoyo?
• Yintoni ekufuneka ndiyazi malunga novavanyo lwemfuzo?
• Olu tshintsho luchaphazela njani unyango?
• I-EGFR
• I-EGFR T790M
• I-ALK / EML4-ALK
• Olunye unyango

Umhlaza wamaphaphu ongaqhelekanga (NSCLC) ligama elinikwa imeko ebangelwa kukutshintsha kwemfuza okungaphezulu kwesinye kwimiphunga. Ukuvavanywa kolu tshintsho luhlukeneyo kunokuchaphazela izigqibo zonyango kunye neziphumo.

Qhubeka nokufunda ukuze ufunde ngeentlobo ezahlukeneyo ze-NSCLC, kunye novavanyo kunye nonyango olukhoyo.

Yintoni utshintsho lwemfuza?

Ukutshintsha kwemfuza, nokuba kuzuzwe njengelifa okanye kufunyenwe, kudlala indima kuphuhliso lomhlaza. Uninzi lweenguqu ezichaphazelekayo kwi-NSCLC sele zichongiwe. Oku kuncede abaphandi ukuba baphuhlise iziyobisi ezijolise kwezinye zeenguqulelo ezithile.

Ukwazi ukuba loluphi uguquko oluqhuba umhlaza wakho lunokunika ugqirha wakho umbono wokuba uza kuziphatha njani umhlaza. Oku kunokukunceda ukufumanisa ukuba zeziphi iziyobisi ezinokuthi zisebenze. Inokuchonga iziyobisi ezinamandla ekungenakwenzeka ukuba zikuncede kunyango lwakho.

Kungenxa yoko le nto ukuvavanywa kwemfuza emva kokuchongwa kwe-NSCLC kubaluleke kakhulu. Kuyanceda ukwenza unyango lwakho lube lolwakho.

Inani lezonyango ekujoliswe kulo kwi-NSCLC liyaqhubeka nokukhula. Singalindela ukubona inkqubela phambili njengoko abaphandi bafumanisa ngakumbi malunga notshintsho oluthile olwenza ukuba i-NSCLC iqhubeke.

Zingaphi iindidi zeNSCLC ezikhoyo?

Zimbini iintlobo eziphambili zomhlaza wemiphunga: umhlaza wamangqamuzana amancinci kunye nomhlaza wamaphaphu ongaqhelekanga. Phantse iipesenti ezingama-80 ukuya kuma-85 yazo zonke i-cancer ze-lung ziyi-NSCLC, enokuthi ihlukaniswe ngakumbi kwii-subtypes:

• Adenocarcinoma
  iqala kwiiseli ezincinci ezikhupha incindi. Olu hlobo lungaphantsi luhlala lufumaneka kwi
  amalungu angaphandle emiphunga. Ihlala ixhaphakile kubafazi kunamadoda kwaye
  kubantu abancinci. Ngokuqhelekileyo ngumhlaza okhula kancinci, uwenze ube ngaphezulu
  ukufunyanwa kwinqanaba lokuqala.
• Iqela
  iiseli zemiphunga qala kwiiseli ezithe tyaba ezihamba ngaphakathi kwiindlela zomoya
  kwimiphunga yakho. Olu hlobo luza kuqala kufutshane nendlela yomoya ephambili embindini
  yemiphunga.
• Enkulu
  iiseli zemiphunga ingaqala naphi na emphefumlweni kwaye inokuba ndlongondlongo.

Iimpawu ezincinci eziqhelekileyo zibandakanya i-adenosquamous carcinoma kunye ne-sarcomatoid carcinoma.

Nje ukuba wazi ukuba loluphi uhlobo lwe-NSCLC onayo, inyathelo elilandelayo liqhele ukumisela utshintsho oluthile olunokuthi lubandakanyeke.

Yintoni ekufuneka ndiyazi malunga novavanyo lwemfuzo?

Xa wawunayo i-biopsy yakho yokuqala, ugqirha wakho wezonyango wayejonga ubukho bomhlaza. Isampuli efanayo yesicubu kwi-biopsy yakho inokusetyenziselwa ukuvavanywa kofuzo. Uvavanyo lwe-Genetic lunokujonga ikhulu lotshintsho.

Olu lolunye lolona tshintsho luqhelekileyo kwi-NSCLC:

• I-EGFR
  Utshintsho lwenzeka malunga neepesenti ezili-10 zabantu abaneNSCLC. Phantse isiqingatha sabantu abane-NSCLC abangazange batshaye
  zifunyenwe zinolu tshintsho lwemfuza.
• I-EGFR T790M
  Umahluko kwiprotein ye-EGFR.
• IKRAS
  Utshintsho lubandakanya malunga neepesenti ezingama-25 zexesha.
• I-ALK / EML4-ALK
  Uguquko lufumaneka malunga neepesenti ezintlanu zabantu abaneNSCLC. Kuhlala kunjalo
  kubandakanya abantu abancinci kunye nabangatshayiyo, okanye abatshayayo abambalwa abane-adenocarcinoma.

Ukutshintsha okuncinci kwemfuza okuhambelana neNSCLC kubandakanya:

• IBRAF
• I-HER2 (ERBB2)
• MEK
• MET
• RET
• ROS1

Olu tshintsho luchaphazela njani unyango?

Zininzi iindlela zonyango ezahlukeneyo zeNSCLC. Kuba ayizizo zonke i-NSCLC ezifanayo, unyango kufuneka luqwalaselwe ngononophelo.

Ukuvavanywa kweemolekyuli ngokweenkcukacha kunokukuxelela ukuba i-tumor yakho ineenguqu ezithile zemfuza okanye iiproteni. Unyango ekujoliswe kulo luyilelwe ukunyanga iimpawu ezithile zethumba.

Olu lolunye unyango ekujoliswe kulo lwe-NSCLC:

I-EGFR

I-EGFR inhibitors ibhloka umqondiso osuka kuhlobo lwe-EGFR olukhuthaza ukukhula. Oku kubandakanya:

• afatinib (Gilotrif)
• erlotinib (iTarceva)
• gefitinib (Iressa)

Zonke ezi ziyeza zonyango. Kwi-NSCLC ehambele phambili, la machiza anokusetyenziswa yedwa okanye ngekhemotherapy. Xa i-chemotherapy ingasebenzi, la machiza asenokusetyenziswa nokuba awunayo i-EGFR.

INecitumumab (Portrazza) yenye ye-EGFR inhibitor esetyenziselwa i-squamous cell NSCLC. Inikwa nge-intravenous (IV) infusion ngokudibanisa ne-chemotherapy.

I-EGFR T790M

I-EGFR inhibitors zinciphisa amathumba, kodwa la machiza anokuyeka ukusebenza. Xa oko kusenzeka, ugqirha wakho unoku-odola i-tumor biopsy eyongezelelweyo ukuze abone ukuba ngaba uhlobo lwe-EGFR luphuhlise olunye utshintsho olubizwa ngokuba yi-T790M.

Ngo-2017, i-US Food and Drug Administration (FDA) ukuya kwi-osimertinib (Tagrisso). Eli chiza liphatha phambili i-NSCLC ebandakanya utshintsho lwe-T790M. Iyeza lanikwa imvume ekhawulezileyo ngo-2015. Unyango lubonakalisiwe xa i-EGFR inhibitors ingasebenzi.

I-Osimertinib lunyango lomlomo oluthathwa kanye ngemini.

I-ALK / EML4-ALK

Unyango olujolise kwiprotheni engaqhelekanga ye-ALK lubandakanya:

• Intsingiselo (Alecensa)
• ibrigatinib (Alunbrig)
• isitifiketi (iZykadia)
• crizotinib (Xalkori)

La mayeza omlomo anokusetyenziswa endaweni ye-chemotherapy okanye emva kokuba ichemotherapy iyekile ukusebenza.

Olunye unyango

Olunye unyango ekujoliswe kulo lubandakanya:

• I-BRAF: dabrafenib (iTafinlar)
• I-MEK: trametinib (iMekinist)
• I-ROS1: crizotinib (Xalkori)

Okwangoku, akukho lonyango lujolise ekuguqukeni kwe-KRAS, kodwa uphando luyaqhubeka.

Amathumba kufuneka enze imithambo yegazi emitsha ukuze iqhubeke nokukhula. Ugqirha wakho unokuyalela unyango ukuba uvimbe ukukhula kweenqanawa zegazi kwi-NSCLC ephambili, enje:

• i-bevacizumab (Avastin), enokusetyenziswa kunye okanye
  ngaphandle kwekhemotherapy
• ramucirumab (Cyramza), enokudityaniswa nayo
  ichemotherapy kwaye ihlala inikwa emva kokuba olunye unyango lungasasebenzi

Olunye unyango lwe-NSCLC lunokubandakanya:

• utyando
• ichemotherapy
• imitha
• Unyango lokuthomalalisa iintlungu

Uvavanyo lwezonyango luyindlela yokuvavanya ukhuseleko kunye nokusebenza kweendlela zonyango ezingagunyaziswanga ukuba zisetyenziswe. Thetha nogqirha wakho ukuba ungathanda ukufunda ngakumbi malunga novavanyo lweklinikhi ye-NSCLC.