Oko Kufuneka Ukwazi Ngokuphumelela kwi-Immunotherapy Impumelelo yeeRelanoma

Umxholo

• Ushwankathelo
• Iindidi zonyango lwe-immunotherapy
• Inhibitors zokujonga
• Unyango lweCytokine
• Unyango lwe-Oncolytic virus
• Amanqanaba okuphumelela kwe-immunotherapy
• Ipilimumab (Yervoy)
• IPembrolizumab (Keytruda)
• INivolumab (Opdivo)
• INivolumab + ipilimumab (Opdivo + Yervoy)
• IiCytokines
• Talimogene laherparepvec (Imlygic)
• Iziphumo ebezingalindelekanga ze-immunotherapy
• Iindleko zonyango lwe-immunotherapy
• Uvavanyo lwezonyango
• Utshintsho kwindlela yokuphila
• Imbonakalo

Ushwankathelo

Ukuba unomdlavuza wesikhumba se-melanoma, ugqirha wakho unokuncoma i-immunotherapy. Olu hlobo lonyango lunokunceda ukukhulisa impendulo yomzimba wakho ngokuchasene nomhlaza.

Zininzi iintlobo zamachiza e-immunotherapy akhoyo kunyango lwe-melanoma. Kwiimeko ezininzi, la machiza amiselwe abantu abanesigaba 3 okanye isigaba 4 se-melanoma. Kodwa kwezinye iimeko, ugqirha wakho unokumisela i-immunotherapy ukunyanga i-melanoma engaphantsi.

Funda ukuze ufunde kabanzi malunga nendima enokudlalwa yi-immunotherapy kunyango lwesi sifo.

Iindidi zonyango lwe-immunotherapy

Ukuqonda amazinga okuphumelela kwe-immunotherapy, kubalulekile ukwahlula phakathi kweentlobo ezahlukeneyo ezikhoyo. Kukho amaqela amathathu aphambili e-immunotherapy asetyenziselwa ukunyanga i-melanoma:

• inhibitors zokutshekisha
• unyango lwe-cytokine
• Unyango lwe-oncolytic yonyango

Inhibitors zokujonga

I-Checkpoint inhibitors iziyobisi ezinokukunceda ukuba amajoni akho omzimba aqonde kwaye abulale iiseli zomhlaza wolusu lwe-melanoma.

Ulawulo lwezoKutya kunye noLawulo lweziyobisi (i-FDA) luvumile iintlobo ezintathu ze-inhibitors zokujonga unyango lwe-melanoma:

• ipilimumab (Yervoy), ethintela iprotein yokujonga i-CTL4-A
• pembrolizumab (Keytruda), ethintela iproteni yokujonga PD-1
• i-nivolumab (Opdivo), ekwa thintela iPD-1

Ugqirha wakho unokumisela inhibitors enye okanye ezingaphezulu ukuba unenqanaba lesithathu okanye inqanaba lesine le-melanoma elingenakususwa ngotyando. Kwezinye iimeko, banokumisela ii-inhibitors zokujonga ngokudibana notyando.

Unyango lweCytokine

Unyango ngee-cytokines lunokunceda ukukhulisa amajoni akho omzimba kunye nokomeleza impendulo yawo kumhlaza.

I-FDA ivume iintlobo ezintathu zecytokines kunyango lwe-melanoma:

• I-interferon alfa-2b (Intron A)
• I-interferon ye-alfa-2b (iSylatron)
• I-interleukin-2 (aldesleukin, Proleukin)

I-Interferon alfa-2b okanye i-peferlated interferon alfa-2b imiselwe ngokubanzi emva kokuba i-melanoma isuswe ngotyando. Oku kwaziwa njengonyango oluncedisayo. Inokukunceda ukunciphisa amathuba okubuya komhlaza.

Iproleukin ihlala isetyenziselwa ukunyanga inqanaba lesi-3 okanye inqanaba lesi-4 le-melanoma ethe yasasazeka.

Unyango lwe-Oncolytic virus

Iintsholongwane ze-Oncolytic ziintsholongwane eziguqulweyo ukuze zisulele kwaye zibulale iiseli zomhlaza. Banokubangela ukuba amajoni akho omzimba ahlasele iiseli zomhlaza emzimbeni wakho.

I-Talimogene laherparepvec (Imlygic) yintsholongwane ye-oncolytic evunyiweyo ukunyanga i-melanoma. Kukwaziwa nangokuthi yi-T-VEC.

I-Imlygic iqhele ukumiselwa ngaphambi kotyando. Oku kwaziwa ngokuba lonyango lwe-neoadjuvant.

Amanqanaba okuphumelela kwe-immunotherapy

I-Immunotherapy inokunceda ukwandisa ubomi kwabanye abantu abanesigaba 3 okanye isigaba 4 se-melanoma- kubandakanya nabanye abantu abane-melanoma engenakususwa ngotyando.

Xa i-melanoma ingenakususwa ngotyando, yaziwa njenge-melanoma engenakuphikwa.

Ipilimumab (Yervoy)

Kuphononongo olwapapashwa ngo-2015, abaphandi bahlanganisa iziphumo zezifundo ezili-12 ezidlulileyo kwi-checkpoint inhibitor Yervoy. Bafumanise ukuba kubantu abanesigaba esingafumanekiyo se-3 okanye isigaba se-4 se-melanoma, iipesenti ezingama-22 zezo zigulana ezafumana i-Yervoy zazisaphila kwiminyaka emi-3 kamva.

Nangona kunjalo, olunye uphononongo lufumene amaqondo asezantsi empumelelo kubantu abanyangwe ngeli chiza.

Xa abaphandi abavela kwisifundo se-EURO-VOYAGE bejonga iziphumo zonyango kubantu abayi-1,043 abane-melanoma ephambili, bafumanisa ukuba iipesenti ezili-10.9 ezafumana iYervoy zihlala iminyaka emi-3 ubuncinci. Iipesenti ezisibhozo zabantu abafumene eli chiza basinda kangangeminyaka emi-4 okanye nangaphezulu.

IPembrolizumab (Keytruda)

Uphando lubonisa ukuba unyango nge-Keytruda kuphela lunokunceda abanye abantu kunonyango lwe-Yervoy kuphela.

Kwi, izazinzulu zithelekisa ezi zonyango kubantu abanesigaba esingathandekiyo se-3 okanye isigaba se-4 se-melanoma. Bafumanise ukuba iipesenti ezingama-55 zabo bafumana uKtrtruda basinda ubuncinci iminyaka emi-2. Xa kuthelekiswa, iipesenti ezingama-43 zabo baphathwa nge-Yervoy basinda iminyaka emi-2 okanye nangaphezulu.

Ababhali bophando lwamva nje baqikelele ukuba i-5 yeminyaka yokuphila kwinqanaba labantu abane-melanoma eqhubekileyo abaphathwa nge-Keytruda babengama-34 eepesenti. Bafumanise ukuba abantu abafumene eli chiza baphila umndilili ophakathi kangangeminyaka emibini.

INivolumab (Opdivo)

Izifundo ziye zafumanisa ukuba unyango nge-Opdivo kuphela lunokunyusa amathuba okusinda ngaphezulu konyango ngeYervoy yodwa.

Xa abaphandi beqhathanisa olu nyango kubantu abanesigaba esingathandekiyo se-3 okanye inqanaba lesi-4 le-melanoma, bafumanisa ukuba abantu abanyangwe nge-Opdivo bodwa basinda kwi-avareji yeminyaka emi-3. Abantu abaphathwe nge-Yervoy bodwa basinda kumndilili ophakathi weenyanga ezingama-20.

Isifundo esifanayo safumanisa ukuba i-4 yeminyaka yokuphila iyonke yayiyiipesenti ezingama-46 kubantu ababephathwa nge-Opdivo kuphela, xa kuthelekiswa neepesenti ezingama-30 kubantu abaphathwa ngeYervoy bodwa.

INivolumab + ipilimumab (Opdivo + Yervoy)

Ezinye zeziphumo zonyango ezithembisayo kubantu abane-melanoma engenakulinganiswa ziye zafunyanwa kwizigulane eziphathwe ngokudibanisa i-Opdivo ne-Yervoy.

Kwisifundo esincinci esapapashwa kwiJenali ye-Clinical Oncology, izazinzulu zixele iminyaka emi-3 yokuphakama kwenqanaba lokusinda kweepesenti ezingama-63 phakathi kwezigulana ezingama-94 eziphathwe ngale nhlanganisela yeziyobisi. Zonke izigulana zazinenqanaba 3 okanye inqanaba 4 le-melanoma elingenakususwa ngotyando.

Nangona abaphandi benxibelelanise olu nyango lwamayeza ekuphuculeni amazinga okusinda, bakufumanisile ukuba kubangela iziphumo ebezingalindelekanga ezibi rhoqo kunamayeza wodwa.

Izifundo ezikhulu kolu dibaniso lonyango ziyafuneka.

IiCytokines

Kubantu abaninzi abane-melanoma, izibonelelo zonyango ezinokubakho nge-cytokine therapy zibonakala zincinci kunezo zithatha indawo yokujonga inhibitors. Nangona kunjalo, ezinye izigulana ezingaphenduli kakuhle kwezinye iindlela zonyango zinokuxhamla kunyango lwe-cytokine.

Ngo-2010, abaphandi bapapasha ukuphononongwa kwezifundo kwi-interferon alfa-2b kunyango lwenqanaba 2 okanye kwinqanaba 3 le-melanoma. Ababhali bafumanise ukuba abaguli abafumana idosi eziphezulu ze-interferon alfa-2b emva kotyando babenamazinga okusinda asimahla kwezifo, xa kuthelekiswa nalawo angafumananga olu nyango. Baye bafumanisa ukuba abaguli abafumene i-interferon alfa-2b emva kotyando babenamazinga okusinda abhetele kancinci.

Uphando olwenziwe nge-peferlated interferon alfa-2b lufumanise ukuba kolunye uphononongo, abantu abanesigaba sesi-2 okanye isigaba sesi-3 se-melanoma abafumene eli yeza emva kotyando babenamazinga aphezulu okusinda angaphindanga. Nangona kunjalo, ababhali bafumene ubungqina obuncinci bokuphuculwa kwamanqanaba okusinda.

Ngokolunye uphononongo, uphando lufumanise ukuba i-melanoma ayibonakali emva konyango ngeedosi eziphezulu ze-interleukin-2 kwipesenti ezi-4 ukuya kwezi-9 zabantu abane-melanoma engabonakaliyo. Kwenye i-7 ukuya kwi-13 leepesenti yabantu, iidosi eziphezulu ze-interleukin-2 ziye zaboniswa zinciphisa amathumba e-melanoma angenakulinganiswa.

Talimogene laherparepvec (Imlygic)

Uphando olwenziweyo kwinkomfa ye-2019 YaseYurophu ye-Oncology yezoNyango iphakamisa ukuba ukusebenzisa i-Imlygic ngaphambi kokuba kususwe imelanoma kunokunceda ezinye izigulana ziphile ixesha elide.

Olu pho nonongo lufumene ukuba phakathi kwabantu abane-advanced melanoma abaye baphathwa ngokuhlinzwa kuphela, iipesenti ezingama-77.4 basinda ubuncinane iminyaka emi-2. Phakathi kwabo baphathwa ngokudityaniswa kotyando kunye ne-Imlygic, iipesenti ezingama-88.9 zasinda ubuncinci iminyaka emibini.

Olunye uphando luyafuneka kwiziphumo ezinokubakho zolu nyango.

Iziphumo ebezingalindelekanga ze-immunotherapy

I-Immunotherapy inokubangela iziphumo ebezingalindelekanga, ezohluka ngokuxhomekeka kuhlobo oluthile kunye nedosi ye-immunotherapy oyifumanayo.

Umzekelo, iziphumo ebezingalindelekanga ezinokubakho zibandakanya:

• ukudinwa
• ifiva
• Ukugodola
• isicaphucaphu
• ukugabha
• urhudo
• irhashalala

Ezi zezinye zeziphumo ebezingalindelekanga ezinokubangelwa yi-immunotherapy. Ukuze ufunde okungakumbi malunga neziphumo ebezingalindelekanga zonyango oluthile, thetha nogqirha wakho.

Iziphumo ebezingalindelekanga ze-immunotherapy zihlala zimnene, kodwa kwezinye iimeko zinokuba nzulu.

Ukuba ucinga ukuba unokufumana iziphumo ebezingalindelekanga, yazisa ugqirha wakho kwangoko.

Iindleko zonyango lwe-immunotherapy

Iindleko eziphuma epokothweni ze-immunotherapy ziyahluka, kuxhomekeka kwinxalenye enkulu kwi:

• uhlobo kunye nedosi ye-immunotherapy oyifumanayo
• nokuba unayo okanye awunayo i-inshurensi yezempilo yonyango
• nokuba ungafaneleka na kwiinkqubo zoncedo lwesigulana kunyango
• ingaba uyalufumana na unyango njengenxalenye yolingo lwezonyango

Ukuze ufunde okungakumbi malunga nexabiso lesicwangciso sakho sonyango olucetyiswayo, thetha nogqirha wakho, usokhemesti kunye nomboneleli weinshurensi.

Ukuba ukufumanisa kunzima ukufumana iindleko zokhathalelo, yazisa iqela lakho lonyango.

Banokucebisa utshintsho kwisicwangciso sakho sonyango. Okanye banokwazi ngenkqubo yoncedo enokukunceda ekuhlawuleni iindleko zokhathalelo lwakho. Ngamanye amaxesha, banokukukhuthaza ukuba ubhalise kuvavanyo lweklinikhi oluya kukuvumela ukuba ufikelele kwichiza simahla ngelixa uthatha inxaxheba kuphando.

Uvavanyo lwezonyango

Ukongeza kunyango lwe-immunotherapy oluvunyiweyo kunyango lwe-melanoma, oososayensi ngoku bafunda ezinye iindlela zovavanyo lwe-immunotherapy.

Abanye abaphandi baphuhlisa kwaye bavavanya iintlobo ezintsha zamachiza e-immunotherapy. Abanye bafunda ngokhuseleko kunye nokusebenza ngokudibanisa iintlobo ezininzi ze-immunotherapy. Abanye abaphandi bazama ukuchonga iindlela zokufunda ukuba zeziphi na izigulana ezinokuthi zixhamle kunyango olo.

Ukuba ugqirha wakho ucinga ukuba ungazuza ngokufumana unyango okanye ukuthatha inxaxheba kuphando olwenziwe kwi-immunotherapy, banokukukhuthaza ukuba ubhalise kuvavanyo lweklinikhi.

Ngaphambi kokuba ubhalise kulo naluphi na uvavanyo, qiniseka ukuba uyaziqonda izibonelelo ezinokubakho kunye nomngcipheko.

Utshintsho kwindlela yokuphila

Ukukunceda ukuxhasa impilo yakho ngokwasemzimbeni nangokwengqondo ngelixa usiya kwi-immunotherapy okanye olunye unyango lomhlaza, ugqirha wakho unokukukhuthaza ukuba wenze utshintsho kwindlela ophila ngayo.

Umzekelo, banokukukhuthaza ukuba:

• lungisa imikhwa yakho yokulala ukuze ufumane ukuphumla okungakumbi
• lungisa indlela otya ngayo ukuze ufumane izakhamzimba okanye iikhalori ezingakumbi
• tshintsha imikhwa yakho yokuzilolonga ukuze ufumane umsebenzi owaneleyo, ngaphandle kokurhafisa umzimba wakho kakhulu
• Hlamba izandla zakho kwaye unciphise ukubekeka kwakho kubantu abagulayo ukunciphisa umngcipheko wosulelo
• phuhlisa ulawulo loxinzelelo kunye neendlela zokuphumla

Ngamanye amaxesha, ukuhlengahlengisa imikhwa yakho yemihla ngemihla kunokukunceda ujongane neziphumo zonyango. Umzekelo, ukuphumla ngakumbi kunokukunceda ukulawula ukudinwa. Ukwenza utshintsho kwindlela otya ngayo kunokukunceda ukulawula isicaphucaphu okanye ukulahleka kwesidlo.

Ukuba ufuna uncedo lokuhlengahlengisa indlela ophila ngayo okanye ulawule iziphumo ebezingalindelekanga zonyango, ugqirha wakho unokukuthumela kwingcali ukuze ufumane inkxaso. Umzekelo, ingcali yokutya inokukunceda uhlengahlengise indlela otya ngayo.

Imbonakalo

Umbono wakho ngomhlaza we-melanoma uxhomekeke kwizinto ezininzi, kubandakanya:

• impilo yakho iyonke
• Inqanaba lomhlaza onalo
• ubungakanani, inani, kunye nendawo yamathumba emzimbeni wakho
• uhlobo lonyango olufumanayo
• umzimba wakho uphendula njani kunyango

Ugqirha wakho unokukunceda ufunde ngakumbi malunga nemeko yakho kunye nembono yexesha elide. Banokukunceda uqonde ukhetho lwakho lonyango, kubandakanya iimpembelelo zonyango ezinokuba nazo kubude kunye nomgangatho wobomi bakho.