Ke litla-morao life tseo ngaka ea hau e tla li sheba?
Joaloka phekolo leha e le efe, ho na le sehlabelo le se senyehileng. Taba ea hore immunotherapy e se e sebelisetsoa ho ntlafatsa mokhoa oa ho tšoaroa ke mefuta e meng ea kankere joaloka kankere ea pele e seng e nyane ea kankere ea matšoafo, kankere ea melanoma, kankere ea senole ea senalone, kankere ea colon le Hodgkin's lymphoma. Ka mantsoe a mang, batho ba fuoa monyetla oa bobeli bophelong ba nako e telele le ba phutholohileng-ntho e ts'oanang e fetola sefahleho sa kankere ea kankere.
Ha e le hantle, ho ikakhela ka setotsoana ho immunotherapy ho qalile feela, 'me ena ke sebaka se thabisang le se tsotehang haholo lipatlisisong tsa kankere le tlhokomelo hona joale.
Ka hona, ha batho ba bangata ba ntse ba phekoloa ka immunotherapy, haholo-holo checkpoint inhibitors (ipilimumab, nivolumab, le pembrolizumab), lingaka li tseba mathata a ikhethang a ka hlahang ka lebaka la ho noa meriana ena e mecha.
Tlhahlobo ea Checkpoint Inhibitors
E le hore u utloisise liphello tse bohloko kapa chefo ea inhibitors ea checkpoint , ke habohlokoa ho utloisisa hore na mofuta ona oa immunotherapy o sebetsa joang.
Ka bokhutšoanyane, lisebelisuoa tsa ho itšireletsa mafung li atisa ho ba holim'a lisele tsa 'mele tsa immune (tse bitsoang lisele tsa T). Limolek'hule tsena tsa ho hlahloba li sebetsa ka mokhoa o rarahaneng oa tsela ea ho thibela lisele tsa motho tsa T hore li se ke tsa hlasela lisele tse mpe tse tsoang linaheng tse ling feela (ka mohlala, lisele tse tšoaelitsoeng ke kokoana-hloko).
Ka bomalimabe, lisele tsa kankere li thetsana ka hore li etsa le ho hlalosa limolek'hule tsa tsona tsa ho hlahloba, 'me ke kahoo' mele oa hau o sa hlasele hlahala e bohloko, joalokaha u ne u tla nahana.
Leha ho le joalo, bo-rasaense ba 'nile ba loantša ka ho theha mekhoa ea phekolo e thibelang libaka tsena tsa ho hlahloba tse nang le lisele tsa kankere ka tšepo ea hore hona joale' mele oa 'mele o tla lemoha kankere e le osele, o hlasele tlhaselo,' me ae hlakise.
Toxicities ea Checkpoint Inhibitors
Ha e le hantle, mathata a ka 'na a hlaha haeba sesole sa motho sa ho itšireletsa mafung se qala ho ferekana' me se qala ho hlasela lisele tsa bophelo bo botle ho phaella ho lisele tse mpe tsa kankere.
Ka mantsoe a mang, ho ruruha ho matla, tšenyo ea 'mele le maloetse a mangata a ka' na a hlaha ka ho sebelisa li-inhibitors tsena tsa checkpoint.
Ha e le hantle, phuputso e bonts'oa hore lintho tsena tse kotsi, tse bitsoang liketsahalo tse mpe tse amanang le 'mele, li etsahetse ho batho ba ka etsang liphesente tse 85 ka mor'a hore ba phekoloe ka chefo ea inhibitor ipilimumab. Li etsahala ho batho ba ka etsang liphesente tse 70 ka mor'a hore ba phekoloe ka chefo ea inhibitors nivolumab kapa pembrolizumab.
Joalokaha e le ka thōko, lilimimab li thibela ho itšireletsa mafung a lefu la tšoaetso ea CTLA-4 (cytotoxic T- lymphocyte-e amanang le protheine 4) 'me e' nile ea sebelisoa ho phekola melanoma .
Nivolumab le pembrolizumab sepheo sa PD-1 (se amoheletsoeng ka lefu la lefu la 1) 'me se' nile sa sebelisoa ho phekola kankere e kang melanoma, kankere ea senalone ea senal, kankere e seng e nyenyane ea kankere ea matšoafo, le Hodgkin's lymphoma.
Leha ho le joalo, ho khutlela litsing tsa toxicities, lits'ebetso tse ka sehloohong tseo li-inhibitors tsa ho hlahloba "ka phoso" li hlaselang 'meleng ke letlalo, matšoao a masapo, sebete le tsamaiso ea endocrine.
Skin Toxicities
Mathata a letlalo ke a bohlokoa ka ho fetisisa a amanang le ho itšireletsa mafung a amanang le 'mele a amanang le ho nka checkpoint inhibitor,' me a boetse a atisa ho ba teng pele kalafo kalafo.
Mehlala ea mathata a letlalo a kenyeletsa lehare, ho hlohlona, alopecia (ho lahleheloa ke moriri) le vitiligo .
Mathata a molomo a tšoana le molomo o omileng le molomo oa mucositis (ha liluru li etsa molomong) li ka boela tsa etsahala.
Kalafo ea rash hangata e akarelletsa ho sebelisa tranelate ea corticosteroid. Le hoja ha lehlaseli le le matla, ka linako tse ling molomo oa corticosteroid o hlokahala. Ho nka antihistamine ea molomo e kang Benadryl (diphenhydramine) e ka ba molemo bakeng sa ho hlohlona.
Hangata, haeba lehare le le boima, le bolela hore ho na le karolo ea 30 lekholong ea 'mele, motho o tla hloka steroid e fanoang ka methapo (intravenously) e lateloa ke taper ea oral steroids.
Hape ke habohlokoa ho hlokomela hore li-rashes tse matla joaloka lefu la Stevens-Johnson li 'nile tsa e-ba teng ka seoelo ho batho ba ntseng ba nka checkpoint inhibitor.
Ke ka lebaka leo uena kapa ngaka ea hau ea kankere ea moratuoa ea hau a tla u hlahloba ka hloko ha u ntse u e-na le immunotherapy 'me hang-hang u bona dermatologist haeba rash ea hao e shebahala e tšoenyehile (joalo ka haeba e etsa blisters) kapa haeba u sa fumane liphallelo ka mehato e bonolo joaloka tranelate ea corticosteroid.
Likokoana-hloko tsa Litlhapi tsa Meriana
Letšollo le colitis, tse bakang mahlaba ka mpeng le ka linako tse ling mali maling, ke mathata a mabeli a mala a ka 'nang a hlaha ka lebaka la ho nka inhibitor ea checkpoint. Haeba liphello tsena li etsahala, li hlaha hangata libeke tse tšeletseng kapa hamorao ka mor'a ho qala immunotherapy.
Seo se boletse hore liphello tse bohloko li bonahala li atile haholo ho ba fumanang li-antibodies tsa CTLA-4 (mohlala, ipilimumab bakeng sa melanoma e tsoetseng pele), ha bapisoa le ba amohelang li-inhibitor tsa PD-1 (mohlala, nivolumab bakeng sa sele e tsoetseng pele ea squamous e sa nyenyane kankere ea lesapo la mokofo).
Phekolo ea letsšollo le bonolo le mathoasong ho na le phepo e ngata ea phepo ea metsi, phepo e khahlanong le letšollo , mohlomong le meriana e khahlanong le letšollo joaloka Imodium (loperamide). Empa haeba letšollo le tsoela pele ka matsatsi a fetang a mabeli kapa a mararo, ho sa tsotellehe mekhoa ena e bonolo, kapa haeba letšollo le le matla haholo (mekhoa e metso e mene kapa e mengata ka letsatsi ho feta tloaelo), tlhahlobo e feletseng e tla etsoa bakeng sa ho hlahlobisisa letšollo-joaloka tšoaetso ke sesosa, eseng sethethefatsi.
Haeba tšoaetso e hlahisoa, 'me sesosa se nkoa e le se amanang le kalafo, corticosteroids e hlokahala ebile ka linako tse ling meriana e matla le e matla e thibelang tsamaiso ea' mele ea ho itšireletsa mafung joaloka Remicade (infliximab) e hlokahale.
E 'ngoe ea lintho tse ka sehloohong tse kotsing ea bophelo, ho sa tloaelehang, mathata a ho kula ha lingaka tseo lingaka li li hlokomelang ke entestinal perforation (moo lesoba le kenang leboteng la mala a tsoang ho ruruha ho matla).
Liver Toxicities
Inhibitors ea Checkpoint e ka lebisa ho phahameng ea li-enzyme tsa sebete, e leng pontšo ea ho ruruha ha sebete. Hangata likhoeli tsena li bonoa likhoeli tse peli ho isa ho tse tharo ka mor'a ho qala phekolo.
Hangata, ngaka e tla hlahloba liteko tsa mali tsa sebete , haholo pele ho tekanyo e 'ngoe le e' ngoe ea immunotherapy, 'me haeba li-enzyme li eketseha, ho tla etsoa mosebetsi oa ho etsa qeto ea hore na sesosa se amana le immunotherapy kapa ntho e' ngoe (mohlala, meriana e meng kapa tšoaetso ea kokoana-hloko).
Joaloka liphello tse ling tse kotsi tse amanang le 'mele, haeba sesosa se ikemiselitse ho amana le immunotherapy, corticosteroids e tla be e laeloa. Haeba toxicity ea sebete e le matla, phekolo ea immunotherapy e ka hloka ho emisoa ka ho feletseng.
Toxicities ea Endocrine System
Liketsahalo tse bohloko tse amanang le 'mele li ka' na tsa e-ba teng tsamaisong ea 'mele ea' mele, e akarelletsang lesela la pituitary, lesela la qoqotho le litšoelesa tsa adrenal. Ka karolelano, matšoao a hlaha ka mor'a libeke tse robong ka mor'a ho qala kalafo '
- Mokhathala
- Bofokoli
- Nausea
- Pherekano
- Hlooho ea hlooho
- Ho lahleheloa ke takatso ea lijo
- Mathata a pono
- Feberu
E 'ngoe ea liphello tse mpe ka ho fetisisa tsa endocrine ke hypothyroidism , e leng ha motho a hlahisa qoqotho e sa sebetseng.
Boloetse ba thyroid bo feteletseng, bo bitsoang hyperthyroidism, bo boetse bo tlalehiloe. Maemo ana ka bobeli a ka laoloa ke setsebi sa thuto ea ho qetela 'meleng' me a fumanoa ka ho hlahlojoa ke mali, haholo-holo lefu la qoqotho le hlahisang li-hormone (TSH) tlhahlobo ea mali. Hyothyothyism e hloka phekolo ka hormone ea thyroid e bitsoang Synthroid (levothyroxine).
Ho phaella ho hypothyroidism, bothata bo bong bo tloaelehileng ba endocrine bo ka hlahang ka lebaka la ho nka ho thibela ho hlahloba immunotherapy ke hypophysitis, e leng ho ruruha ha lesela la pituitary-le bitsoa master gland hobane le ntša lihomone tse ngata 'meleng.
Hypophysitis e ka 'na ea baka mokhathala le hlooho le liteko tsa mali ho senola mefuta e' maloa ea lihomone tse nyenyane. Ho nahana ka liteko ho ka 'na ha senola ho ruruha ha lesela la pituitary. Haeba ho fumanoa kapelenyana, lekhopho le phahameng la corticosteroids le ka kokobetsa ho ruruha ho lekaneng ho thibela tlhokahalo ea lithethefatsi tsa nako e telele tse nkeloang sebaka.
Haeba litšoelesa tsa adrenal li ameha, motho a ka 'na a hlaseloa ke khatello e tlase ea mali, ho felloa ke metsi' meleng le mathata a electrolyte joaloka maemo a phahameng a potassium le maemo a tlaase a sodium maling. Ena ke tšohanyetso ea bongaka 'me e hloka hore motho a kenngoe sepetlele' me a fumane corticosteroids.
Qetellong, lefu la ts'oaetso la mofuta o mocha oa mofuta o sa tsoa qala ho amana le ho nka PD-1 inhibitor. Ke kahoo lingaka li atisang ho hlahloba tsoekere (tsoekere ka mali a hau) ha u qala ho phekola.
Litlhapi tse holimo
Ho ba le immunotherapy ho ka boela ha etsa hore ho ruruha matšoafong, 'me sena se bitsoa pneumonitis, le hoja e le ntho e sa tloaelehang, ha e bapisoa le chefo e boletsoeng ka holimo. Tšusumetso ena e mpe e hlile e tšoenya batho ba tšoeroeng ke kankere ea matšoafo e tsoetseng pele e etsoang ke immunotherapy, kaha mapheo a bona a se a ntse a sitoa ho tšoaroa ke kankere. E ka 'na ea baka matšoao joaloka khohlela kapa mathata a phefumolohang.
Le hoja ka tloaelo ho e-na le phello e sa tloaelehang, pneumonitis e ka beha bophelo kotsing. Haeba ho belaelloa, ngaka ea hao e tla laola lisosa tse ling tsa ho ruruha ha matšoafo joaloka tšoaetso ea matšoafo (e bitsoang pneumonia) kapa tsoelo-pele ea kankere. Ngaka e atisa ho laela hore setšoantšo sa CT se hlahlobe sefuba ho thusa ho hlahloba.
Kalafo e atisa ho kenyelletsa ho thibela immunotherapy nako e khethiloeng ha motho a ntse a hlahlobisisa mafu a bona. Hangata Corticosteroids e fuoa, 'me maemong a boima, ho itšireletsa mafung a kang Remicade (infliximab) ho ka hlokahala ha motho a sa ntlafatse ka steroids.
Qetellong, liphello tse ling tse sa tloaelehang tse amanang le ho itšireletsa mafung li 'nile tsa tlalehoa joaloka mathata a methapo kapa mahlo. Nakong ena, ngaka ea hau e tla u fetisetsa ho setsebi, setsebi sa methapo ea mafu kapa setsebi sa likokoana-hloko , bakeng sa ho fumana lefu le nepahetseng.
Lentsoe le Tsoang ho
Haeba uena kapa moratuoa oa hau o ntse a nka inhibitor ea checkpoint, ho molemo hore u tsebe tse ling tsa lik'hemik'hale tse fapaneng tse amanang le eona, kaha li ikhetha ho tse amanang le likhemotherapies tsa setso.
Ka mantsoe a mang, matšoao a poteletseng le liphello tsa liphello tsena tse bohloko ke romana ho lingaka tsa kankere hape. Leha ho le joalo, u se ke ua tšoha ke bona. Ho e-na le hoo, ba rutoe le ho falimeha, joalokaha ba bangata ba tla rarolla haeba ba tsejoa hang-hang.
> Mehloli:
> Kroschinsky F et al. Lithethefatsi tse ncha, li-toxicities tse ncha: litla-morao tse matla tsa mehleng ea kajeno ea lihlaseli le tsa immunotherapy tsa kankere le tsamaiso ea bona. Tlhokomelo ea Crit. 2017; 21: 89.
> Linardou H, Gogas H. Toxicity tsamaiso ea immunotherapy bakeng sa bakuli ba melanoma ea metastatic. Ann Transl Med . 2016 Moo; 4 (14): 272.
> Michot JM et al. Liketsahalo tse bohloko tse amanang le 'mele le ho thibela ho itšireletsa mafung: tlhahlobo e feletseng. Eur J Kankere . 2016 Feb; 54: 139-48.
> Posto M, Wolchok J. Toxicities e amanang le checkpoint inhibitor immunotherapy. Ka: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, Amin A. Li-checkpoint tsa immune tsa ho itšireletsa mafapheng a bophelo ba meriana: ntlafatsa ka tsamaiso ea likokoana-hloko tse amanang le 'mele. Fetolela Kankere ea Kankere ea Res . 2015 Oct; 4 (5): 560-75.