Immunotherapy e fetoha mokhoa o matla oa ho loantša mafu, haholo-holo maloetse ao ho leng thata ho a phekola. Le kankere ea immunotherapy , sesole sa 'mele se sebelisetsoa ho loantša lihlahala ka litsela tse sa tloaelehang. Mekhoa ea ho itšireletsa mafung e ka fetisetsa tsamaiso ea 'mele ea ho itšireletsa mafung kapa ea hlahisa sesole sa' mele ka liprotheine tsa maiketsetso, kapa likokoana-hloko , ho koetlisa sesole sa 'mele ka lihlahala.
Liente tsa phekolo ea kankere ke mofuta oa immunotherapy o sebelisetsoang ho phekola kankere e seng e ntse e le teng. Hangata, liente tsa phekolo ea kankere ke li-biologics, kapa biopharmaceuticals. Likokoana-hloko tse ling li akarelletsa likarolo tsa mali, phekolo ea liphatsa tsa lefutso, li-allergenic le liente tse ling.
Hona joale, tšoaetso feela ea kankere eo FDA e e amohetseng e bitsoa Provenge ho phekola kankere ea prostate .
Liente tsa Phekolo ea Kankere
Li-antigen ke lintho tse bakang tsamaiso ea 'mele ea ho itšireletsa mafung. Bongata ba liente tsa kankere ea phekolo ea kankere li hlahisa likokoana-hloko tse amanang le kankere ho lisele tse nyenyane. Lisele tsena tsa dendritic ke lisele tsa 'mele tse itšetlehileng ka ho toba ka lekaneng (dermis) le ho sebetsana le antigen. Ho feta moo, limolek'hule tsa immunostimulatory tse kenang liente tsa kankere li phahamisa, kapa li eketsa tlhahiso, ea limolek'hule tse hlokahalang ho qetella li kopana le lisele tsa T. Tlhokomelo, li-antigens tse amanang le kankere li ka ba tsa mofuta o mong oa kankere kapa sehlopha sa lik'hemik'hale tse 'maloa.
Lisele tsena tse entsoeng ka dendritic li fallela lymph nodes, tse nang le likaroloana tse nyenyane tsa lisele tsa immunologic tse teng 'meleng oohle. Hang ha lisele tsena tse entsoeng ka dendritic li etsa hore e be le lymph node, li hlahisa lisele tsa T tse thibelang kankere. Lisele tse entsoeng tsa T li tsamaela hohle 'meleng ebe li lebisa lisele tsa kankere tse hlahisang antigen le lyse, kapa ho senya, sele ea kankere.
(Ka ho eketsehileng, lisebelisoa tsa CD4 + T activated li hlahisa li-cytokines tse etsang hore ho be le pululo ea lisele tsa CD 8, kamora 'mele oa' mele o tlotsitsoeng ka nako ea 'mele.)
Ho ea ka FDA, liente tse 'maloa tsa kankere tse nakong ea nts'etsopele li sebelisa libaktheria, likokoana-hloko kapa tomoso e le likoloi kapa li-vector , ho tsamaisa li-antigen. Libaktheria, likokoana-hloko, tomoso le tse ling li na le likarabo tsa 'mele ka bobona; Leha ho le joalo, li fetotsoe e le hore li se ke tsa baka maloetse.
Ntle le moo, liente tsa phekolo ea kankere li ka etsoa ka ho sebelisa DNA kapa RNA hore e be le li-antigen. Hona joale liphatsa tsa lefutso li kenngoa ka lisele tse hlahisang likokoana-hloko. Tšepo ke hore lisele tsena tsa 'mele tse fetotsoeng li tla hlahisa li-antigen tse nang le kankere tse lekaneng bakeng sa ho susumetsa matla a mmele a ho itšireletsa mafung ka ho bolaea lisele tsa tumor.
Qetellong, ho lokela ho finyelloa litekanyetso tse tharo bakeng sa lisele tse hlahisang likokoana-hloko hore li senngoe ke ente e latelang:
- ho na le lisele tse ngata tsa 'mele tsa ho itšireletsa mafung tse nang le likamano tse ngata tsa kankere tse lokelang ho hlahisoa
- lisele tsena tsa T li lokela ho khona ho kenella ka hlahala
- lisele tsena tsa T li lokela ho qala ho sebetsa sebakeng sa maqeba ho baka tšenyo e khethehileng ea sebaka
Liente tsa Kankere li Atleha Hakae?
Lilemong tse 'maloa tse fetileng, liente tse makholo tsa kankere (dendritic-cell) li' nile tsa lekoa.
Leha ho le joalo, litekanyetso tsa likarabo ho liente tsena li tlase haholo-hoo e ka bang karolo ea 2,6 lekholong. Ha e le hantle, mefuta e meng ea immunotherapy e ipakile e atlehile haholo, e susumelitseng litsebi tse ngata hore li belaelle lithibela tsa rona tsa ho phekola lefu la ho kula.
Kahoo, haeba kankere ea mafu a kankere e sa atlehe hakae ho batho, ke hobane'ng ha re ntse re tsoela pele ho sebelisa lichelete le nako ho nts'etsopele ea liente tsa kankere? Ho na le bonyane mabaka a mararo a hlalosang thahasello ea rona ka mokhoa ona oa ho kenella.
Ntlha ea pele, liente li 'nile tsa atleha ho thibela kankere,' me katleho ena e fetiselitsoe phekolo ea kankere ka liente.
Ka mantsoe a mang, mosebetsi oo re o entseng oa ho hlahisa liente tsa thibelo ea kankere o re rutile haholo ka immunology ea lisele tsa kankere 'me o fane ka moralo oa thuto oa tlhahiso ea liente tsa kankere ea kankere. Hona joale ho na le liente tse peli tse thibelang kankere: thibelo ea lefu la sebete e thibela kankere ea sebete, 'me ente ea motho ea papillomavirus (HPV) e thibela mokokotlo oa mokokotlo oa mokokotlo oa kankere, mokokotlo, li-anal, le tse ling
Ntlha ea bobeli, liente tsa phekolo ea kankere li bonolo ho beha le ho baka liphello tse seng kae tse mpe tse mpe.
Ntlha ea boraro, bafuputsi ba atisa ho ba le boikemelo ha ba hlalosa litlhoko tsa liteko tse amanang le mafu a mafu a kankere, a fanang ka phepo e amanang le mofuta ona oa ho kenella. Haholo-holo, bafuputsi ba atisa ho tsepamisa mohopolo linthong tsa hae tse sa hlokahaleng, kapa li-cellular, liphetoho le lymphocyte (T cell) ho kenella ha lihlahala ho e-na le ho lebisa tlhokomelo ea phetoho ea sebele : ho fokotseha ka boholo ba tumor kapa ntlafatso matšoao a meriana.
Ho feta moo, bafuputsi ba ka sehloohong ba hlahlobang liente tsa kankere hangata ba sebelisa litlhaloso le mantsoe a khelosang ho hlahisa liphello, tse kang "matšoao a nyamela," "ho hōla ha nakoana ho metastases," "tumor necrosis" le "ho phela nako e sa lebelloang nako e telele." Ntle le lintlha tse ling, mantsoe ana ha a bolele letho.
Tlhahisoleseding e amanang le eona, lipatlisiso tse ngata tsa thibelo ea kankere li entsoe ka tekanyo ea mantlha ea thuto ea bongaka ka mehlala ea liphoofolo. Litoeba, joalo ka ha e ka 'na ea e-ba teng ho tloha boholo ba tsona, boitšoaro le ponahalo ea boea, li fapane le batho. Ka hona, katleho leha e le efe eo re e bonang ha re phekola liphoofolo tsena ka liente tsa mafu a kankere ha e bolele ho batho.
Haholo-holo, le hoja liente tsa kankere li ipakile li atleha liphoofolong, ha ho bonolo hore motho a fumane tšusumetso e joalo ho batho. Haholo-holo, ho na le thibelo e le 'ngoe feela ea phekolo ea kankere e amoheloang ke FDA bakeng sa phekolo ea kankere ho batho: Fana ka. Leha ho le joalo, ho na le ente e 'ngoe ea kankere ea prostate hona joale litekong tsa 3 tsa Phase tse bontšitsoeng hore li atleha: Prostvac.
Pele re sheba Provenge le Prostac, a re ke re phunyeletse tsebo ea rona ka kankere ea senya .
Kankere ea Prostate
Ntle le kankere ea letlalo, kankere ea tšoelesa ea prostate ke kankere e tloaelehileng ka ho fetisisa e amang banna ba Amerika. Le hoja ba ka bang 1 ho ba supileng ba Maamerika ba hlahisa kankere ea prostate, ba bangata ba shoa lefu lena (hoo e batlang e le 1 ho ea ho 39). Ho e-na le hoo, banna ba atisa ho shoa ka lefu le leng pele, joaloka lefu la pelo. Leha ho le joalo, ka 2016, ho ne ho e-na le batho ba 26.120 ba bolailoeng ke kankere ea senya.
Ka lebaka la ho hlahloba kankere ea prostate-specific (PSA) e pharaletseng, e leng setsi sa kankere ea tšoelesa ea senya, re khonne ho lemoha linyeoe tsa kankere ea tšoelesa ea senya pele ho moo, ha kankere e sa ntse e koaletsoe ho prostate, ho feta moo, banna ba nang le kankere ea prostate e fokolisitseng kapa e hasana masapong 'me ea fetoha lefu.
Lintho tse eketsang kotsing ea kankere ea senya li akarelletsa botsofali, morabe oa Afrika oa Amerika le histori ea lelapa.
Batho ba bangata ba nang le kankere ea prostate ha ba hloke phekolo 'me ho e-na le hoo ba hlokomeloa ke lingaka tsa bona. Kalafo bakeng sa kankere ea prostate e ka kenyelletsa tsamaiso e lebelloang (tlhokomelo e sebetsang), opereishene (prostatectomy kapa ho tlosoa ha prostate), radiotherapy le androgen, kapa hormone ea thobalano, ho hloka.
Fana ka
Ho fana ka litlhapi kapa li-sipuleucel-T ke ente ea dendritic-cell e amoheletsoeng ke FDA ka 2010. Nyehelo ke eona e tsejoang e le autologous cellular immunotherapy 'me e sebelisetsoa ho phekola lefu la metastatic le sa kang la hasana haholo ho sa le joalo (ho fokotseha hanyenyane). Ho feta moo, Fana ka tšoaro ea kankere ea senya e sa mameleng li-hormone (hormone refractory).
Tlhahisoleseding e amanang le eona, li-hormone tsa kankere ea kankere li arabela ka ho phekoloa ha li-hormone, kapa lithethefatsi tse senyang li-orrogens, kapa li-hormone tsa thobalano (nahana ka ts'oaetso ea bongaka).
Ho fana ka litlhapi ho lokiselitsoe ho sebelisa lisele tsa mali tse tšoeu tsa mokuli (lisele tsa mali tsa mononuclear tsa mali) tse ling tse nang le protheine e bitsoang granulocyte-macrophage-kolone-e susumetsang motsoako (GM-CSF) le prostatic acid phosphatase, kapa PAP, e leng antigen ea kankere ea antigen.
Lebaka leo GM-CSF e fanoang ka PAP ea antigen ke hobane bafuputsi ba lumela hore GM-CSF e thusa tlhahiso ea antigen. Taba ea bohlokoa, lisele tsa mali tsa mononuclear tsa mali li sebetsa e le lisele tsa dendritic tse hlahisoang ke antigen.
Ka bomalimabe, Merero e fetisetsa bophelo ka likhoeli tse ka bang 4 feela. Leha ho le joalo, nako ena e ka 'na ea lumella motho hore a phethe litaba tsa hae hantle' me a qete nako e eketsehileng le lelapa la hae.
Litholoana tse mpe tsa Merero li akarelletsa tse latelang:
- feberu
- ho tsuba
- mokhathala
- bohloko ba morao
- hlooho
Nakong ea liteko tsa meriana ea Provenge, banna ba 'maloa ba ile ba e-ba le liphello tse mpe tse tebileng ho kenyeletsa bothata ba ho hema, bohloko ba sefubeng, ho ba le pelo e sa tloaelehang, ho ba le botenya ba ho fokola le ho fetoha ha khatello ea mali. Kahoo, batho ba nang le mathata a pelo le a matšoao ba lokela ho bua ka maemo ana le mofani oa bona oa tlhokomelo ea bophelo.
Prostvac
Mochine oa Prostvac o fapana le Mekhabiso.
Prostvac e na le mochine oa poxvirus (fowlpox), prostate-specific antigen (PSA) le complex complex cosmulatory e bitsoang TRICOM. Lenane la PSA-TRICOM le tšoaetsa lisele tsa antigen-tse hlahisang li etsa hore ba hlalose liprotheine tsa prostate-specific antigen holim'a bona. Lisele tsena tse hlahisang antigen li hlahisa lisele tsa T le ho ba koetlisa ho hlasela lisele tsa kankere ea prostate.
Litlhahlobo tsa meriana ea Prostvac Phase 2 li kenyelelitse litho tsa 82 tse ileng tsa fumana Prostvac tse 42. Prostvac o ile a atolosa bophelo sehlopheng sa liteko ka phaello ea bohareng ba likhoeli tse 8.5. Hona joale, Prostvac e le litekong tsa tlhokomelo ea likhallelo tsa Phase 3, mme bafuputsi ha ba leke feela ho netefatsa phaello ea pholoho ea lithethefatsi empa hape ba leka ho fumana hore na GM-CSF e ka ekeletsoa ho ente.
Nakong ea liteko tsa meriana ea Phase 2, liphello tse mpe tsa Prostvac li kenyelelitsoe tse latelang:
- phekolo ea sebaka sa ente (bohloko, ho ruruha, bofubelu joalo-joalo)
- mokhathala
- feberu
- ho ruruha
- ho tsuba
- bohloko bo kopanetsoeng
- botsoa
- ho nyekeloa ke pelo
- ho hlatsa
- letšollo
- ho patoa
Liente tsa kankere ea prostate ha li reretsoe ho sebelisoa e le phekolo ea pele ea kankere ea prostate. Ho e-na le hoo, li tsamaisoa ho phaella chemotherapy.
Imlygic ke Eng?
Ka selemo sa 2015, FDA e lumelletse ho tlosa li-imlygic, ente e entsoeng ka li-oncolytic bakeng sa phekolo kapa melanoma e kotsi e ke keng ea sebetsoa. Le hoja tekete e se lefu la kankere ea phekolo ea meriana, Imlygic e na le liphello tse tšoanang le tsa mafu a lefu la kankere.
Likokoana-hloko tsa oncolytic ke mofuta oa immunotherapy moo kokoana-hloko e entsoeng ka liphatsa tsa lefutso e kenngoa ka ho toba ka kankere ea melanoma le lyses kapa e pshatla lisele tse hlahisang likokoana-hloko fatše. Ntle le ho senya lisele, likokoana-hloko tsena li na le phello e kholo ea ho etsa hore e be le phello e tšoanang le ea liente tsa anticancer.
Lik'hemik'hale tsa meriana ea lefuba le 'na
Hona joale, tšebeliso ea liente tsa kankere metseng ea kliniki e lekanyelitsoe. Ho phaella moo, joalokaha ho boletsoe pejana, ho 'nile ha e-ba thata ho fumana liente tsa kankere tse nang le phello ho litho tsa batho. Ho ke ke ha etsahala hore re tla bona liente tsa kankere tse sebelisetsoang ho tšoara kankere e fapa-fapaneng neng kapa neng haufinyane.
Leha ho le joalo, liente tsa kankere li emela tsoelo-pele ea sesole sa 'mele hammoho le tšimo ea immunotherapy. Ha re utloisisa hantle mokhoa oa 'mele oa ho itšireletsa mafung, ho molemo hore re lebise tlhokomelo ea meriana eo ka letsatsi le leng e ka pholosang bophelo ba batho.
Lisebelisoa:
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Kantoff PW et al. Ho hlahloba ka ho pharaletseng ha Palo ea Bobeli ea Phase II Lehloeo le laoloang le laoloa la Poxviral-Based Based PSA-Targeted Immunotherapy ka Kankere ea Prostate e Hanyetsanang le Metastatic Castration. J Clin Oncol. 2010 Mar. 1; 28 (7): 1099-1105.
Pienta KJ. Khaolo ea 96. Kankere ea Prostate. Ka: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. eds. Hazzard's Geriatric Medicine le Gerontology, 6e . New York, NY: Hill ea McGraw; 2009. E fihlile ka la 22 Phupu, 2016.
Rosenberg SA, Yang JC Restifo NP. Kankere Immunotherapy: Ho Tsamaea ka Ntle ho Hona Joale Liente. Nat Med . 2004 September: 10 (9): 909-915.