Na ho ke ke ha e-ba monate haeba lingaka li ka sheba kankere ea hau, sheba mefuta e fapa-fapaneng ea phekolo e ntseng e hlaha, 'me u etse qeto ea hore na ke life tse ka atlehang haholo?
Le hoja li-oncologists li ka ba le lisebelisoa tse ntle le lisebelisoa tsa ho sebelisa litsela tse fapaneng, phekolo e sa tsoa hlaha e ka 'na ea e-ba thata ho bolela esale pele, ntle le phihlelo ea bongaka.
Tsoelo-pele ea tsebo e tsoa litekong tsa bongaka, moo bakuli ba lumellanang ho kenya lithuto le lithethefatsi tsa lipatlisiso tse bontšitseng tšepiso e itseng; empa, joalokaha polelo e reng 'teko' e bolela, kamehla ho na le tekanyo ea ho ba le khoao mabapi le hore na moriana o tla etsa hantle hakae le hore na ke mang ea tla rua molemo ka ho fetisisa-ke hore, ke mefuta efe ea mokuli le lihlopha tsa kankere.
Kankere ea Immunotherapy ke Eng?
Cancer immunotherapy ke phekolo e akarelletsang likarolo tse ling tsa tsamaiso ea 'mele ea motho ea ho itšireletsa mafung ho loantša malignancy. Mohlala o mong oa immunotherapy ke tšebeliso ea li-antibodies tse monoclonal tse kang rituximab le obinutuzumab . Li-antibodies tsa monoclonal ke li-antibodies tse entsoeng ke batho, kapa liprotheine tsa 'mele oa ho itšireletsa mafung. Li-antibodies tsena li ka hlasela karolo e khethehileng ea sele ea kankere ho tse tsejoang e le phekolo e entsoeng .
Mefuta e meng ea kankere ea immunotherapy e kenyeletsa ho itšireletsa mafung , e leng ho nka 'brakes' matla a 'mele oa ho itšireletsa mafung ho thusa ho lemoha le ho hlasela lisele tsa kankere.
Lefatše la kankere ea immunotherapy ha le felle feela mehlala e ka holimo, leha ho le joalo, le likhopolo tse ncha tsa ho sebelisa 'mele oa hau oa' mele ho loantša lisele tsa kankere li ntse li tsoela pele ho ntlafatsoa le ho hlahlojoa.
Na Immunotherapy e Sebetsa Bakeng sa Kankere Tsohle?
Motho e mong le e mong o ikhetha, 'me kankere ea motho e mong le e mong e ikhetha; ha ho motho e mong le e mong ea arabang ka tsela e tšoanang le ea immunotherapy.
Ka katleho gauging, esale pele, seo batho ba ka 'nang ba se etsa ha ba e-na le immunotherapy ba ka ba molemo ho tsoa lihlopheng tse' maloa. Bakeng sa mokuli, e ka boloka nako ea bohlokoa, e ka fetolang ho fumana thuso ea bongaka.
Ka mantsoe a mang, u ke ke ua senya nako ea hau kapa litla-morao tse kotsi ho leka ntho e ka 'nang ea e-ba le phello e fokolang ha ho ka ba le' sethunya se seholo 'kapa phekolo e sebetsang haholo. Empa motho a ka tseba joang mofuta ona oa ntho esale pele? Pale e le 'ngoe e buang ka hore na bafuputsi le bafuputsi ba kankere ba ntse ba etsa joang ho qala ka ntho e bitsoang neoantigens.
Neoantigens: Achilles ea kankere e folisa?
Lisele tsa kankere li ka sneaky. Hangata ba na le liphetoho tse 'maloa liphatleng tsa bona tsa lefutso, tse ling tsa tsona li ka lumellana le matla a bona a ho etsa lintho tse mpe tseo lisele tse tloaelehileng, tse phetseng hantle li ke keng tsa khona ho li etsa. Tse ling tsa liphetoho tsena li hlile li fella ka ho se tšoane ha 'mele kapa ka ntle ho lisele tsa kankere tse ka fumanoang ke tsamaiso ea' mele ea ho itšireletsa mafung. Likarolo tsena tsa lisele tsa kankere tseo tsamaiso ea 'mele ea ho itšireletsa mafung e ka e tsebang e le linaheng tse ling e bitsoa "neoantigens."
Neo, e bolelang hore e ncha, hobane e hlaha e sa tsoa tloha lisele tsa rona, e e-na le kankere , ho fapana le li-antigen tse tloaelehileng hangata li bua ka mafu a tšoaetsanoang.
Li-antigen tse tloaelehileng li ka fumanoa ka ntle ho libaktheria kapa ka lisele tse nang le tšoaetso. Ka lehlakoreng le leng, li-neoangens li tšoana le lifolakha tse khubelu tse ka bonang sesole sa 'mele seo lisele tsa rona li se etsang hampe.
Neoantigens e etsa hore ho sebelisoe lisele tse tšoeu tsa mali tse tsejoang e le li-T- masole a 'mele oa' mele. Masole ana a T-seli a tsamaisa methapo ea mali, joaloka litsela tsa majoe a Roma ea Boholo-holo, hore a fihle setsing sa lisele tse sa laoleheng tse sa laoleheng, a kena ka har'a hlahala 'me a thuse ho felisa baahi ba moo lisele tse bolaeang.
Kahoo, neoantigens ke e 'ngoe ea linotlolo tsa mafu a meriana a khahlanong le kankere.
Seo se boletse hore ho atisa ho hlōla ntoa hangata ho akarelletsa ho itšireletsa mafung a le mong, 'me ho hlokahala hore mokhoa o mong oa lefatše o chesitsoeng o atlehe; immunotherapy e atisa ho sebelisoa hammoho le cytotoxic chemotherapy le / kapa tse ling tsa immunotherpies, ho itšetlehile ka ho bolaea le mokuli ka mong .
Na Immunotherapy e Tla Sebetsa ho 'na?
Ena ke potso ea bohlokoa mehleng ea kajeno ea oncology, le e sebetsang ka mafolofolo. Ho fihlela qetellong, litšoaneleho tse peli tsa lisele tsa kankere li ka thusa lingaka hore li bolelle hore na li-immunotherapies tse fumanehang hantle li tla sebetsa joang: TMB le MSI.
Mokhatlo oa mantlha oa moferefere, kapa TMB , o ka nahanoa e le letšoao la liphetoho tsohle tsa liphatsa tsa lefutso ka lisele tsa kankere tse 'nileng tsa ea liphatsa tsa lefutso, ka mohlala, tse neng li sebelisoa ho khothaletsa lintho tsohle tse tloaelehileng tseo sele e ka li hlokang-empa ba le liphetoho kapa liphetoho tabeng ea lisele tsa kankere. Ka nako e 'ngoe TMB e boetse e bitsoa moroalo oa machaba kapa menahano.
Li-tumor tse nang le TMB e phahameng li lumeloa hore li na le li-neoantigens tse ngata 'me kahoo li ka arabela hantle ho immunotherapy. Lisele tsa kankere li ka qetella li e-na le TMB e phahameng ka ho hlahisa likarolo tse amanang le kankere, ho akarelletsa le koae kapa khanya ea UV. Tsela e 'ngoe ke ka ho se tsitsane ha microsatellite, kapa MSI , lentsoe le sebelisanang le tekanyetso e bolelang bothata ba mekhoa ea' mele ea 'mele oa hao ea ho lokisa-bothata bo fanang ka liphetoho tse ngata tse sa fetoheng tsa DNA ea liphatsa tsa lefutso.
Khampani e 'ngoe e bitsoang Foundation Medicine e fana ka liteko tsa pele tsa TMB tse kenyelletsoeng ka botlalo le tse tiisitsoeng ka botlalo, e le karolo ea ts'ebeliso ea FoundationOne, e ka thusang ho bolela hore na motho a ka arabela joang ho immunotherapy.
Vincent Miller, MD, eo e leng setsebi sa bongaka sepetleleng sa Foundation Medicine, o hlalosa: "Li-genomes tse fokolang ke tsona tse tloaelehileng tsa kankere eohle. "Ho itšunya-tšoaea le palo e phahameng ka ho khetheha ea liphetoho li atisa ho hlahisa liprotheine tse ncha tse sa tloaelehang tse bitsoang neoantigens. Tsamaiso ea 'mele ea ho itšireletsa mafung e hlokomela hore li-neoangens tsena ke tsa linaheng tse ling' me li lula li falimehile, li qalisa letoto le rarahaneng la mehato ea ho hlasela hlahala. "
Na Sebaka sa Boikemisetso ba ho Sireletsa Lefu la 'Mele se ka Ntšebeletsa?
Morero ona o tiisa hore lik'hemik'hale tse ling li hlahisitse mekhoa e feteletseng ea ho qoba sesole sa 'mele-ka ho etsa liprotheine tse hlileng li kenyang mefuta e itseng ea lisele tsa hau tsa' mele. Sesebelisoa sa liaparo tsa biologic , haeba u ka rata.
E le ho thibela kankere hore e se ke ea itlama ka tsela ena, li-immunotherapi tse ling li etselitsoe ho thibela liprotheine tsena tsa ho itšireletsa mafung. Li-immunotherapies tsena, tse tsejoang e le " immune checkpoint inhibitors" , li kenyeletsa li-anti-PD1 le li-anti-PDL1 . 'Me, joaloka mefuta e meng ea immunotherapy, ho na le bopaki bo bontšang hore litekanyetso tse phahameng tsa neoantigens lisele tsa kankere li amana le likarabo tse molemo ho thibela ho itšireletsa mafung.
Karabelo ea ho hlahloba ntlha ea inhibitor e fapana le hoo e ka bang karolo ea 20 lekholong ea kankere ea matšoafo ho ea ho karolo ea 80 lekholong Hodgkin lymphoma. Lebaka leo ka lona li-tumor tse itseng li arabelang ka ho hlahloba litekanyetso tsa inhibitors le ba bang ha ho hlakile.
Bohlokoa ba ho Bolela Tlhahlobo ea Meriana ea Boipheliso
Lisebelisoa tsena tsa ho qeta pele le katleho ea tsona e ne e le taba ea puisano sebokeng sa selemo sena sa American Society of Clinical Oncology, kapa ASCO.
TMB e bontšitsoe hore e bolela esale pele monyetla o moholo oa karabo le nako e telele ea karabo ho kankere ea kankere ea senya, kankere ea matšoafo, melanoma le lisele tse ling tse tsoetseng pele. Ho phaella TMB, FoundationOne e boetse e lekanyetsa ho se tsitse ha microsatellite, e emelang tlhahlobo e le 'ngoe ho tataisa liqeto tsa phekolo bakeng sa phekolo ea meriana, liteko tsa kliniki le kankere ea immunotherapies e amohelehang ea FDA e sebelisang phetoho e le' ngoe.
Dr. Miller o re: "Cancer immunotherapies e ka pele ho phekolo ea kankere, 'me ho hlokahala litsela tse ncha, tse ngata bakeng sa ho bolela esale pele likliniki tsa likarabo ho sehlopha sena sa bohlokoa, empa hape se theko e boima, sa phekolo ea meriana."
"Ho khona ho lekanya ka mokhoa o nepahetseng likarolo tse ngata tsa lihlahisoa tsa metsi ka nako e le 'ngoe, ho akarelletsa le TMB le MSI, ke phetoho ea bohlokoa bakeng sa tšimo ea kankere ea immunotherapy, le e ikhethang ho Motheo oa Meriana," ho boletse mookameli oa lenaneo la thuto ea oncology, Thomas University, MD. . "Motheo oa meriana ea lipalangoang tse tsoetseng pele le mekhoa e mengata ea sebopeho e nepahetseng e mpha monyetla oa ho fihlella ho bakuli ba ka bohle ka nako e le 'ngoe, ho thusa ho boloka nako le lisele."
"Re ile ra khothatsoa ke liphuputso tse hlahisitsoeng ASCO, ho kenyelletsa le monyetla oa ho khetholla bakuli ba ka 'nang ba rua molemo ka checkpoint inhibitor immunotherapy," ho rialo Dr. Miller. "Sepheo sa rona ke ho matlafatsa lingaka le bakuli ba nang le boitsebiso bo bongata bo sebetsang, bo sebetsang ba genomic, 'me re thabile ho fana ka tharollo ea rona e ikhethang ea ho lekanya TMB le MSI ka nako e le' ngoe le ka ho nepahala ho ikhethileng, ho tšehetsoa ke mekhoa e rarahaneng ea mekhoa ea metsoako le metse ea metsoako ho tloha setsing sa rona sa tsebo FoundationCORE. Sena hase ntho e 'ngoe e fanoeng ke sethala sa mekhoa e latelang ea sethala. "
E ikemetseng ea litlhahlobo tsa FoundationOne le FoundationOne Heme, Foundation Medicine e boetse e fana ka liteko tsa polelo ea protheine ea PD-1 le PD-L1, e fanang ka eona, ho kopantsoe le litlhahlobo tsa FoundationOne, setsi se feletseng sa kankere ea immunotherapy bakeng sa oncologists.
Lentsoe le Tsoang ho
Le hoja ka sebele ena e le sebaka se tšepisang, saense e ntse e tsoela pele 'me liteko tse fapa-fapaneng li ntseng li ithutoa le ho tiisoa. Lintho tsohle tse teng hona joale bakeng sa ho bolela esale pele ka lik'hemik'hale ho hlahloba lintlha tsa inhibitors li na le lipatlisiso feela 'me hona joale ha ho liteko tse amohelehang tsa FDA tse ka tsebang hantle hore na karabo e tla ba efe ho hlahloba litekanyetso tsa inhibitors.
> Mehloli:
> Foundation Medicine e fana ka boitsebiso bo bocha ho ASCO 2016 e bontšang hore FoundationOne e ka thusa ho bolela esale pele hore na kankere ea immunotherapy e tla tšoaroa joang ka likarolong tse fapaneng tsa kankere.
Ansell SM, Lesokhin AM, Borrello I, le al. PD-1 Blockade le Nivolumab ka Lothphoma ea Hodgkin e khutliselitsoeng hape kapa e tsitsitseng. N Engl J Med. 2015; 372 (4): 311-319.
Pardoll DM. Ho thibela ho itšireletsa mafung ka kankere ea immunotherapy. Kan Rev Kankere. 2012; 12 (4): 252-64.