Immunotherapy no ka Metastatic Renal Cell Carcinoma

Anter

• He aha ka immunotherapy?
• Cytokines
• Interleukin-2 (IL-2)
• Interferon-alfa
• Nā mea kāohi checkpoint
• Nivolumab (Opdivo)
• Ipilimumab (Yervoy)
• Nā hopena ʻē aʻe
• Lawe aku

Hōʻike Overview

Nui a hewahewa nā maʻi no ka metastatic renal cell carcinoma (RCC), e like me ke ʻoki ʻana, ka lāʻau hoʻomōhala ʻana, a me ka chemotherapy.

Akā i kekahi mau hihia, hoʻopau paha ʻoe i ka pane ʻana i ka lāʻau i hoʻomākaukau ʻia. I nā manawa ʻē aʻe, hiki i nā lāʻau lapaʻau hoʻomākaukau ʻia ke kumu i nā hopena ʻino a i ʻole nā ​​hopena maʻi.

Inā kū kēia, hiki i kāu kauka ke koi aku i kahi ʻano lapaʻau ʻē aʻe i kapa ʻia ʻo immunotherapy. Eia kahi nānā kikoʻī i ke ʻano o ka immunotherapy, a inā he kūpono ia nāu.

He aha ka immunotherapy?

ʻO ka Immunotherapy kahi ʻano o ka mālama ʻana i ka maʻi ʻaʻai e hoʻohana i nā mea kūlohelohe a me nā mea hana e hoʻololi i ke ʻano o nā pūnaewele i kou kino. Ke hana nei kekahi ʻano o ka immunotherapy e kaua aku a luku paha i nā hunaola maʻi ʻaʻai. Hoʻoikaika a hoʻonui paha nā mea ʻē aʻe i kāu ʻōnaehana pale a kōkua i ka mālama ʻana i nā ʻōuli a me nā hopena ʻē aʻe o kāu maʻi ʻaʻai.

Aia he ʻelua ʻano nui o ka mālama ʻana i ka maʻi immunotherapy no ka RCC metastatic: cytokines a me nā mea hoʻopaneʻe kiko.

Cytokines

ʻO nā cytokine nā mana o ka protein i hana ʻia e ke kanaka e hoʻoulu a hoʻonui i ka ʻōnaehana pale. ʻO nā cytokine ʻelua i hoʻohana pinepine ʻia e mālama ai i ka maʻi ʻaʻai ʻōpala ʻo interleukin-2 a me interferon-alpha. Ua hōʻike ʻia lākou e kōkua i ka hōʻemi ʻana i ka maʻi ʻaʻai ʻōpala i kahi pākēneka liʻiliʻi o nā mea maʻi.

Interleukin-2 (IL-2)

ʻO kēia ka cytokine maikaʻi loa no ka mālama ʻana i ka maʻi ʻaʻai kidney.

ʻO nā kiʻekiʻena o ka IL-2, hiki i nā hopena ʻino ke hōʻeha a i kekahi manawa. Hoʻopili kēia mau hopena i ka luhi, ke koko haʻahaʻa, pilikia ka hanu ʻana, ka loaʻa ʻana o ka wai i nā akemāmā, ke kahe ʻana o ka ʻōpū, ka maʻi diarrhea, a me nā puʻuwai puʻuwai.

Ma muli o kona ʻano kūlana kiʻekiʻe loa, hāʻawi pinepine ʻia ʻo IL-2 i ka poʻe i lawa ke olakino e kū i nā hopena ʻaoʻao.

Interferon-alfa

ʻO Interferon-alfa kekahi cytokine i kekahi manawa e mālama i ka maʻi ʻaʻai ʻōpū. Hāʻawi pinepine ʻia ia ma ke ʻano he subcutaneous injection ʻekolu manawa o ka pule. ʻO nā hopena ʻē aʻe e pili pū me nā hōʻailona like flu, nausea, a me ka luhi.

ʻOiai ʻoi aku ka paʻakikī o kēia mau hopena ʻaoʻao ma mua o IL-2, ʻaʻole maikaʻi ka interferon ke hoʻohana ʻia e ia iho. A ʻo kahi hopena, hoʻohana mau ʻia ia me ka lāʻau i manaʻo ʻia i kapa ʻia ʻo bevacizumab.

Nā mea kāohi checkpoint

Pale kou ʻōnaehana pale pale iā ia iho mai ka hoʻouka ʻana i nā hunaola maʻamau i kou kino ma o ka hoʻohana ʻana i nā “checkpoints.” ʻO kēia mau mole i kou mau hunaola pale e pono e huli a hoʻopau ʻia paha e hoʻomaka ai kahi pane pale. Hoʻololi i nā hunaola i kekahi manawa i hoʻohana i kēia mau wahi huli e hōʻalo ʻole i ka māka ʻia e ka ʻōnaehana pale.

ʻO nā mea hoʻopailaha checkpoint nā lāʻau e kuhi i kēlā mau wahi nānā. Kōkua lākou i ka mālama ʻana i ka pane o kāu ʻōnaehana pale maʻi i nā hunaola maʻi ʻaʻai.

Nivolumab (Opdivo)

ʻO Nivolumabis kahi mea hoʻowahāwahā helu nāna e pale a pale iā PD-1. ʻO PD-1 kahi protein i nā pūnaewele T o kou pale pale pale e pale iā lākou i ka hoʻouka kaua ʻana i nā hunaola ʻē aʻe i kou kino. Kōkua kēia i ka hoʻoikaika ʻana i kāu pane pale pale kūʻē i nā hunaola maʻi ʻaʻai a i kekahi manawa hiki ke hōʻemi i ka nui o nā tumors.

Hāʻawi pinepine ʻia ʻo Nivolumab i hoʻokahi manawa i kēlā me kēia pule ʻelua. He koho kūpono ia no ka poʻe nona ka RCC i hoʻomaka e ulu hou ma hope o ka hoʻohana ʻana i nā lāʻau lapaʻau ʻē aʻe.

Ipilimumab (Yervoy)

ʻO Ipilimumab kahi mea pale pale pale ʻē aʻe e māka ana i ka protein CTLA-4 ma nā hunaola T. Hāʻawi ʻia me ka intravenously, maʻa mau i kēlā me kēia pule i ʻekolu pule no ʻehā mau lāʻau.

Hiki ke hoʻohana ʻia ʻo Ipilimumab i ka hui pū me ka nivolumab. ʻO kēia no ka poʻe me ka maʻi ʻaʻai kiʻekiʻe loa i loaʻa ʻole ka lāʻau.

Ua hōʻike ʻia kēia hui ʻana e hoʻonui i ka nui o ke ola ʻana. Hāʻawi nui ʻia i ʻehā mau lāʻau, a ukali ʻia e ka papa o ka nivolumab nona iho.

ʻO nā ʻikepili mai kēia noi ʻana i paʻi ʻia ma ka New England Journal of Medicine i hōʻike ʻia i kahi lālani ola maikaʻi he 18 mau makahiki me ka mālama pū ʻana o ka nivolumab a me ka ipilimumab.

Ma ʻApelila 16, 2018, ua ʻae ka FDA i kēia hui pū ʻana no ka mālama ʻana i nā poʻe me ka carcinoma kōkō nui ʻoi loa a me waena.

Nā hopena ʻē aʻe

ʻO nā hopena maʻa mau o nā mea pale pale pale luhi ka luhi, ʻili, ʻili, a me ka diarrhea. I nā hihia kakaikahi, hiki i nā mea kāohi PD-1 a me CTLA-4 ke alakaʻi i nā pilikia o ke kino ʻino e lilo i mea hoʻoweliweli i ke ola.

Inā loaʻa iā ʻoe i kēia manawa ka mālama ʻana i ka lāʻau immunotherapy me hoʻokahi a ʻelua paha o kēia mau lāʻau a hoʻomaka i ka ʻike ʻana i nā hopena ʻē aʻe, hōʻike koke iā lākou i kāu kauka.

Lawe aku

ʻO ka lāʻau āu e hoʻoholo ai a me kāu kauka e pili ai i nā kumu he nui. Inā ʻoe e noho nei me ka metastatic RCC, e kamaʻilio me kāu kauka e pili ana i kāu koho lapaʻau.

Hiki iā ʻoe ke kūkākūkā inā paha he ala lapaʻau kūpono kēia na ʻoe. Hiki iā lākou ke kamaʻilio pū me ʻoe e pili ana i nā hopohopo āu e pili ana i nā hopena a i ʻole ka lōʻihi o ka lāʻau.