ukwelashwa ukuguqulwa kofuzo ukwelashwa komdlavuza wamaphaphu

Ukwelashwa Kwezinguquko Zofuzo Kumdlavuza WamaphaphuUkuqonda Nokwelapha Ukuguquka Kwezakhi Zofuzo Kumdlavuza Wamaphaphu: Umhlahlandlela Ophelele Umdlavuza wamaphaphu uyisifo esiyinkimbinkimbi, futhi ukwelashwa kwawo kuvame ukuncika ekuguquguqukeni kofuzo okuthile okukhona esimila. Lo mhlahlandlela unikeza umbono obanzi wendima yokuhlolwa kofuzo kumdlavuza wamaphaphu, ukuguqulwa kofuzo okuvamile, kanye nezinketho zokwelashwa ezitholakalayo. Ihlose ukunika iziguli kanye nemindeni yazo amandla ngolwazi oludingekayo ukuze zihambe kulolu hambo oluyinselele. Sizohlola izindlela zokwelapha ezihlosiwe, i-immunotherapy, namanye amasu asetshenziswa njengamanje ekulawuleni umdlavuza wamaphaphu oqhutshwa ukungahambi kahle kofuzo.

Ukuhlolwa Kofuzo Kumdlavuza Wamaphaphu

Ukubaluleka Kwephrofayili Yemolekyuli

Ngaphambi kokuqala ukwelashwa ukuguqulwa kofuzo ukwelashwa komdlavuza wamaphaphu, ukuhlolwa kwezakhi zofuzo kubalulekile. Le nqubo, evame ukubizwa ngokuthi iphrofayili yamangqamuzana noma ukuhlolwa kwe-biomarker, ikhomba izinguquko ezithile zofuzo ngaphakathi kwamaseli wesimila. Lezi zinguquko zingaba nomthelela ezinqumweni zokwelashwa futhi zibikezele amathuba okusabela kokwelashwa. Izakhi zofuzo ezivame ukuhlolwa zifaka i-EGFR, ALK, ROS1, BRAF, ne-KRAS. Ukwazi ukuguqulwa kwezakhi zofuzo ezithile kuvumela izazi ze-oncologist ukuthi zenze izindlela zokwelapha ezihambisana nomdlavuza wesiguli ngasinye. Imiphumela yokuhlolwa kofuzo ibalulekile ukuze kutholwe inkambo engcono kakhulu yokwenza.

Izinhlobo Zokuhlolwa Kwezakhi Zofuzo

Ziningi izindlela ezitholakalayo zokuhlolwa kofuzo, ngayinye inezinzuzo zayo kanye nokubi. Lokhu kufaka phakathi ukulandelana kwesizukulwane esilandelayo (i-NGS), okuvumela ukuhlolwa ngesikhathi esisodwa kwezakhi zofuzo eziningi, kanye ne-polymerase chain reaction (PCR), indlela eqondiswe kakhulu egxile ezakhini ezithile zofuzo. Ukukhethwa kwendlela kuncike ezintweni ezifana nezinsiza ezikhona kanye nemibuzo ethile yomtholampilo okukhulunywa ngayo. I-oncologist yakho izokuqondisa kunketho yokuhlola engcono kakhulu esekelwe esimweni sakho ngasinye.

Ukuguqulwa Kofuzo Okujwayelekile Kumdlavuza Wamaphaphu kanye Nokwelashwa Kwawo

Ukushintsha kwe-EGFR

Ukuguqulwa kwe-EGFR kuvamile kumdlavuza wamaphaphu ongewona omncane (NSCLC), ikakhulukazi ezigulini ezingakaze zibheme noma ezinomlando wokubhema okuncane. Izindlela zokwelapha ezihlosiwe, njenge-EGFR tyrosine kinase inhibitors (TKIs), zisebenza kahle kakhulu ezigulini ezinalezi zinguquko. Lawa ma-inhibitors avimba umsebenzi wephrotheni ye-EGFR eguquliwe, ivimbele ukukhula kwesimila. Izibonelo zifaka i-gefitinib, i-erlotinib, ne-afatinib. Nokho, ukumelana nale mithi kungakhula ngokuhamba kwesikhathi.

Ukuhlelwa kabusha kwe-ALK

Ukuhlelwa kabusha kwe-ALK kungolunye uguquko olubalulekile lomshayeli ku-NSCLC. Ngokufanayo nokuguqulwa kwe-EGFR, ukuhlela kabusha kwe-ALK kuvame ukuqondiswa ngama-TKI athile. I-Criztinib ne-alectinib yizibonelo ze-ALK inhibitors eziye zabonakala zisebenza kahle ekwelapheni iziguli ezinomdlavuza wamaphaphu we-ALK-positive. Ukuqapha okuvamile kubalulekile ukuze kubonakale nokulawula noma yikuphi ukumelana okungase kuthuthuke.

Ukuhlelwa kabusha kwe-ROS1

Ukuhlelwa kabusha kwe-ROS1 akuvamile kunokuhlelwa kabusha kwe-EGFR noma kwe-ALK, kodwa kwabelana ngezindlela ezifanayo zokwelapha. Iziguli ezinomdlavuza wamaphaphu we-ROS1-positive zingazuza ekwelashweni okuhlosiwe, njenge-crizotinib, i-lorlatinib, ne-entrectinib. Lezi zindlela zokwelapha zibonise impumelelo ekwandiseni isikhathi sokuphila kanye nokwenza ngcono izinga lempilo yeziguli ezinalolu shintsho.

Ezinye Izinguquko

Okunye ukuguqulwa kofuzo okuningi kungaba nomthelela ekuthuthukisweni komdlavuza wamaphaphu, okuhlanganisa ukuguqulwa kwe-BRAF, KRAS, kanye ne-HER2. Nakuba izindlela zokwelapha ezihlosiwe zikhona kwezinye zalezi zinguquko, isimo sokwelapha siyaqhubeka sishintsha, nocwaningo oluqhubekayo luhlola izinketho ezintsha nezithuthukisiwe. I-Shandong Baofa Cancer Research Institute (https://www.baofahospital.com/) uhamba phambili kulolu cwaningo, ehlala ehlola izindlela ezintsha zokwelapha umdlavuza wamaphaphu.

Amasu Okwelapha Angaphezu Kokwelashwa Okuhlosiwe

I-Immunotherapy

I-Immunotherapy ihlanganisa amandla amasosha omzimba esiguli ukulwa nomdlavuza. Ama-Checkpoint inhibitors, njenge-pembrolizumab ne-nivolumab, asetshenziswa ku ukwelashwa ukuguqulwa kofuzo ukwelashwa komdlavuza wamaphaphu, ngezinye izikhathi kuhlanganiswe nokwelashwa okuhlosiwe noma ukwelashwa ngamakhemikhali. Le mithi ivimba izindawo zokuhlola amasosha omzimba, ivumela amasosha omzimba ukuthi abone kangcono futhi ahlasele amangqamuzana omdlavuza. I-Immunotherapy ingasebenza ngisho nasezimeni lapho izindlela zokwelapha ezihlosiwe zingase zingasebenzi.

I-Chemotherapy

I-Chemotherapy isalokhu iyindlela yokwelapha ebalulekile yomdlavuza wamaphaphu, ikakhulukazi ezimeni lapho izindlela zokwelapha ezihlosiwe noma i-immunotherapy zingafanelekile. Kodwa-ke, i-chemotherapy ngokuvamile ayihlosiwe kakhulu kunezokwelapha ezintsha, futhi ingaba nemiphumela emibi kakhulu.

Ukwelapha Ngemisebe

Ukwelashwa ngemisebe kungasetshenziswa ukukhomba nokubhubhisa amangqamuzana omdlavuza. Ivame ukusetshenziselwa ukunciphisa amathumba, ukunciphisa ubuhlungu, noma ukunciphisa ezinye izimpawu. Ingasetshenziswa yodwa noma ihlanganiswe nezinye izindlela zokwelapha.

Ukuzulazula Ohambweni Lokwelapha

Uhlobo Lokwelapha	Izinzuzo	Ukubi
Ukwelapha Okuhlosiwe	Ukusebenza okuphezulu ezinguqukweni ezithile, imiphumela engemihle embalwa kune-chemotherapy.	Ukumelana kungakhula, kungasebenzi kuzo zonke izinguquko.
I-Immunotherapy	Izimpendulo ezihlala isikhathi eside, zingasebenza ngisho nokumelana nezinye izindlela zokwelapha.	Okungaba khona ezehlakalweni ezimbi ezihlobene nokuzivikela komzimba.
I-Chemotherapy	Isebenza ezinhlotsheni eziningi zomdlavuza, ezitholakala kabanzi.	Imithelela engemihle eminingi kunokwelashwa okuqondisiwe noma i-immunotherapy, ukwelashwa okungaqondisiwe kakhulu.

Ukukhetha okulungile ukwelashwa ukuguqulwa kofuzo ukwelashwa komdlavuza wamaphaphu kuyinqubo eyinkimbinkimbi edinga ukubambisana okuseduze phakathi kwesiguli, i-oncologist yaso, nabanye ochwepheshe bezempilo. Kubalulekile ukubuza imibuzo, ukuqonda izinketho zokwelashwa, nokubamba iqhaza ngokukhuthala ekuthathweni kwezinqumo. Khumbula, intuthuko ocwaningweni ihlale icwenga amasu okwelapha umdlavuza wamaphaphu. Hlala unolwazi, futhi ungangabazi ukufuna ukwesekwa emaqenjini amelela iziguli namanethiwekhi okusekela.Umshwana wokuzihlangula: Lolu lwazi lwenzelwe izinjongo zokufundisa kuphela futhi akufanele luthathwe njengeseluleko sezokwelapha. Hlala uthintana nochwepheshe bezempilo nganoma yikuphi ukukhathazeka ngezempilo noma ngaphambi kokwenza noma yiziphi izinqumo ezihlobene nempilo noma ukwelashwa kwakho.