Kwimpumelelo engazange ibonwe ngaphambili, ibhinqa elinomhlaza webele ophucukileyo osasazeke emzimbeni walo wabonisa ukwehla ngokupheleleyo kwesi sifo ngokusebenzisa amandla amajoni akhe omzimba ukulwa nomhlaza.
Umhlaza webele ngowona mhlaza uxhaphakileyo kubasetyhini kwihlabathi liphela, kwihlabathi eliphuhlileyo nelingenaphuhliso kangako. Umhlaza webele ukwangowona mhlaza uxhaphakileyo kubasetyhini. Malunga ne-1.7 yezigidi zeziganeko ezintsha zifunyaniswa minyaka le kwaye umhlaza webele umele i-25% yazo zonke iintlobo zomhlaza kubasetyhini. Unyango lomhlaza webele luxhomekeke kwinqanaba kwaye ngokubanzi lufuna enye okanye ngaphezulu kwezi nkqubo zilandelayo - i-chemotherapy, unyango lwe-radiation, unyango lwe-hormone kunye notyando. Umhlaza webele osasazekayo , oko kukuthi, xa umhlaza usasazeke usuka ebeleni uye kwezinye iindawo zomzimba, awunyangeki. Kufuneka iindlela ezingxamisekileyo zokujonga nokuthintela ukusasazeka kwesi sifo sibulalayo.
Ukuphumelela ekunyangeni umhlaza webele we-metastatic
I-Immunotherapy luhlobo lonyango olusebenzisa nje iindawo ezithile zesistim somzimba somntu ukulwa nezifo ezifana nomhlaza . Le ndlela ibandakanya ukuvuselela isistim somzimba sakho ukuze sisebenze ngokufanelekileyo ukuhlasela iiseli zomhlaza/ithumba emzimbeni. Kwisifundo esitsha esikhokelwa nguGqr. Steven A. Rosenberg, oyiNtloko yoGqirha kwiNational Cancer Institute (NCI), abaphandi baphuhlise indlela eyahlukileyo ye-immunotherapy yokunyanga umhlaza 1. Baphuhlise indlela ephezulu yokuchonga utshintsho olukhoyo kumhlaza (iiseli) kwaye olunokuqatshelwa yinkqubo yomzimba yokuzikhusela. Zonke iimhlaza zinenguqu kwaye ezo "zijoliswe" okanye "zihlaselwa" kule ndlela ye-immunotherapy. Unyango olutsha luhlobo oluguquliweyo lwe-ACT (adoptive cell transfer) oluye lwasetyenziswa ngaphambili ekunyangeni ngempumelelo i-melanoma (umhlaza wolusu) apho kukho inani elikhulu leenguqu ezifunyenweyo. Nangona kunjalo, le ndlela ayisebenzi kakuhle kwiimhlaza eziqala kwizicubu zomzimba, njengesisu, i-ovarian kunye nebele. Olu phononongo njengoko ababhali besitsho lukwinqanaba lokuqala kwaye ikakhulu luvavanyo kodwa ngokuqinisekileyo luthembisa.
Ibhinqa elineminyaka engama-49 ubudala elinomhlaza webele okhula ngokukhawuleza nowawusele ufikelele kwinqanaba lokugqibela ( oko kukuthi, usasazeke kwamanye amalungu omzimba walo) ladlula kuvavanyo lweklinikhi lwale ndlela intsha. Ngaphambili lalifumene unyango oluninzi, kuquka iindlela ezininzi zonyango lwe-chemotherapy kunye nonyango lwe-hormone, kodwa zonke ezi zinto zazingaphumeleli ukunqanda inkqubela yomhlaza ebeleni lalo lasekunene kwaye lalisele lisasazeka esibindini nakwezinye iindawo zomzimba walo. Ezi zifo zazichaphazela nemithambo-luvo yalo nto leyo eyayikhokelela kwiintlungu zokudubula emzimbeni. Laliyekile kwaye lalizilungiselela ngokwengqondo ukuba imeko yalo yayingaphenduli kunyango, isiya isiba mandundu kwaye liseneminyaka emithathu kuphela yokuphila. Le yayiyimeko yengqondo awayekuyo xa wayeza kulingwa. Ukuze bakwazi ukusebenzisa unyango lwe-immunotherapy kuye, abaphandi balandelelanisa i-DNA kunye ne-RNA kwizicubu eziqhelekileyo nakwinye yezihlunu zakhe ezinobungozi ngokuzisika zibe ziingceba ezincinci. Ngale ndlela babenokufumana ngononophelo utshintsho olwalukho ngokukodwa kumhlaza walo . Bakwazile ukuchonga utshintsho oluhlukeneyo olungama-62 kwiiseli zalo zesifo ngokujonga ikakhulu ii-gene ezine eziphazamisekileyo ezazinoxanduva lokuvelisa iiproteni ezingaqhelekanga ngaphakathi kweeseli zomhlaza.
Abaphandi bakwakhuphe "iiseli zomzimba" (ii-lymphocytes ezifaka i-tumor okanye ii-TIL) kwii-biopsies ze-tumor ukuze baqonde indlela i-immune system yesigulane ehlasele ngayo i-tumor yaza yazama ukuyibulala kodwa ngokucacileyo ayizange iphumelele kwaye yiyo loo nto umhlaza uqhubeka. I-immune system iyasilela xa iiseli zayo zokulwa zibuthathaka okanye zimbalwa ngenani. Abaphandi bahlalutye phantse ibhiliyoni yeeseli zomzimba zomzimba ezikhulayo okanye ii-TIL kwilebhu kwaye bahlola uluhlu olufutshane lweeseli zomzimba ezithile ezazisebenza ekubulaleni ii-tumor ngokuqaphela iiproteni ezingaqhelekanga eziveliswe kukuguqulwa kwezakhi zofuzo kwasekuqaleni. Emva koko bafaka iiseli zomzimba ezikhethiweyo ezimalunga ne-80 yeebhiliyoni emzimbeni wesigulane kunye neyeza eliqhelekileyo elibizwa ngokuba yi-pembrolizumab elinceda i-immune system ukulwa nomhlaza . Okumangalisayo kukuba, emva kolu nyango isigulane sasingenawo umhlaza kwaye sihlale singenawo ngokupheleleyo umhlaza phantse iinyanga ezingama-22 ngoku. Isigulane sicinga oku njengohlobo oluthile lommangaliso kwaye ngokwenene kunjalo. Le immunotherapy itsha epapashwe kwi-Nature Medicine ibonakalise ukuba ibulala iiseli zomhlaza ngempumelelo kakhulu. Kwilingo leklinikhi lesigaba sesi-2 eliqhubekayo , izazinzulu ziphuhlisa uhlobo lwe-ACT olusebenzisa ii-TIL ezijolise ngokukodwa kwiinguqu zeeseli zethumba ukuze zibone ukuba zinokuncitshiswa na ngenxa yomhlaza ofana nowebele emva kokuba zibuyiselwe kwisigulana. Injongo kukudala impendulo enamandla yomzimba yokulwa nethumba.
Future
Le ngxelo yetyala ibonakalisa ngokulula nangokufanelekileyo amandla e-immunotherapy kuba inkqubo yethu yokuzikhusela komzimba ikholelwa ukuba inamandla kakhulu. Luphononongo olumangalisayo kuba umhlaza webele, njengomhlaza we-prostrate kunye nomhlaza we-ovarian, une-mutations ezimbalwa kakhulu ezenza kube nzima ngakumbi ukuba inkqubo yokuzikhusela yomzimba iwabone kwaye iwaphawule njengezicubu ezingaphiliyo. Nangona ivavanywa kweli nqanaba, le ndlela intsha iyathembisa kakhulu kuba isebenzisa i-immunotherapy exhomekeke kwi-mutations kungekhona kuhlobo lomhlaza ngoko ke ngaloo ndlela ingasetyenziselwa unyango lweentlobo ezininzi zomhlaza. Ke, olu hlobo lonyango lunokuba "lungekho kuhlobo oluthile lomhlaza ". Sele luvelise ithemba ekunyangeni umhlaza webele osasazekayo (ongenazo ii-antigens ezininzi) emva kokuphumelela kwisigulana esinye kwaye ngaloo ndlela ukunyanga eminye i-cancer "enzima" efana ne-prostrate kunye ne-ovarian kufuneka kufezekiswe. Kubonakala ngathi kuthembisa ukusebenza kuluhlu lwee-tumor apho iindlela ezaziwa ngaphambili ze-immunotherapy zingasebenzi kakuhle. Olu phononongo luyonwabisa kodwa kufuneka luphindwe ukuze abanye abaguli bavavanye impumelelo yalo. Abaphandi sele becwangcise uvavanyo olukhulu lweklinikhi ukuvavanya ukusebenza kolu nyango kwinani elikhulu lezigulane. Izazinzulu zikholelwa ukuba kusekude kakhulu ngaphambi kokuba unyango olunjalo lufumaneke kunyango oluqhelekileyo lwezigulane. Unyango olunjalo luyinkimbinkimbi kakhulu kwaye lubiza kakhulu kuba lufuna ukungena kwiiseli zomzimba zesigulana kwaye ukwandiswa kwezi seli nako akunakwenzeka kuzo zonke iimeko. Nangona kunjalo, uphando oluphambili ngokuqinisekileyo lunike ulwalathiso kwinjongo engaqondakaliyo yokujolisa kwiinguqu ezininzi kumhlaza ngokusebenzisa unyango lwe-immunotherapy.
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Umthombo (s)
1. UZacharakis N et al. 2018. Ukuqatshelwa kwamasosha omzimba kotshintsho lwe-somatic olukhokelela ekubuyeleni okungapheliyo kumhlaza webele osasazekayo. Nature Medicine . https://doi.org/10.1038/s41591-018-0040-8
2. Ithala leeNcwadi leSizwe lezonyango lase-US. Unyango lwe-Immunotherapy olusebenzisa i-Tumor Infiltrating Lymphocytes kwizigulane ezineMetastatic Cancer. https://clinicaltrials.gov/ct2/show/NCT01174121 . [Kufikelelwe ngoJuni 6, 2018].
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Amagqabantshintshi zivaliwe.