Mhando dzeImmunotherapy yekurapa kenza
Kurapa kenza inzira yekurapa kenza inoshandisa masoja emuviri kuti aone uye arwise masero ekenza. Kusiyana nechemotherapy, iyo inorwisa masero anokamura nekukurumidza, kana radiotherapy, iyo inokuvadza DNA yemasero ekenza nemwaranzi, immunotherapy inoshanda ne "kuwedzera," "kutungamira," kana "kusunungura mabhureki" pamhinduro yemasoja emuviri, zvichiita kuti muviri uve unoshanda zvakanyanya pakuparadza kenza. Mumakore achangopfuura, immunotherapy yave budiriro huru mu oncology nekuti inogona kupa mhinduro dzinogara kwenguva refu kune vamwe varwere, kunyangwe mumakenza aimbove akaoma kurapa.
Zvisinei, kurapa nekudzivirira muviri hakukodzeri mhando dzese dzekenza kana varwere vese. Migumisiro inogona kusiyana nekurapa kwakajairika, kazhinji kunokonzerwa nekuwanda kwesimba remuviri rekudzivirira muviri. Nokudaro, sarudzo yekurapa nekudzivirira muviri inowanzoenderana nerudzi rwekenza, danho rechirwere, mamiriro emurwere, uye zviratidzo zvebiomarker. Idzi ndidzo mhando dzinonyanya kushandiswa pakurapa nekudzivirira muviri.
1. Zvidziviriro zveImmune Checkpoint (Zvidziviriro zveImmune Checkpoint)
Imwe yenzira dzinozivikanwa zvikuru dzekurapa nekudzivirira muviri imishonga inodzivirira immune checkpoint. Masoja ekudzivirira muviri ane "nzvimbo dzekutarisa," nzira dzechisikigo dzinodzivirira mhinduro dzakawandisa dzekudzivirira muviri dzinogona kukuvadza nyama dzemuviri. Masero egomarara anowanzo shandisa nzvimbo idzi dzekutarisa kuti "avanze" kubva pakurwiswa nemasero eT (masero ekudzivirira muviri anouraya).
Zvinodzivirira masero ekenza zvinoshanda nekuvharira mapuroteni chaiwo ekuongorora, zvichibvumira masero eT kuti atangezve uye arwise masero ekenza. Zvinhu zviviri zvinonyanya kutariswa ndeizvi:
– PD-1/PD-L1 (Programmed Death-1 / Ligand-1): Masero egomarara anogona kuburitsa PD-L1 kuti "adzime" masero eT. Mishonga inodzivisa PD-1 kana PD-L1 inogona kubatsira kuvhurazve basa remasero eT.
– CTLA-4 (Cytotoxic T-Lymphocyte–Associated Protein 4): CTLA-4 inodzivirira kushanda kwemasero eT, kunyanya pakutanga kwemhinduro yemuviri.
Mishonga inodzivirira Checkpoint inoshandiswa kurapa mhando dzakasiyana dzekenza, kusanganisira melanoma, kenza yemapapu, kenza yeitsvo, kenza yedundira, uye dzimwe kenza dzemusoro nemutsipa. Kubatsira kwekurapa uku ndiko kugona kwemhinduro inogara kwenguva refu, asi njodzi dzinosanganisira migumisiro ye autoimmune yakadai se colitis, pneumonitis, thyroid disorders, uye kunyange autoimmune hepatitis.
2. Kurapa neCAR T-Cell (CAR T-Cell Therapy)
Kurapa neCAR T-cell imishonga inorwisa kenza yakagadzirwa nemunhu wese. Mukurapa uku, masero eT emurwere anotorwa kubva muropa obva agadziriswa murabhoritari kuti ave nereceptor yakakosha inonzi Chimeric Antigen Receptor (CAR). Iyi receptor yakagadzirirwa kuziva maantigen chaiwo pamusoro pemasero ekenza. Kana yangogadziriswa uye yawanda, masero eT anodzoserwa mumuviri wemurwere kuti atsvage nekuparadza masero ekenza.
Kurapa neCAR T-cell kwaratidza kubudirira kukuru kunyanya mune mamwe magomarara eropa, akadai se:
- acute lymphoblastic leukemia (ALL) mune dzimwe nguva,
- mamwe ma lymphoma asiri eHodgkin,
- multiple myeloma mune zvimwe zviratidzo.
Zvisinei, kurapwa uku kunogonawo kukonzera matambudziko akakomba, akadai seCytokine Release Syndrome (CRS), iyo inokonzera fivha yakanyanya uye BP yakaderera, pamwe nezvimwe zvirwere zvetsinga. Uyezve, mitengo uye kuwanikwa kwenzvimbo zvinonetsa nekuda kwemaitiro akaomarara.
3. MaAntibodies eMonoclonal
Ma antibodies emonoclonal mapuroteni akagadzirwa kuti abatanidzwe kune zvinangwa zvakananga pamasero ekenza. Ne "kuisa mazita" pamasero ekenza, ma antibodies anobatsira masoja emuviri kuziva bundu kana kukanganisa zviratidzo zvekukura kwekenza.
Kune nzira dzakasiyana-siyana dzinoshanda nadzo ma antibodies e monoclonal mukenza:
1. Ma antibodies anodzivirira kukura kwemasero ekenza: anodzivirira kukura kwemasero ekenza.
2. Masoja ekudzivirira muviri anokonzera kuparadzwa nemasoja ekudzivirira muviri: anokwezva masero ekudzivirira muviri kuti arwise masero ane mavara.
3. Mushonga wekudzivirira muviri (ADC): ma antibodies anotakura "mutoro" wemishonga yechemotherapy kuenda kumasero ekenza kuitira kuti anyatsonangwa.
4. Radioimmunotherapy: ma antibodies anotakura zvinhu zvine mwaranzi kuenda kugomarara.
Ma antibodies e monoclonal anoshandiswa zvakanyanya kurapa mhando dzakasiyana dzekenza, kusanganisira kenza yemazamu, lymphoma, kenza ye colorectal, nezvimwewo. Migumisiro yakasiyana, kubva pakuiswa kwemishonga uye mapundu paganda kusvika pakukuvara kwenhengo, zvichienderana nechinangwa chavanoda.
4. Majekiseni eKenza
Majekiseni egomarara anovavarira kuita kuti masoja emuviri akwanise kuziva maantigen egomarara. Kusiyana nemajekiseni ekudzivirira zvirwere zvinotapukira, majekiseni egomarara anoiswa muzvikamu zviviri zvikuru:
– Majekiseni ekudzivirira: kudzivirira kenza inokonzerwa nemavhairasi akasiyana. Mienzaniso inozivikanwa zvikuru ndeye HPV, iyo inoderedza njodzi yekenza yemumuromo wechibereko uye mamwe magomarara emusoro nemutsipa, uye hepatitis B, iyo inoderedza njodzi yegomarara rechiropa.
– Majekiseni ekurapa: anopiwa varwere vane kenza kare kuti vabatsire masoja emuviri kurwisa bundu.
Majekiseni ekurapa anowanzo tarisa maantigen chaiwo egomarara remurwere kana maantigen akajairika kune mamwe marudzi egomarara. Mhinduro dzinogona kusiyana, uye tsvakiridzo iri kuramba ichivandudza kushanda kwayo, kusanganisira kushandisa musanganiswa wezvinodzivirira chirwere.
5. Kurapa neCytokine
MaCytokine anoratidza mamorekuru anoshandiswa nemasero emuviri kutaurirana uye kudzora maitiro emuviri ekudzivirira chirwere. Mukurapa kenza, mamwe macytokine anogona kupihwa kuti awedzere kushanda kwemuviri.
Mienzaniso yema cytokines akashandiswa zvakanyanya inosanganisira:
– Interleukin-2 (IL-2): inogona kukurudzira kuwanda kwemasero eT nemasero eNK (natural killer). Yakashandiswa mune mamwe kenza yeitsvo uye melanomas.
– Interferon alpha: inogona kuwedzera simba rekudzivirira muviri uye ine simba rekudzivirira kukura kwezvirwere zvegomarara.
Kurapa ne cytokine kunogona kushanda kune vamwe varwere, asi kazhinji kune migumisiro yakaipa mumuviri yakaita sefivha, kuneta kwakanyanya, BP yakaderera, uye kusashanda zvakanaka kwenhengo dzemuviri, saka kushandiswa kwayo kwava kusarudza zvakanyanya uye kunowanzo tsiviwa nemishonga chaiyo yekudzivirira muviri.
6. Kurapa neOncolytic Virus
Kurapa nehutachiona hweOncolytic kunoshandisa mavhairasi akagadziriswa kutapurira nekuparadza masero ekenza, ukuwo "kumutsa" masoja emuviri kuti aone bundu. Kana hutachiona hwapwanya (kupwanya) masero ekenza, maantigen ebundu anoburitswa, zvichikonzera mhinduro yakakura yekudzivirira muviri.
Kurapa uku kunokwezva nekuti kunoshanda nenzira mbiri: kuparadzwa zvakananga kwemasero egomarara uye kusimbiswa kwesimba rekudzivirira chirwere chegomarara. Kazhinji kunopihwa kuburikidza nekubaiwa zvakananga mugomarara. Tsvagiridzo iri kuenderera mberi yekuwedzera kushandiswa kwaro mumhando dzakasiyana dzegomarara uye kuisanganisa ne checkpoint inhibitors kuti iite basa rakasimba.
7. Kurapa kweTIL uye Kumwe Kurapa KwemaSero Ekurera
Kunze kweCAR T, kune dzimwe nzira dzinonzi adoptive cell therapy, dzakadai se tumor-infiltrating lymphocytes (TIL) therapy. MuTIL therapy, vanachiremba vanotora masero ekudzivirira muviri aripo kare munyama yebundu (lymphocytes "dzinopinda" mubundu, voawedzera murabhoritari, vozoadzosera kumurwere. Nekuti masero aya "akadzidziswa" kuziva nzvimbo yebundu, kurapa uku kunogona kushanda mune dzimwe nguva, kunyanya mukutsvaga nedzimwe nzvimbo dzekenza.
Kunewo nzira dzekugadzira masero eT nemamwe mareceptor (semuenzaniso, masero eT akagadzirwa neTCR), ayo anotarisa maantigen egomarara kuburikidza nenzira yakasiyana yekuziva kupfuura maCAR.
Kusanganiswa kweImmunotherapy uye Matambudziko Emangwana
Mukurapa, immunotherapy inowanzo sanganiswa ne chemotherapy, radiotherapy, therapy yakanangana, kana musanganiswa we immunotherapy. Chinangwa ndechekuwedzera mukana wekupindura, kukunda kuramba, uye kuwedzera huwandu hwevarwere vanogona kubatsirwa.
Zvisinei, matambudziko makuru achiripo, akadai se:
- havasi varwere vese vanopindura,
- kufanotaura mhinduro kunoda zviratidzo chaizvo (semuenzaniso PD-L1 expression, bundu rinochinja, MSI-yakakwira mune mamwe magomarara),
- migumisiro ye autoimmune inofanira kutariswa zvakanyanya,
- kuwana rubatsiro uye mutengo wekurapwa zvichiri dambudziko munzvimbo dzakawanda.
Penutup
Kurapa nekudzivirira kenza kwakachinja mamiriro ekurapa kenza nekupa nzira itsva yekushandisa simba remuviri wekudzivirira kenza. Sarudzo idzi dzinotangira pakuongorora mishonga inodzivirira kenza, CAR T-cell therapy, monoclonal antibodies, majekiseni ekenza, cytokine therapy, oncolytic viruses, uye adoptive cell therapy dzakadai seTILs. Nzira yega yega ine zvakanakira zvakasiyana, zvisingakwanisike, uye zviratidzo. Nokudaro, sarudzo nezve immunotherapy dzinofanira kuitwa nekubvunzana nachiremba wekenza, tichifunga nezverudzi rwekenza, mamiriro emurwere, uye zviratidzo zvakakodzera. Nekuenderera mberi nekutsvaga, immunotherapy inotarisirwa kuti ishande zvakanyanya, yakachengeteka, uye inowanikwa nyore nyore kune varwere vekenza.
