Chakudya Chamtundu Wokha / Chakudya cha Khansa ya M'mawere ya Metastatic

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Khansa ya m'mawere ya metastatic ndi khansa yayikulu yomwe yafalikira mbali zina za thupi kupitirira minofu ya m'mawere, ndipo imakhala yolakwika kwambiri. Chithandizo cha chotupa cha m'mawere chotupa chotupa chimasunthira pakukonda kwanu chifukwa cha khansa. Zakudya zofananira zaumwini (chakudya ndi zowonjezera) zotengera khansa ndi chithandizo zikusowa ndipo zimafunikira kwambiri kuti zithetse mwayi wopambana komanso moyo wa wodwala khansa. Blog iyi imawunikira zosowa, mipata ndi zitsanzo za zakudya zopatsa thanzi / zakudya (chakudya ndi zowonjezera) za khansa ya m'mawere.

Maziko a Khansa ya m'mawere

Khansa ya m'mawere ndi khansa yomwe imapezeka kwambiri ndipo ndi imodzi mwazomwe zimayambitsa kufa kwa azimayi padziko lonse lapansi. Chimodzi mwazinthu zodziwika bwino kwambiri za khansa ya m'mawere ndimadalira mahomoni ogonana, estrogen (ER) ndi progesterone (PR) cholandilira cholandila komanso chotupa cha epidermal kukula kwa anthu 2 (ERBB2, yotchedwanso HER2) yoyipa - (ER + / PR + / HER2- subtype). Hormone positive subtype ya khansa ya m'mawere ili ndi chiwonetsero chabwino chokhala ndi zaka 5 zapakati pa 94-99% (Waks ndi Winer, JAMA, 2019). Mitundu ina ya bere khansa ndi ma hormone receptor negative, HER2 positive subtype ndi triple negative breast cancer (TNBC) subtype yomwe ndi ER, PR ndi HER2 negative. Mtundu wamtundu wa TNBC uli ndi vuto loyipa kwambiri komanso mwayi waukulu kwambiri wopitilira matenda ochedwa omwe afalikira ndikufalikira kumadera ena athupi.

Khansara ya m'mawere ndi yotupa kwambiri, khansa ya IV yomwe yakhala ikufalikira mbali zina za thupi (nthawi zambiri mafupa, mapapo, chiwindi kapena ubongo). Pali azimayi 6% okha omwe amapezeka kuti ali ndi zotupa m'mimba poyambitsa matenda oyamba. Matenda ena ambiri opatsirana kapena owopsa am'mimba ndi pomwe khansa idabwereranso mwa wodwalayo atamaliza kulandira chithandizo ndikukhala wokhululukidwa kwa zaka zambiri. Khansara ya m'mawere, yomwe imapezeka kwambiri mwa azimayi komanso imapezeka mwa amuna ochepa, imakhala ndi chiyembekezo chochepa kwambiri chokhala ndi moyo wazaka 5 kukhala ochepera 30% malinga ndi chidziwitso kuchokera ku American Cancer Society Publication (Cancer Facts and Figures, 2019 ). Kupulumuka kwapakatikati kwa metastatic TNBC ndi chaka chimodzi chokha poyerekeza ndi zaka 1 zamagulu ena awiriwa. (Waks AG ndi Winer EP, JAMA 2019)

Njira Zothandizira Kuchiza Khansa ya M'mawere

Khansara ya m'mawere imachiritsidwa ndi mitundu ingapo yamankhwala kuphatikiza mitundu yambiri ya chemotherapy, immunotherapy, chithandizo chamankhwala, mankhwala a mahomoni ndi chithandizo cha ma radiation zosankha, kudzera pakuyesera ndi zolakwika, popeza palibe chithandizo chamankhwala cha khansa iyi. Chithandizo chamankhwala chimadalira mamolekyulu am'maselo am'mbuyomu a khansa ya m'mawere, chithandizo cha khansa yapam'mbuyomu, momwe wodwalayo aliri komanso komwe khansa yafalikira. 

Ngati khansa ya m'mawere yafalikira m'mafupa, ndiye kuti limodzi ndi mankhwala a endocrine, chemotherapy kapena chithandizo chofunikira, wodwalayo amathandizidwanso ndi othandizira mafupa monga bisphosphonates. Izi zimathandiza ndi chisamaliro chodekha koma sizinawonetsere kuti zipulumutse moyo wonse.  

Ngati khansa ya m'mawere yomwe ili ndi khansa yayamba kufika pachimake cha metastatic site IV, odwala amathandizidwa ndi mankhwala owonjezera a endocrine ndi othandizira omwe amasintha kapena kuletsa ma estrogen receptors, kapena amaletsa kupanga estrogen m'thupi. Thandizo la endocrine, ngati silothandiza, limagwiritsidwa ntchito limodzi ndi mankhwala ena a chemotherapy kapena mankhwala omwe amalimbana nawo monga cell cycle kinase inhibitors kapena mankhwala omwe amalimbana ndi malo owonekera amkati, kutengera mawonekedwe am'magazi ndi genomic a khansa.

Pazakudya za mahomoni, khansa ya m'mawere ya HER2, khansa ya m'mawere, njira yofunika kwambiri yochizira ndi mankhwala opatsirana a HER2 kapena ma molekyulu ang'onoang'ono. Izi zimaphatikizidwa ndi mankhwala ena a chemotherapy.

Komabe, kwa khansa yamatenda amtundu wa TNBC omwe ali ndi vuto loyipa kwambiri, palibe njira zodziwikiratu zamankhwala. Zimatengera kupezeka kwa zosintha zina zazikulu mumtundu wa khansa. Pankhani ya khansa yosinthika ya BRCA, amathandizidwa ndi zoletsa za poly-ADP ribose (PARP). Khansa ngati ili ndi malo otetezera chitetezo cha mthupi, imatha kuthandizidwa ndi mankhwala a immunotherapy monga ma anti-checkpoint inhibitors. Mwinanso, odwalawa amathandizidwa ndi mankhwala amphamvu kwambiri a chemotherapy monga mankhwala a platinamu (Cisplatin, Carboplatin), adriamycin (Doxorubicin), mankhwala osokoneza bongo (Paclitaxel), topoisomerase inhibitors (Irinotecan, Etoposide) ndi zilolezo zosiyanasiyana ndi izi, kuwongolera kufalikira kwa matendawa. Kuphatikiza kwa chemotherapy yomwe imagwiritsidwa ntchito pochiza khansa yam'mimba yamatenda komabe imakhala ndi kawopsedwe koopsa ndipo imakhudza kwambiri moyo wa odwala.

Kufunika Kwa Malangizo Amtundu Waumoyo a Odwala Khansa

Kuzindikira khansa palokha ndichinthu chosintha moyo chokhudzana ndi nkhawa zaulendo wamankhwala womwe ukuyembekezeka komanso kuwopa kusatsimikizika kwazotsatira. Atapezeka kuti ali ndi khansa, odwala amalimbikitsidwa kuti asinthe machitidwe awo omwe amakhulupirira kuti apititsa patsogolo thanzi lawo, kuchepetsa chiopsezo chobwereza, ndikuchepetsa zovuta zoyipa zamankhwala awo a chemotherapy. Nthawi zambiri, amayamba kugwiritsa ntchito zowonjezera zowonjezera zakudya, limodzi ndi mankhwala awo a chemotherapy, kuti athandize kuchepetsa zovuta zoyipa komanso kukonza thanzi lawo. Pali malipoti a 67-87% ya odwala khansa omwe amagwiritsa ntchito zowonjezera zowonjezera pambuyo popezeka. (Velicer CM et al, J Chipatala. Oncol., 2008)  

Komabe, malangizo azakudya ndi zakudya kwa odwala khansa masiku ano sanasankhidwe. Ngakhale kupita patsogolo kwa ma genomics, ma metabolomics, ma proteinomics omwe athandiza kumvetsetsa kwathu mikhalidwe ya khansa ndikuthandizira njira zachipatala zoyenera, chitsogozo cha zakudya ngati chilipo. Chitsogozo cha zakudya sichimatengera mtundu wa khansa komanso mawonekedwe amtundu wa khansa, kapena mtundu wa chithandizo chomwe akupatsidwa wodwalayo. Malangizo onse pazakudya / zakudya monga akuwonetsedwera ndi American Cancer Society ndi awa: 

• Kukhala wathanzi; 
• Kutengera moyo wakhama; 
• Kugwiritsa ntchito chakudya chopatsa thanzi ndikutsindika magwero azomera; ndipo 
• Kuchepetsa kumwa mowa. 

Njira zochiritsira khansa zosiyanasiyana ndizopangira umboni ndikulimbikitsidwa ndi magulu osiyanasiyana a khansa monga National Comprehensive Cancer Network (NCCN) kapena American Cancer Society (ACS). Umboni womwe umapezeka chifukwa cha mankhwala umachokera pamayeso akulu azachipatala (RCTs). Mankhwala ambiri amayang'aniridwa ndi machitidwe ena amtundu wa khansa. Ngakhale zili choncho, kwa khansa zambiri zapamwamba monga metastatic TNBC, palibebe malangizo oyenera komanso mankhwala omwe amadziwika kuti ndi othandiza. Chithandizo cha kachidutswa kameneka kakhazikikabe pamayeso ndi zolakwika.  

Komabe, palibe umboni woterewu wokhudzana ndi zakudya zomwe mungasankhe. Pali kuchepa kwa ma RCT kuti apange umboni wopanga malingaliro ndi malangizo azakudya kuti athandizire mitundu yosiyanasiyana ya khansa ndi mankhwala. Uwu ndi mpata waukulu womwe tili nawo pakadali pano posamalira khansa. Ngakhale chidziwitso chowonjezeka chazomwe zimayenderana ndi majini, zovuta zamachitidwe azakudya ndi kulumikizana ndizovuta kuthana nazo mokwanira pogwiritsa ntchito kafukufuku aliyense wa RCT. (Blumberg J et al, Mtedza. Rev, 2010)  

Chifukwa cha kuchepa uku, mulingo wa umboni wothandizira zakudya ndi chidaliro pofotokozera zofunikira za zakudya / zakudya kwa odwala khansa nthawi zonse zimakhala zosiyana ndi zomwe zimafunikira pakuwunika kwamankhwala. Kuphatikiza apo, kuwongolera zakudya / kadyedwe kosiyana ndi chithandizo chamankhwala ndikwachilengedwe, kotetezeka komanso kogwirizana ndi zotsatira zochepa kapena zochepa nthawi zambiri. Komabe, personalizing malangizo zakudya kwa enieni nkhani ya khansa mtundu ndi chithandizo chozikidwa pa njira za sayansi zomwe zikudutsana ndi malingaliro omwe amathandizidwa ndi deta yoyesera, ngakhale kuti sizofanana ndi umboni wa RCT, akhoza kupereka chitsogozo chabwino kwa odwala ndi kupititsa patsogolo chisamaliro chophatikizika cha khansa.

Popeza pali heterogeneity ngakhale khansa ndi chithandizo cha zotupa zamatenda owopsa amtundu womwewo, malingaliro azakudya monga gawo limodzi la chisamaliro chophatikizira khansa adzafunikiranso kukhala amunthu. Chakudya choyenera choyenera komanso koposa zonse zakudya zomwe muyenera kupewa munthawi yamankhwala komanso zitha kuthandizira kukulitsa zotsatira.

Ubwino Wothandizirana ndi Makonda a Zakudya / Zakudya (Zakudya ndi Zowonjezera) za Metastatic Breast Cancer

Popeza matenda ndi chithandizo cha khansa ya m'mawere imasiyana mosiyanasiyana malinga ndi gawo loyambirira la matenda, zofunika pazakudya zopatsa thanzi / zakudya (zakudya ndi zowonjezera) sizingafanane nazo zonse. Zidzadalira mawonekedwe amtundu wa khansa ya m'mawere ndi mtundu wa mankhwala omwe akulandila. Chifukwa chake chibadwa cha matendawa, zofunikira zina za wodwalayo malinga ndi kuchuluka kwa thupi lawo (BMI) kuti athe kuyesa kunenepa kwambiri, momwe amakhalira monga kuchita masewera olimbitsa thupi, kumwa mowa ndi zina zonse zidzakhala zofunikira pakupanga makonda anu zakudya zomwe zitha kukhala zothandiza komanso zothandiza kusokoneza khansa nthawi iliyonse yamatenda.  

Kufunika koperekera malangizo pazakudya / zakudya zomwe zikugwirizana ndi khansa ndi chithandizo, kwa odwala omwe ali ndi zotupa m'mimba amatha kupereka zotsatirazi: (Wallace TC et al, J. wa Amer. Sungani. Zakudya Zamtundu., 2019)

1. Kuchepetsa mphamvu ndi chitetezo chokwanira cha wodwalayo popanda kusokoneza mphamvu yothandizira.
2. Thandizani pakuchepetsa zoyipa zamankhwala.
3. Kuthandizira kupititsa patsogolo chithandizo chamankhwala posankha zakudya ndi zowonjezera zomwe zingagwirizane ndi njira yogwiritsira ntchito mankhwalawa popititsa patsogolo njira zoyenera, kapena kuletsa njira zomwe zingatsutse.
4. Pewani zakudya ndi zowonjezera zomwe zingasokoneze chithandizo chamankhwala kudzera munthawi ya mankhwala omwe angachepetse mphamvu kapena kuwonjezera poizoni wa mankhwala.

Zitsanzo za Kusankha Kwamunthu / Zakudya (Zakudya ndi Zowonjezera) za Khansa ya M'mawere ya Metastatic

Zakudya / zopatsa thanzi (zakudya ndi zowonjezera) malangizo a khansa ya metastatic omwe ali ndi khansa omwe akupitilizabe kulandira mankhwala a endocrine monga Tamoxifen adzakhala osiyana kwambiri ndi odwala ena am'mimba am'mimba.  

Zitsanzo za Zakudya / Zowonjezera Zomwe Mungapewe ngati mukumwa mankhwala ndi Estrogen Modulators

Kwa odwala omwe ali ndi ma modulators a estrogen, zitsanzo za zakudya ndi zowonjezera zomwe angafunike kupewa zomwe zingasokoneze mankhwala awo a endocrine pamodzi ndi malingaliro asayansi atchulidwa pansipa:  

Curcumin 

Curcumin, chogwiritsidwa ntchito kuchokera ku curry spice turmeric, ndichowonjezera chachilengedwe chomwe chimadziwika pakati pa odwala khansa ndi opulumuka chifukwa cha anti-khansa ndi anti-inflammatory properties. Chifukwa chake, mwayi woti odwala khansa ya m'mawere amatenga Curcumin ali pa mankhwala a Tamoxifen ndi okwera. 

Mankhwala amkamwa a Tamoxifen amasinthidwa mthupi mthupi mwa ma metabolism omwe amagwiritsidwa ntchito ndi mankhwala kudzera mu michere ya cytochrome P450 m'chiwindi. Endoxifen ndi metabolite yogwira ya Tamoxifen, ndiye mkhalapakati wofunikira wa mankhwala a tamoxifen (Del Re M et al, Pharmacol Res., 2016). Kafukufuku woyembekezeredwa waposachedwa (EudraCT 2016-004008-71 / NTR6149) kuchokera ku Erasmus MC Cancer Institute ku Netherlands, adawonetsa kulumikizana koyipa pakati pa Curcumin ndi Tamoxifen mwa odwala khansa ya m'mawere (Hussaarts KGAM et al, Khansa (Basel), 2019). Zotsatirazo zikuwonetsa kuti kuchuluka kwa metabolite yogwira Endoxifen kunachepa munjira yowerengera pomwe Tamoxifen idatengedwa limodzi ndi chowonjezera cha Curcumin.  

Maphunziro ngati awa sangathe kunyalanyazidwa, ngakhale m'mawere ochepa khansa odwala, ndikupereka chenjezo kwa amayi omwe amatenga tamoxifen kuti asankhe zowonjezera zachilengedwe zomwe amazitenga mosamala, zomwe sizimasokoneza mphamvu ya mankhwala a khansa mwanjira iliyonse. Malingana ndi umboniwu, Curcumin sichikuwoneka ngati chowonjezera choyenera kutengedwa pamodzi ndi Tamoxifen. Komabe, izi sizikutanthauza kuti curcumin monga zokometsera ndi zokometsera mu curries ziyenera kupewedwa kwathunthu.

DIM (diindolylmethane) Zowonjezera  

Chowonjezera china chofala kwambiri pakati pa odwala khansa ya m'mawere ndi DIM (diindolylmethane), metabolite wa I3C (Indole-3-carbinol), omwe amapezeka cruciferous masamba monga broccoli, kolifulawa, kale, kabichi, mphukira za brussel. Kutchuka kwa DIM kumatha kutengera maphunziro azachipatala omwe awonetsa kuti kudya kwambiri masamba a cruciferous pazakudya / zakudya kumalumikizidwa kwambiri ndi chiopsezo chochepa cha 15 cha khansa ya m'mawere. (Liu X et al, Chifuwa, 2013) Komabe, kafukufuku wazachipatala, wopunduka, wakhungu kawiri yemwe adayesa kugwiritsa ntchito Zowonjezera za DIM pamodzi ndi Tamoxifen mwa odwala khansa ya m'mawere, yawonetsa kuwopsa kwa tamoxifen yogwira kuchepa kwa metabolite, potero kuthekera kochepetsa mphamvu ya endocrine therapy. (NCT01391689) (Thomson CA, Khansa ya m'mawere Res. Chitani., 2017).

Popeza chidziwitso cha zamankhwala chikuwonetsa kuyanjana pakati pa DIM ndi tamoxifen, odwala khansa ya m'mawere ali pa tamoxifen therapy ayenera kusamala ndi kupewa kupezeka ndi DIM supplement. Chakudya chodyera chodyera chomwe chili ndi ndiwo zamasamba otchedwa cruciferous chimatha kupereka phindu lakutenga chowonjezera cha DIM munthawi imeneyi.

Zakudya Zopindulitsa ndi Zosankhidwa za Khansa ya M'mawere ya Metastatic

Pali zakudya zambiri komanso zowonjezera zomwe zimakhudzana ndi kusintha kwa zotsatira za odwala khansa ya m'mawere. Kusanthula kwa meta kwamaphunziro angapo omwe akuyembekezeredwa ndi ma RCTs omwe asindikizidwa posachedwa ndi ofufuza ochokera ku Institut Curie ku France akuti chakudya chochepa kwambiri chamafuta chimalumikizidwa ndi kupulumuka kwabwino. Komanso, zakudya zomwe zinali zolemera alireza kuchokera ku zipatso ndi ndiwo zamasamba, kunachepetsa chiopsezo chobwereranso ndi khansa. Ndipo, chakudya chopatsa thanzi chokhala ndi zakudya zopangidwa ndi mbewu chimalumikizidwa ndi kusintha kwa moyo wonse komanso chiopsezo cha imfa. (Maumy L et al, Khansa ya Bull, 2020)

Kafukufuku wofalitsidwa koyambirira kwa chaka chino adayesa zovuta zakudya za ketogenic / zakudya zopatsa thanzi odwala khansa ya m'mawere. Adapeza kuti chakudya cha ketogenic limodzi ndi mankhwala omwe akupitilira chemotherapy adathandizira kuti moyo wawo ukhale wopanda zovuta zina kwa odwala. (Khodabakhshi A, Nutr. Khansa, 2020Zakudya za ketogenic ndizochepa kwambiri zomwe zimalimbikitsa kupititsa patsogolo mafuta m'thupi la ketone (osati ma carbohydrate mu glucose) kuti apereke mphamvu yayikulu mthupi. Maselo abwinobwino amthupi lathu amatha kusintha kugwiritsa ntchito matupi a ketone kuti apange mphamvu, koma ma cell a khansa sangathe kugwiritsa ntchito matupi a ketone mphamvu chifukwa chamatenda osazolowereka. Izi zimapangitsa kuti ma chotupawo akhale pachiwopsezo chachikulu komanso, matupi a ketone amachepetsa chotupa cha angiogenesis ndi kutupa kwinaku chikuthandizira kufa kwa chotupa. (Wallace TC et al, J. wa Amer. Sungani. Zakudya Zamtundu., 2019)

Popeza zofunikira zenizeni zochiritsira ziyenera kukwaniritsidwa kutengera mtundu wa khansa ndi mtundu wa chithandizo, kupatsa thanzi molondola komanso makonda akuyenera kutengera zakudya ndi zowonjezerapo zomwe zili ndi njira zokhazikitsidwa zamagulu amomwe zimakhudzira majini njira. (Reglero C ndi Reglero G, Zakudya zopatsa thanzi, 2019)

 Mwachitsanzo, njira imodzi yopewera metastasis ya khansa ndikuletsa angiogenesis, kuphuka kwa mitsempha yatsopano, yomwe ingatetezenso chemotherapy kukana. Pali zakudya ndi zowonjezera ndi bioactive silibinin, monga atitchoku ndi nthula mkaka, zomwe zawonetsedwa mwasayansi poletsa angiogenesis. Malangizo aumwini pazakudya / zowonjezerazi munthawi imeneyi ya khansa ya m'mawere yochitidwa ndi chemotherapy, itha kuthandizira pakuthandizira chithandizo chamankhwala ndikupewa kubwereranso. (Binienda A, et al, Anticancer Agents Med Chem, 2019)

Mofananamo, zofunikira zina za khansa ndi chithandizo zitha kusanthula kuti zipeze zakudya zoyenera komanso zowonjezera pamavuto azakudya za khansa kuti zifanane ndi khansa yawo monga khansa ya m'mawere ndi chithandizo.

Kutsiliza

Pamene malingaliro a chithandizo akupita patsogolo pakusintha kwamunthu kutengera ma genomics a khansa komanso mawonekedwe a khansa ya wodwala aliyense, chisamaliro chophatikizika cha khansa chimafunikanso kupita ku zakudya / zakudya zothandizira payekha malinga ndi siteji ndi mtundu wa khansa ndi chithandizo. Awa ndi malo osagwiritsidwa ntchito kwambiri omwe angathandize kwambiri pakuwongolera zotulukapo komanso moyo wabwino kwa odwala omwe ali ndi khansa ya m'mawere ya metastatic. Mukakhala ndi thanzi labwino, zakudya zachilengedwe ndi zowonjezera sizivulaza. Koma, pamene nkhaniyo ndi khansa yomwe thupi likuchita kale ndi kusokonezeka kwamkati mkati mwa metabolism ndi chitetezo cha mthupi chifukwa cha matenda ndi mankhwala omwe akupitilira, ngakhale zakudya zachilengedwe, ngati osasankhidwa molondola, ali ndi kuthekera kovulaza. Chifukwa chake, zakudya zopangidwa mwakukonda kwanu zomwe zimadziwika ndi khansa (monga khansa ya m'mawere) ndi mtundu wa chithandizo zitha kuthandizira zotsatira zabwino komanso thanzi la wodwalayo.

Chakudya chomwe mumadya komanso chomwe chimakupatsani thanzi ndi chisankho chomwe mumapanga. Lingaliro lanu liyenera kuphatikizapo kulingalira za kusintha kwa majini a khansa, khansa, chithandizo chamankhwala chopitilira muyeso, zovuta zilizonse, zidziwitso za moyo, kulemera, kutalika ndi zizolowezi.

Kukonzekera kwa khansa kuchokera ku addon sikudalira pakusaka kwa intaneti. Zimakusankhirani zomwe mungasankhe malinga ndi sayansi yamayendedwe omwe asayansi athu ndi akatswiri a mapulogalamu. Mosasamala kanthu kuti mumasamala kumvetsetsa zomwe zimayambira zamagulu am'thupi kapena ayi - pakukonzekera zakudya za khansa kumvetsetsa kumafunikira.

Yambirani TSOPANO ndikukonzekera zakudya zanu poyankha mafunso okhudzana ndi khansa, kusintha kwa majini, mankhwala opitilira muyeso ndi zowonjezera, chifuwa chilichonse, zizolowezi, moyo, gulu la zaka komanso jenda.

Odwala khansa nthawi zambiri amakhala ndi zovuta zosiyanasiyana chemotherapy mavuto zomwe zimakhudza moyo wawo ndikuyang'ana njira zina zochiritsira khansa. Kutenga chakudya choyenera ndi zowonjezera zowonjezera kutengera zomwe asayansi amalingalira (kupewa kuyerekezera ndi kusankha mwachisawawa) ndiye njira yabwino kwambiri yachilengedwe ya khansa komanso chithandizo chamankhwala zotsatira zakets.

• Phindu Lopanda Chithandizo cha Irinotecan ndi Etoposide mwa Odwala Omwe Ali ndi Khansa Ya M'mawere
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