Types/breast/breast-hormone-therapy-fact-sheet

Thandizo la Hormone la Khansa ya m'mawere

Kodi mahomoni ndi chiyani?

Mahomoni ndi zinthu zomwe zimagwira ntchito ngati amithenga amthupi. Zimakhudza machitidwe am'magazi ndi ziwalo m'malo osiyanasiyana mthupi, nthawi zambiri zimakwaniritsa zolowa m'magazi.

Mahomoni a estrogen ndi progesterone amapangidwa ndi thumba losunga mazira m'mayi azimayi otha msinkhu komanso zophatikizika zina, kuphatikiza mafuta ndi khungu, mwa amayi ndi abambo a premenopausal komanso postmenopausal. Estrogen imalimbikitsa kukula ndi kusamalira mikhalidwe yakugonana kwachikazi komanso kukula kwa mafupa ataliatali. Progesterone imathandizira kusamba ndi kutenga pakati.

Estrogen ndi progesterone amalimbikitsanso kukula kwa khansa ya m'mawere, yomwe imadziwika kuti khansa ya m'mawere (kapena yodalira mahomoni). Maselo a khansa ya m'mawere omwe amakhala ndi vuto la mahomoni amakhala ndi mapuloteni otchedwa ma hormone receptors omwe amatsegulidwa mahomoni akawamangira. Ma receptors omwe adatsegulidwa amachititsa kusintha kwamawonedwe amtundu winawake, omwe angalimbikitse kukula kwa maselo.

Kodi mankhwala a mahomoni ndi chiyani?

Thandizo la mahomoni (lomwe limatchedwanso kuti hormonal therapy, mankhwala a mahomoni, kapena endocrine therapy) limachedwetsa kapena kuyimitsa kukula kwa zotupa zomwe zimakhudza mahomoni poletsa kuthekera kwa thupi kutulutsa mahomoni kapena posokoneza zotsatira za mahomoni m'maselo a khansa ya m'mawere. Zotupa zomwe sizimva mahomoni zilibe ma hormone receptors ndipo sizimayankha mankhwala a mahomoni.

Kuti adziwe ngati maselo a khansa ya m'mawere ali ndi zotengera za mahomoni, madokotala amayesa zitsanzo za zotupa zomwe zachotsedwa ndi opaleshoni. Ngati chotupacho chili ndi zotengera za estrogen, khansara amatchedwa estrogen receptor positive (ER positive), estrogen sensitive, kapena estrogen imayankha. Momwemonso, ngati chotupacho chimakhala ndi progesterone receptors, khansara amatchedwa progesterone receptor positive (PR kapena PgR positive). Pafupifupi 80% ya khansa ya m'mawere ndi ER positive (1). Khansa yambiri yam'mimba ya ER imakhalanso ndi PR. Zotupa za m'mawere zomwe zimakhala ndi estrogen ndi / kapena progesterone receptors nthawi zina amatchedwa hormone receptor positive (HR positive).

Khansa ya m'mawere yomwe ilibe ma estrogen receptors amatchedwa estrogen receptor negative (ER negative). Zotupa izi ndizosaganizira za estrogen, kutanthauza kuti sagwiritsa ntchito estrogen kukula. Zotupa za m'mawere zomwe zimasowa progesterone receptors zimatchedwa progesterone receptor negative (PR kapena PgR negative). Zotupa za m'mawere zomwe sizikhala ndi estrogen ndi progesterone receptors nthawi zina zimatchedwa hormone receptor negative (HR negative).

Chithandizo cha mahomoni a khansa ya m'mawere sayenera kusokonezedwa ndi menopausal hormone therapy (MHT) -kuchiza ndi estrogen kokha kapena kuphatikiza ndi progesterone yothandizira kuthetsa kusamba kwa kusamba. Mitundu iwiri yamankhwalayi imabweretsa zotsatirapo zake: mankhwala a khansa ya m'mawere amalepheretsa kukula kwa khansa ya m'mawere ya HR, pomwe MHT imatha kukulitsa kukula kwa khansa ya m'mawere ya HR. Pachifukwa ichi, mayi yemwe akutenga MHT akapezeka ndi khansa ya m'mawere ya HR nthawi zambiri amafunsidwa kuti asiye mankhwalawo.

Ndi mitundu iti ya mankhwala a mahomoni omwe amagwiritsidwa ntchito pa khansa ya m'mawere?

Njira zingapo zimagwiritsidwa ntchito pochiza khansa ya m'mawere yokhudza mahomoni:

Kuletsa kugwira ntchito kwa ovari: Chifukwa chakuti thumba losunga mazira ndiye gwero lalikulu la estrogen mwa amayi omwe ali ndi premenopausal, milingo ya estrogen mwa azimayiyi imatha kuchepetsedwa pochotsa kapena kupondereza ntchito yamchiberekero. Kuletsa ntchito yamchiberekero kumatchedwa kuchotsa mazira.

Kuchotsa mavitamini kumatha kuchitidwa opareshoni pochotsa thumba losunga mazira (lotchedwa oophorectomy) kapena pochiza ndi radiation. Mtundu wamtunduwu wochotsa pamimba nthawi zambiri umakhala wokhazikika.

Kapenanso, ntchito yamchiberekero imatha kuponderezedwa kwakanthawi ndi mankhwala ndi mankhwala otchedwa gonadotropin-releasing hormone (GnRH) agonists, omwe amadziwikanso kuti agonist a luteinizing hormone-releasing hormone (LH-RH). Mankhwalawa amalepheretsa zizindikilo zochokera kumtundu wa pituitary womwe umapangitsa kuti thumba losunga mazira litulutse estrogen.

Zitsanzo za mankhwala osokoneza bongo omwe avomerezedwa ndi US Food and Drug Administration (FDA) ndi goserelin (Zoladex®) ndi leuprolide (Lupron®).

Kuletsa kupanga kwa estrogen: Mankhwala omwe amatchedwa aromatase inhibitors amagwiritsidwa ntchito kutsekereza michere yotchedwa aromatase, yomwe thupi limagwiritsa ntchito kupanga estrogen m'mimba mwake ndi m'matumba ena. Aromatase inhibitors amagwiritsidwa ntchito makamaka mwa amayi omwe ali ndi postmenopausal chifukwa thumba losunga mazira la amayi omwe ali ndi premenopausal amatulutsa aromatase yochulukirapo kuti ma inhibitors aletse bwino. Komabe, mankhwalawa atha kugwiritsidwa ntchito mwa amayi omwe sanakumane ndi msambo ngati atapatsidwa limodzi ndi mankhwala omwe amaletsa kugwira ntchito kwa ovari.

Zitsanzo za aromatase inhibitors zovomerezedwa ndi FDA ndi anastrozole (Arimidex®) ndi letrozole (Femara®), zonsezi zimaletsa aromatase, ndi exemestane (Aromasin®), yomwe imaletseratu aromatase.

Kuletsa zotsatira za estrogen: Mitundu ingapo yamankhwala imalepheretsa kuthekera kwa estrogen kukweza kukula kwa maselo a khansa ya m'mawere:

• Ma modulators osankhidwa a estrogen receptor (SERMs) amamangirira kuma estrogen receptors, kuteteza estrogen kuti isamangidwe. Zitsanzo za ma SERM ovomerezeka ndi a FDA pochiza khansa ya m'mawere ndi tamoxifen (Nolvadex®) ndi toremifene (Fareston®). Tamoxifen yakhala ikugwiritsidwa ntchito kwa zaka zopitilira 30 kuchiza khansa ya m'mawere yolandila mahomoni.

Chifukwa ma SERM amamangiriridwa ndi ma estrogen receptors, sangangoletsa zochitika za estrogen (mwachitsanzo, kukhala otsutsana ndi estrogen) komanso amatsanzira zotsatira za estrogen (mwachitsanzo, amakhala ngati agonists a estrogen). Ma SERM amatha kukhala ngati otsutsana ndi estrogen m'matumba ena komanso ngati ma agonist a estrogen m'matumba ena. Mwachitsanzo, tamoxifen imatseka zotsatira za estrogen m'minyewa yamawere koma imakhala ngati estrogen m'chiberekero ndi fupa.

• Mankhwala ena a antiestrogen, monga fulvestrant (Faslodex®), amagwira ntchito munjira ina yosiyanitsira zotsatira za estrogen. Monga ma SERM, wodzaza mafuta amamangiriza ku estrogen receptor ndipo amagwira ntchito ngati wotsutsana ndi estrogen. Komabe, mosiyana ndi ma SERM ,vestvestrant alibe zovuta za estrogen agonist. Ndi antiestrogen wangwiro. Kuphatikiza apo, fulvestrant akamangirira ku estrogen receptor, wolandirayo amayenera kuwonongedwa.

Kodi mankhwala a mahomoni amagwiritsidwa ntchito bwanji pochiza khansa ya m'mawere?

Pali njira zitatu zazikuluzikulu zomwe mankhwala amtundu wa mahomoni amagwiritsidwira ntchito pochiza khansa ya m'mawere yomwe imazindikira ma mahomoni:

Chithandizo cha Adjuvant cha khansa ya m'mawere koyambirira: Kafukufuku wasonyeza kuti azimayi omwe amalandila chithandizo chazaka zosakwana 5 ndi tamoxifen atachitidwa opaleshoni ya khansa ya m'mawere yoyeserera ya ER yachepetsa ziwopsezo zobwerezanso khansa ya m'mawere, kuphatikiza khansa yatsopano ya m'mawere. m'chifuwa china, ndi kufa zaka 15 (2).

Tamoxifen imavomerezedwa ndi a FDA kuti athandizire azimayi othandizira amayi omwe ali ndi khansa ya m'mawere komanso omwe ali ndi postmenopausal (ndi amuna) omwe ali ndi khansa ya m'mawere yoyeserera ya ER, komanso aromatase inhibitors anastrozole ndi letrozole amavomerezedwa kuti agwiritsidwe ntchito mwa amayi omwe atha msinkhu.

Gulu lachitatu la aromatase inhibitor, exemestane, limavomerezedwa kuti lithandizire pochiza khansa ya m'mawere koyambirira mwa amayi omwe atha msinkhu omwe alandila tamoxifen kale.

Mpaka posachedwa, amayi ambiri omwe amalandira mankhwala owonjezera a mahomoni kuti achepetse mwayi wobwereranso khansa ya m'mawere amatenga tamoxifen tsiku lililonse kwa zaka 5. Komabe, poyambitsa mankhwala atsopano a mahomoni, ena mwa iwo amafanizidwa ndi tamoxifen m'mayesero azachipatala, njira zina zowonjezera ma hormone zakhala zofala (3-5). Mwachitsanzo, azimayi ena amatha kumwa aromatase inhibitor tsiku lililonse kwa zaka 5, m'malo mwa tamoxifen. Amayi ena amatha kulandira chithandizo chowonjezera ndi aromatase inhibitor patatha zaka 5 tamoxifen. Pomaliza, azimayi ena amatha kusinthana ndi aromatase inhibitor pakatha zaka ziwiri kapena zitatu za tamoxifen, pazaka 5 kapena kupitilira apo za mankhwala a mahomoni. Kafukufuku wasonyeza kuti kwa azimayi omwe atha msinkhu omwe amathandizidwa ndi khansa ya m'mawere,

Zisankho zamtundu ndi kutalika kwa mankhwala othandizira mahomoni ziyenera kupangidwa payekhapayekha. Njira yovutayi yopangira zisankho imachitika bwino polankhula ndi oncologist, dokotala yemwe amadziwika bwino ndi zamankhwala.

Kuchiza kwa khansa yapakati kapena yamatenda am'mimba: Mitundu ingapo yamankhwala amathandizidwa kuti athetse khansa ya m'mawere yomwe imawoneka mobwerezabwereza. Mankhwala a Hormone ndi njira yothandizira khansa ya m'mawere ya ER yomwe yabwereranso m'mawere, pachifuwa, kapena ma lymph node pafupi ndi chithandizo (chomwe chimatchedwanso kuti kubwereza mobwerezabwereza).

Ma SERM awiri amavomerezedwa kuti athetse khansa ya m'mawere, tamoxifen ndi toremifene. Odzaza mafuta a antiestrogen amavomerezedwa kwa azimayi omwe ali ndi postmenopausal omwe ali ndi khansa ya m'mawere ya ER yomwe imafalikira atalandira chithandizo ndi ma antiestrogens ena (7). Ikhoza kugwiritsidwanso ntchito mwa amayi omwe ali ndi vuto loyambilira omwe ali ndi vuto lotulutsa mazira.

Mankhwala a aromatase inhibitors anastrozole ndi letrozole amavomerezedwa kuti aperekedwe kwa azimayi omwe atha msinkhu ngati mankhwala oyamba a khansa ya m'mawere yomwe imawoneka bwino kwambiri (8, 9). Mankhwala awiriwa, komanso aromatase inhibitor exemestane, amagwiritsidwa ntchito pochiza amayi omwe ali ndi khansa ya m'mawere omwe ali ndi khansa ya m'mawere omwe matenda awo awonjezeka atalandira chithandizo ndi tamoxifen (10).

Amayi ena omwe ali ndi khansa yapakati ya m'mawere amathandizidwa ndi mankhwala othandizira mahomoni komanso mankhwala omwe amalimbikitsidwa. Mwachitsanzo, mankhwala opatsirana omwe amatchedwa lapatinib (Tykerb®) amavomerezedwa kuti agwiritsidwe ntchito limodzi ndi letrozole pochiza khansa yolandila mahomoni, khansa ya m'mawere ya HER2 yomwe imakhalapo pakati pa azimayi omwe atha msambo omwe amalandila mankhwalawa.

Chithandizo china chololedwa, palbociclib (Ibrance®), chapatsidwa chilolezo chofulumira kuti chigwiritsidwe ntchito kuphatikiza ndi letrozole ngati chithandizo choyambirira chothandizira khansa ya m'mawere yolandila, HER2-khansa ya m'mawere yaposachedwa mwa azimayi a postmenopausal. Palbociclib imaletsa ma kinase awiri omwe amadalira cyclin (CDK4 ndi CDK6) omwe amawoneka kuti amalimbikitsa kukula kwa ma cell a khansa ya m'mawere yolandila.

Palbociclib imavomerezedwanso kuti ingagwiritsidwe ntchito limodzi ndi fulvestrant yothandizira azimayi omwe ali ndi khansa ya m'mawere yolandila mahomoni, khansa ya m'mawere ya HER2-negative kapena metastatic khansa yomwe khansa yake idakulirakulira atalandira chithandizo china cha mahomoni.

Neoadjuvant chithandizo cha khansa ya m'mawere: Kugwiritsa ntchito mankhwala a mahomoni kuchiza khansa ya m'mawere asanachite opareshoni (neoadjuvant therapy) yaphunziridwa m'mayesero azachipatala (11). Cholinga cha mankhwala a neoadjuvant ndikuchepetsa kukula kwa chotupa cha m'mawere cholola opaleshoni yosamalira bere. Zambiri zochokera kumayeso olamulidwa ndi nthawi zonse zawonetsa kuti mankhwala a neoadjuvant hormone - makamaka, okhala ndi aromatase inhibitors - atha kukhala othandiza kuchepetsa kukula kwa zotupa za m'mawere mwa azimayi omwe atha msambo. Zotsatira za amayi omwe ali ndi vuto lofika kumwezi azikhala osadziwika bwino chifukwa mayesero ochepa okha omwe amaphatikizapo azimayi ochepa omwe adayamba kusamba msanga apangidwa pakadali pano.

Palibe mankhwala a mahomoni omwe avomerezedwabe ndi a FDA kuti athe kuchiza khansa ya m'mawere.

Kodi mankhwala a mahomoni angagwiritsidwe ntchito kupewa khansa ya m'mawere?

Inde. Khansa zambiri zam'mawere zimakhala ndi ER, ndipo mayesero azachipatala adayesa ngati mankhwala a mahomoni atha kugwiritsidwa ntchito popewa khansa ya m'mawere mwa azimayi omwe ali pachiwopsezo chotenga matendawa.

Chiyeso chachikulu chachipatala chothandizidwa ndi NCI chotchedwa Breast Cancer Prevention Trial chinapeza kuti tamoxifen, yotengedwa kwa zaka 5, yachepetsa chiopsezo chokhala ndi khansa ya m'mawere pafupifupi 50% mwa azimayi a postmenopausal omwe anali pachiwopsezo chachikulu (12). Kutsatiridwa kwakanthawi kwakanthawi kwamayesero ena, International Breast Cancer Intervention Study I, idapeza kuti zaka 5 zamankhwala a tamoxifen amachepetsa zovuta za khansa ya m'mawere kwa zaka zosachepera 20 (13). Chiyeso chachikulu chotsatira, Study of Tamoxifen ndi Raloxifene, yomwe idathandizidwanso ndi NCI, idapeza kuti zaka 5 za raloxifene (SERM) zimachepetsa chiopsezo cha khansa ya m'mawere mwa azimayi oterewa pafupifupi 38% (14).

Chifukwa cha mayeserowa, ma tamoxifen ndi raloxifene avomerezedwa ndi a FDA kuti athetse chiopsezo chokhala ndi khansa ya m'mawere mwa amayi omwe ali pachiwopsezo chachikulu cha matendawa. Tamoxifen imavomerezedwa kuti igwiritsidwe ntchito mosasamala kanthu za kutha msinkhu. Raloxifene imavomerezedwa kuti igwiritsidwe ntchito mwa amayi omwe atha msinkhu.

Mankhwala awiri otchedwa aromatase inhibitors — exemestane ndi anastrazole — apezekanso kuti achepetse chiopsezo cha khansa ya m'mawere mwa azimayi amene atha msambo atha kudwala. Pambuyo pazaka 3 pakutsata koyeserera, azimayi omwe adatenga exemestane anali ocheperako 65% kuposa omwe adatenga malowa kuti akhale ndi khansa ya m'mawere (15). Pambuyo pazaka zisanu ndi ziwiri zotsatila pamayeso ena, amayi omwe adatenga anastrozole anali ocheperako 50% kuposa omwe adatenga malowa kuti akhale ndi khansa ya m'mawere (16). Onse exemestane ndi anastrozole amavomerezedwa ndi FDA pochiza amayi omwe ali ndi khansa ya m'mawere ya ER. Ngakhale onsewa amagwiritsidwanso ntchito popewera khansa ya m'mawere, sizivomerezedwanso makamaka.

Kodi zotsatira zoyipa za mankhwala a mahomoni ndi ziti?

Zotsatira zoyipa zamankhwala amtundu wa mahomoni zimadalira makamaka mankhwala kapena mtundu wa chithandizo (5). Ubwino ndi zovulaza zakumwa kwa mahomoni ziyenera kuyesedwa mosamala kwa mayi aliyense. Njira yosinthira yofananira yogwiritsira ntchito mankhwala othandizira, momwe odwala amatenga tamoxifen kwa zaka 2 kapena 3, ndikutsatiridwa ndi aromatase inhibitor kwa zaka 2 kapena 3, atha kupereka zabwino ndi zovuta za mitundu iwiri iyi ya mankhwala a mahomoni (17) .

Kutentha, thukuta usiku, ndi kuuma kwa nyini ndizo zotsatira zoyipa za mankhwala a mahomoni. Thandizo la mahomoni limasokonezanso msambo mwa amayi omwe asanabadwe.

Zotsatira zoyipa zochepa koma zoyipa za mankhwala a mahomoni zalembedwa pansipa.

Zamgululi

• Kuopsa kwa magazi m'magazi, makamaka m'mapapu ndi miyendo (12)

• Sitiroko (17)

• Ziphuphu (18)

• Khansa ya endometrial ndi uterine (17, 19)

• Kutaya kwa mafupa mwa azimayi asanakwane kusamba

• Kusintha, kukhumudwa, ndi kutaya kwa libido

• Amuna: mutu, nseru, kusanza, zotupa pakhungu, kusowa mphamvu, komanso kuchepetsa chidwi chogonana

Raloxifene

• Kuopsa kwa magazi m'magazi, makamaka m'mapapu ndi miyendo (12)

• Sitiroko m'magulu ang'onoang'ono (17)

Kupondereza kwamchiberekero

• Kutaya mafupa

• Kusintha, kukhumudwa, ndi kutaya kwa libido

Aromatase zoletsa

• Kuopsa kwa matenda a mtima, angina, kulephera kwa mtima, ndi hypercholesterolemia (20)

• Kutaya mafupa

• Ululu wophatikizana (21-24)

• Kusinthasintha komanso kukhumudwa

Wogulitsa zonse

• Zizindikiro za m'mimba (25)

• Kusowa mphamvu (24)

• Ululu

Kodi mankhwala ena amatha kusokoneza mankhwala?

Mankhwala ena, kuphatikiza ma antidepressants angapo omwe amapezeka m'gulu lomwe limatchedwa serotonin reuptake inhibitors, kapena SSRIs), amaletsa enzyme yotchedwa CYP2D6. Enzyme imeneyi imagwira ntchito yofunika kwambiri pakugwiritsa ntchito tamoxifen ndi thupi chifukwa imagwiritsa ntchito, kapena kuwononga, tamoxifen kukhala mamolekyulu, kapena ma metabolites, omwe amagwira ntchito kwambiri kuposa tamoxifen yomwe.

Kuthekera kwakuti ma SSRIs atha, poletsa CYP2D6, kuchepetsa kagayidwe kake ka tamoxifen ndikuchepetsa mphamvu yake ndikudandaula kuti gawo limodzi mwa magawo anayi a odwala khansa ya m'mawere amakumana ndi kukhumudwa kwamankhwala ndipo atha kuthandizidwa ndi SSRIs. Kuphatikiza apo, ma SSRIs nthawi zina amagwiritsidwa ntchito kuthana ndi zotentha zoyambitsidwa ndi mankhwala a mahomoni.

Akatswiri ambiri amati odwala omwe amamwa mankhwala opatsirana pogonana pamodzi ndi tamoxifen ayenera kukambirana ndi madotolo awo. Mwachitsanzo, madokotala amalimbikitsa kuti musinthe SSRI yomwe ndi choletsa kwambiri CYP2D6, monga paroxetine hydrochloride (Paxil®), kupita ku china chofooka kwambiri choletsa, monga sertraline (Zoloft®), kapena yomwe ilibe vuto lililonse, monga venlafaxine (Effexor®) kapena citalopram (Celexa®). Kapenanso atha kupereka lingaliro loti odwala awo omwe atenga msambo atenga msambo amalandira aromatase inhibitor m'malo mwa tamoxifen.

Mankhwala ena omwe amaletsa CYP2D6 ndi awa:

• Quinidine, yemwe amagwiritsidwa ntchito pochiza mikhalidwe yachilendo ya mtima

• Diphenhydramine, yomwe ndi antihistamine

• Cimetidine, yomwe imagwiritsidwa ntchito pochepetsa asidi m'mimba

Anthu omwe apatsidwa tamoxifen ayenera kukambirana zakugwiritsa ntchito mankhwala ena onse ndi madotolo.

Zolemba Zosankhidwa

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