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

Hormone Therapy yeCancer yeCancer

Chii chinonzi mahormone?

Mahormone zvinhu zvinoshanda semakemikari vatumwa mumuviri. Dzinokanganisa zviito zvemasero uye zvinyama munzvimbo dzakasiyana mumuviri, kazhinji zvichisvika pazvinangwa zvavo kuburikidza neropa.

Mahormone estrogen uye progesterone zvinogadzirwa nemazai mumadzimai epamberi uyeopa nemamwe masukisi, kusanganisira mafuta neganda, mune ese premenopausal uye postmenopausal vakadzi nevarume. Estrogen inosimudzira kusimudzira uye kugadzirisa kwehunhu hwevakadzi pabonde uye kukura kwemapfupa akareba. Progesterone inoita basa rekuenda kumwedzi uye nepamuviri.

Estrogen uye progesterone inosimudzirawo kukura kwevamwe kanzira yemazamu, ayo anonzi mahormone-anonzwisisa (kana mahormone-anoenderana) nekenza yemazamu. Hormone-inonzwisisika maseru emukenza emuzamu ane mapuroteni anonzi mahormone receptors anozovhurwa kana mahormone achisunga paari. Iwo anogamuchirwa anogamuchira anokonzeresa shanduko mukutaura kwemajeni chaiwo, ayo anogona kukurudzira sero kukura.

Chii chinonzi hormone therapy?

Hormone therapy (inonziwo hormonal therapy, hormone treatment, kana endocrine therapy) inononoka kana kumisa kukura kwemamota anonzwisisa mahormone nekuvharira kugona kwemuviri kuburitsa mahormone kana nekukanganisa mhedzisiro yemahormone pane maseru ekenza yemazamu. Mamota ayo ari mahormone asinganzwisisike haana mahormone receptors uye haapindure kune hormone kurapwa.

Kuti uone kana maseru ekenza yemazamu aine mahormone receptors, vanachiremba vanoyedza masampuli ehumarara tishu ayo akabviswa nekuvhiya. Kana maseru emota aine esrogen receptors, iyo kenza inonzi estrogen receptor yakanaka (ER yakanaka), estrogen inonzwika, kana estrogen inopindura. Saizvozvowo, kana maseru emota aine progesterone receptors, kenza inonzi progesterone receptor yakanaka (PR kana PgR yakanaka). Inenge 80% yekenza yemazamu iri ER yakanaka (1). Mazhinji maE--positive mazamu emakenza zvakare ari PR akanaka. Matumbu emuzamu ane estrogen uye / kana progesterone receptors dzimwe nguva anonzi mahormone receptor yakanaka (HR yakanaka).

Cancers yemazamu inoshaya estrogen receptors inonzi estrogen receptor negative (ER negative). Aya mamota ane estrogen isinganzwi, zvichireva kuti haashandise estrogen kukura. Mamota ezamu asina progesterone receptors anonzi progesterone receptor negative (PR kana PgR isina kunaka). Mamota emuzamu anoshaya ese estrogen uye progesterone receptors dzimwe nguva anonzi mahormone receptor isina (HR negative).

Hormone therapy yekenza yemazamu haifanire kuvhiringidzwa ne menopausal hormone therapy (MHT) -kurapa neestrogen chete kana mubatanidzwa neprogesterone kubatsira kubvisa zviratidzo zvekuguma kuenda kumwedzi. Aya maviri marudzi erapi anoburitsa zvinopesana: kemikari yekurapa yekenza yemazamu inovhara kukura kweHR-positive kenza yemazamu, nepo MHT inogona kukurudzira kukura kweHR-positive kenza yemazamu. Nechikonzero ichi, kana mukadzi anotora MHT achionekwa aine hutachiona hweHR-positive anowanzo bvunzwa kuti amise kurapwa ikoko.

Ndedzipi mhando yekurapa kwehomoni inoshandiswa kenza yemazamu?

Maitiro akati wandei anoshandiswa kurapa kenza yemazamu inonzwisisika:

Kuvharira ovari basa: Nekuti maovari ndiwo manyuko eesrogen mune premenopausal vakadzi, eestrogen mazinga mune aya vakadzi anogona kudzikiswa nekubvisa kana kudzvanya ovari basa. Kuvharira ovari basa kunonzi ovarian ablation.

Ovarian ablation inogona kuitwa kuvhiya mukuvhiya kubvisa maovari (anonzi oophorectomy) kana nekurapwa nemwaranzi. Iyi mhando yeovarian ablation inowanzo gara.

Neimwe nzira, ovari basa rinogona kudzvanywa kwenguva pfupi nekurapwa nemishonga inonzi gonadotropin-inosunungura mahormone (GnRH) agonists, ayo anozivikanwa se luteinizing hormone-releasing hormone (LH-RH) agonists. Iyi mishonga inopindirana nezviratidzo kubva pituitary gland inokurudzira maovari kuti ibudise estrogen.

Mienzaniso yekudzvinyirira ovari zvinodhaka zvakagamuchirwa neU.S.Food and Drug Administration (FDA) ndegoserelin (Zoladex®) uye leuprolide (Lupron®).

Kuvhara kugadzirwa kweestrogen: Zvinodhaka zvinonzi aromatase inhibitors zvinoshandiswa kuvharidzira chiitwa che enzyme inonzi aromatase, inoshandiswa nemuviri kugadzira estrogen mumazai uye mune mamwe matukisi. Aromatase inhibitors anoshandiswa kunyanya mumadzimai ekumasopaopausal nekuti maovari mumadzimai epremenopausal anogadzira aromatase yakawandisa yekuti inhibitors ivhare zvinobudirira. Nekudaro, iyi mishonga inogona kushandiswa mumadzimai epamberi ekumiraopaopaus kana ikapihwa pamwe chete nemushonga unodzvinyirira ovari basa.

Mienzaniso yearomatase inhibitors inogamuchirwa neDFA ndeye anastrozole (Arimidex®) uye letrozole (Femara®), zvese zviri zviviri zvinomisa aromatase, uye exemestane (Aromasin®), iyo inogonesa zvachose aromatase.

Kuvhara mhedzisiro yesrogen: Mhando dzinoverengeka dzemishonga dzinokanganisa kugona kwesrogen kukurudzira hutachiona hwekenza yemazamu.

• Sarudzo estrogen receptor modulators (SERMs) inosunga kune esrogen receptors, ichidzivirira estrogen kubva pakusunga. Mienzaniso yeSERMs inogamuchirwa neDFA yekurapa kenza yemazamu ndeye tamoxifen (Nolvadex®) uye toremifene (Fareston®). Tamoxifen yanga ichishandiswa kweanopfuura makore makumi matatu kurapa kenza yemazamu-inovhenekera yemazamu.

Nekuti maSERM anosunga kune esrogen receptors, vanogona kwete kwete kungovharira esrogen chiitiko (kureva., Kushanda sevanopokana nesrogen) asi zvakare kuteedzera esrogen mhedzisiro (kureva, shanda seestrogen agonists). MaSERM anokwanisa kuzvibata sevashori veestrogen mune mamwe matishu uye semaestrogen agonists mune mamwe matishu. Semuenzaniso, tamoxifen inovhara mhedzisiro yeestrogen muzvipfuva zvemuzamu asi inoita sestrogen muchibereko nepfupa.

• Mimwe antiestrogen zvinodhaka, senge fulvestrant (Faslodex®), inoshanda neimwe nzira yakati siyanei yekuvhara mhedzisiro yeestrogen. SaSERMs, fulvestrant inosunga kune iyo estrogen receptor uye inoshanda seanopikisa estrogen. Nekudaro, kusiyana neSERMs, fulvestrant haina estrogen agonist mhedzisiro. Iyo yakachena antiestrogen. Uye zvakare, kana fulvestrant inosunga kune iyo estrogen receptor, iyo inogamuchira inotarirwa kuti iparadzwe.

Kurapa kwehomoni kunoshandiswa sei kurapa kenza yemazamu?

Pane nzira nhatu huru dzinoshandiswa kurapa kemikari kurapa kenza yemazamu inonzwisisika.

Adjuvant therapy yekenza yepazamu-yekutanga: Tsvagiridzo yakaratidza kuti vakadzi vanogamuchira angangoita makore mashanu eadjuvant kurapwa ne tamoxifen mushure mekuvhiyiwa kwekutanga-danho ER-yakanaka kenza yemazamu yakaderedza njodzi dzekenza yemazamu kudzoka, kusanganisira kenza nyowani yemazamu. mune rimwe zamu, uye kufa pamakore gumi nemashanu (2).

Tamoxifen inogamuchirwa neiyo FDA yeadjuvant hormone kurapwa kwe premenopausal uye postmenopausal vakadzi (nevarume) vane ER-inovhenekera-yekutanga-kenza yemazamu, uye aromatase inhibitors anastrozole uye letrozole inogamuchirwa kuti ishandiswe mune vakadzi ve postmenopausal.

Chechitatu aromatase inhibitor, exemestane, inobvumidzwa kurapwa kunobatsira kwekenza yemazamu ekutanga-mukadzi mune postmenopausal vakadzi vakagamuchira tamoxifen kare.

Kusvika nguva pfupi yadarika, vakadzi vazhinji vaigamuchira adjuvant hormone kurapwa kudzora mukana wekenza yemazamu kudzoka vakatora tamoxifen zuva rega rega kwemakore mashanu. Zvisinei, nekuiswa kwemishonga mitsva yehomoni, mamwe ayo akafananidzwa ne tamoxifen mumakiriniki ekuedzwa, dzimwe nzira dzekurapa kwehomoni dzave dzakajairika (3-5). Semuenzaniso, vamwe vakadzi vanogona kutora aromatase inhibitor zuva rega rega kwemakore mashanu, panzvimbo ye tamoxifen. Vamwe vakadzi vanogona kuwana mamwe marapirwo nearomatase inhibitor mushure memakore mashanu etamoxifen. Chekupedzisira, vamwe vakadzi vanogona kuchinjira kune aromatase inhibitor mushure memakore maviri kana matatu etamoxifen, kweanosvika makore mashanu kana anopfuura emakore ekurapwa kwehomoni. Kutsvagurudza kwakaratidza kuti kune vakadzi vanonzi postmenopausal vakadzi avo vakarapwa kenza yepazamu-yekutanga.

Sarudzo nezverudzi uye nguva yeadjuvant hormone therapy inofanirwa kuitwa pane mumwe munhu. Aya maitiro akaomarara ekutora sarudzo anonyanya kuitwa nekutaura nachiremba wezve oncologist, chiremba uyo ane hunyanzvi hwekurapa kenza.

Kurapa kwepamberi kana metastatic kenza yemazamu: Mhando dzinoverengeka dzehomoni yekurapa dzinotenderwa kurapa metastatic kana yakajairika kemikari-inoziva kenza yemazamu Hormone Therapy zvakare yekurapa sarudzo yeE--positive kenza yemazamu yakadzoka muzamu, chifuva madziro, kana lymph node dzepedyo mushure mekurapwa (inonziwo kudzokorodza kwenzvimbo).

MaSERM maviri anotenderwa kurapa metastatic kenza yemazamu, tamoxifen uye toremifene. Iyo antiestrogen fulvestrant inobvumidzwa kune vakadzi vanonzi postmenopausal vane metastatic ER-positive kenza yemazamu yakapararira mushure mekurapwa nemamwe maantiestrogens (7). Inogona zvakare kushandiswa mune premenopausal vakadzi vane kuve neovarian ablation.

Iyo aromatase inhibitors anastrozole uye letrozole inogamuchirwa kuti ipiwe kuvakadzi vanoteveraopaopausal senzira yekutanga yekurapa metastatic kana yemuno yepamusoro kenza yemazamu inonzwisisa (8, 9). Iyi mishonga miviri, pamwe ne aromatase inhibitor exemestane, anoshandiswa kurapa vakadzi vanonzi postmenopausal vane gomarara repazamu rakakura iro chirwere chave chichiwedzera mushure mekurapwa ne tamoxifen (10).

Vamwe vakadzi vane gomarara repazamu repamberi vanorapwa nemubatanidzwa wehomoni yekurapa uye yakanangwa kurapwa. Semuenzaniso, yakanangwa kurapa mushonga lapatinib (Tykerb®) inogamuchirwa kuti ishandiswe pamwe chete ne letrozole kurapa hormone receptor-yakanaka, HER2-yakanaka metastatic kenza yemazamu mune vakadzi vanotevera postopaopausal avo kuratidzwa kwehomoni.

Imwe nzira yakanangwa kurapwa, palbociclib (Ibrance®), yakapihwa mvumo yekukurumidza kuti ishandiswe pamwe chete neletrozole sekutanga kurapwa kwekurapwa kwehormone receptor-inovhenekera, HER2-isina kunaka kenza yemazamu mune vakadzi vemashure. Palbociclib inhibits maviri cyclin-anoenderana kinases (CDK4 uye CDK6) inoita kunge inosimudzira kukura kwehormone receptor-yakanaka kenza yemazamu maseru.

Palbociclib inobvumidzwawo kuti ishandiswe pamwe chete nevestvestrant yekurapa kwemadzimai ane hormone receptor-positive, HER2-negative yakakwira kana metastatic kenza yemazamu ine kenza yatowedzera mushure mekurapwa neimwe hormone kurapa.

Neoadjuvant kurapwa kwekenza yemazamu: Iko kushandiswa kwehomoni kurapwa kurapa gomarara repazamu usati wavhiyiwa (neoadjuvant therapy) yakadzidzwa mumakiriniki ekuedzwa (11). Chinangwa cheiyo neadjuvant kurapwa ndechekudzikisa saizi yethumba remuzamu kubvumidza kuvhiya kwezamu. Dhata kubva kumiedzo yakarongedzwa yakarongedzwa yakaratidza kuti neoadjuvant hormone therapy - kunyanya, ine aromatase inhibitors - inogona kushanda mukudzora saizi yemamota ezamu mumadzimai epostmenopausal. Mhedzisiro muvakadzi ve premenopausal haina kunyatso kujeka nekuti chete mashoma mashoma miedzo anosanganisira mashoma mashoma premenopausal vakadzi akaitwa kusvika ikozvino.

Hapana mushonga wehomoni hausati wagamuchirwa neDAA yekurapa neoadjuvant kurapwa kwekenza yemazamu.

Inogona here kurapwa kwehomoni kudzivirira kenza yemazamu?

Ehe. Makenza mazhinji emuzamu ane ER akanaka, uye kiriniki miedzo yakaedza kuti kurapa kwehomoni kunogona kushandiswa kudzivirira kenza yemazamu muvakadzi vari mungozi yekuvandudza chirwere ichi.

Imwe hombe yeNCI-yakatsigirwa yakasarudzika kiriniki yekuedzwa inonzi Breast Cancer Kudzivirira Trial yakawana kuti tamoxifen, yakatorwa kwemakore mashanu, yakadzora njodzi yekuva nekenza yemazamu inopinda neinosvika makumi mashanu muzana mumadzimai ekumapopaopaopausal vaive nenjodzi yakawedzera (12). Yenguva refu yekutevera kweumwe muyedzo wakasarudzika, iyo International Breast Cancer Kupindira Yekudzidza I, yakawana kuti makore mashanu etamoxifen kurapwa kunoderedza kuitika kwekenza yemazamu kweanenge makore makumi maviri (13). Kuedzwa kukuru kwakatevera kwakasarudzika, iyo Kudzidza kwaTamoxifen naRaloxifene, iyo yakatsigirwawo neNCI, yakaona kuti makore mashanu eraloxifene (SERM) inoderedza njodzi yekenza yemazamu mukati mevakadzi vakadaro neinenge 38% (14).

Nekuda kweiyi miedzo, zvese tamoxifen uye raloxifene zvakagamuchirwa neDFA kudzora njodzi yekuva nekenza yemazamu muvakadzi vari panjodzi huru yechirwere. Tamoxifen inobvumidzwa kushandiswa uku zvisinei nemamiriro ekumiraopaopausal. Raloxifene inogamuchirwa kuti ishandiswe chete mumadzimai epostmenopausal.

Maviri aromatase inhibitors - exemestane uye anastrazole - akawanikwawo achideredza njodzi yekenza yemazamu mumadzimai ekumira kumwedzi nekuwedzera njodzi yechirwere. Mushure memazana matatu emakore ekutevera mumuyedzo wakasarudzika, vakadzi vakatora exemestane vaive ne65% kushoma pane avo vakatora placebo kuita gomarara repazamu (15). Mushure memakore manomwe ekutevera mune kumwe kuyedzwa kusinganzwisisike, vakadzi vakatora anastrozole vaive nemakumi mashanu muzana kushomeka pane avo vakatora placebo kuita gomarara repazamu (16). Zvese exemestane uye anastrozole zvinogamuchirwa neDFA yekurapa vakadzi vane ER-positive kenza yemazamu. Kunyangwe ese ari maviri anoshandiswawo kudzivirira kenza yemazamu, kana kubvumidzwa kune icho chiratidzo kunyanya.

Ndeipi mhedzisiro yemhedzisiro yekurapa kwehomoni?

Iyo mhedzisiro mhedzisiro yekurapa kwehomoni kunoenderana zvakanyanya nemushonga chaiwo kana mhando yekurapa (5). Zvakanakira uye zvinokuvadza zvekutora mushonga wehormone zvinofanirwa kuyerwa zvakaringana kumukadzi wega wega. Nzira yakajairika yekushandura inoshandiswa pakurapa kweadjuvant, uko varwere vanotora tamoxifen kwemakore maviri kana matatu, ichiteverwa nearomatase inhibitor kwemakore maviri kana matatu, inogona kupa yakanakisa chiyero chemabhenefiti uye zvinokuvadza zvemhando mbiri idzi dzehomoni yekurapa (17) .

Kupisa kupisa, kudikitira usiku, uye kuoma kwemadzimai zvinowanzoitika mhedzisiro yehomoni yekurapa. Hormone kurapa zvakare inokanganisa iyo yekuenda kumwedzi mune premenopausal vakadzi.

Zvishoma zvakajairika asi zvakakomba mhedzisiro yehomoni yekurapa zvinodhaka zvakanyorwa pazasi.

Tamoxifen

• Njodzi yekugwamba kweropa, kunyanya mumapapu nemakumbo (12)

• Kurohwa (17)

• Kurwara (18)

• Endometrial uye uterine cancer (17, 19)

• Bone kurasikirwa mune premenopausal vakadzi

• Maitiro anochinja, kushushikana, uye kurasikirwa kwe libido

• Mune varume: kutemwa nemusoro, kuda kurutsa, kurutsa, kuputika kweganda, kushaya simba, uye kudzikira kufarira bonde

Raloxifene

• Njodzi yekugwamba kweropa, kunyanya mumapapu nemakumbo (12)

• Sitiroko mune mamwe mapoka madiki (17)

Kudzvinyirira Ovari

• Bone kurasikirwa

• Maitiro anochinja, kushushikana, uye kurasikirwa kwe libido

Aromatase inhibitors

• Njodzi yekurwadziwa kwemoyo, angina, kutadza kwemoyo, uye hypercholesterolemia (20)

• Bone kurasikirwa

• Kurwadziwa pamwe chete (21-24)

• Maitiro anochinja uye kushushikana

Fulvestrant

• Zviratidzo zvemudumbu (25)

• Kupererwa nesimba (24)

• Kurwadziwa

Mimwe mishonga ingakanganisa kurapwa kwehomoni?

Mimwe mishonga, inosanganisira akati wandei anowanzonzi antidepressants (ayo ari muchikamu chinonzi selective serotonin reuptake inhibitors, kana SSRIs), inhibit enzyme inonzi CYP2D6. Iyi enzyme inoita chinzvimbo chakakosha mukushandiswa kwetamoxifen nemuviri nekuti inogaya, kana kuputsa, tamoxifen mumamorekuru, kana metabolites, ayo anoshanda zvakanyanya kupfuura tamoxifen pachayo.

Iko kugona kwekuti SSRIs inogona, nekudzivisa CYP2D6, kunonoka metabolism yetamoxifen uye kudzikisira kushanda kwayo kunetsekana kupihwa kuti sevazhinji-chimwe chechina chevarwere vegomarara repazamu vanowana kuora mwoyo kwekurapwa uye vanogona kurapwa neSSRIs. Uye zvakare, SSRIs dzimwe nguva inoshandiswa kurapa kupenya kunopisa kunokonzerwa nehutachiona kurapwa.

Nyanzvi zhinji dzinopa pfungwa kuti varwere vari kutora mishonga yekudzvinyirira pamwe ne tamoxifen vanofanirwa kukurukura nzira dzekurapa navanachiremba. Semuenzaniso, vanachiremba vanogona kukurudzira kushanduka kubva kune SSRI iyo inodzivirira inhibitor yeCYP2D6, yakadai separoxetine hydrochloride (Paxil®), kune iyo isina simba inhibitor, senge sertraline (Zoloft®), kana iyo isina chiitiko chekudzivirira, senge venlafaxine (Effexor®) kana citalopram (Celexa®). Kana ivo vanogona kuratidza kuti avo postmenopausal varwere vanotora aromatase inhibitor pane tamoxifen.

Mimwe mishonga inodzivisa CYP2D6 inosanganisira zvinotevera:

• Quinidine, iyo inoshandiswa kurapa zvisina kujairika moyo mutinhimira

• Diphenhydramine, inova antihistamine

• Cimetidine, iyo inoshandiswa kudzikisa mudumbu acid

Vanhu vakarairwa tamoxifen vanofanirwa kukurukura nezvekushandisa kwemimwe mishonga yese navanachiremba.

Sarudzo Referensi

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