Malunga-nomhlaza / unyango / ulingo lweklinikhi / isifo / i-extragonadal-germ-cell-tumors / unyango

Unyango lwezilingo zoNyango lwe-Extragonadal Germ Cell Tumor

Uvavanyo lwezonyango zizifundo zophando ezibandakanya abantu. Uvavanyo lweklinikhi kolu luhlu lolonyango lwe-extragonadal germ cell tumor. Zonke izilingo ezikuluhlu ziyaxhaswa yi-NCI.

Ulwazi olusisiseko lwe-NCI malunga nolingo lweklinikhi luchaza iintlobo kunye nezigaba zovavanyo kunye nendlela ezenziwa ngayo. Uvavanyo lwezonyango lujonga iindlela ezintsha zokuthintela, ukufumanisa, okanye ukunyanga izifo. Unokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi. Thetha nogqirha wakho ngoncedo ekunqumeni ukuba ikulungele na.

Iimvavanyo 1-7 ze-7

Ukujonga ngokuSebenza, iBleomycin, iCarboplatin, i-Etoposide, okanye iCisplatin ekunyangeni abaguli kunye nabaguli abadala abaneGerm Cell Tumors.

Isigaba sesithathu sokuvavanywa kwesilingo sendlela yokugada esebenzayo, i-bleomycin, i-carboplatin, i-etoposide, okanye umsebenzi we-cisplatin ekunyangeni abaguli kunye nakwizigulana zabantu abadala ezinezicubu zeseli zentsholongwane. Ukujonga ngokukuko kunokunceda oogqirha ukuba babeke esweni izifundo ezinomngcipheko ophantsi wesisu sentsholongwane emva kokuba isuswe ithumba. Iziyobisi ezisetyenziswa kwi-chemotherapy, njenge-bleomycin, i-carboplatin, i-etoposide, kunye ne-cisplatin, zisebenza ngeendlela ezahlukeneyo ukunqanda ukukhula kweeseli zethumba, nokuba kungokubulala iiseli, ngokuzinqanda ekwahluleni, okanye ngokuzinqanda zisasazeke.

Indawo: Iindawo ezingama-435

Ukukhawulezisa okanye umGangatho we-BEP Chemotherapy ekunyangeni abaguli abanesifo esiPhakathi okanye esiMngcipheko seMetastatic Germ Tumors.

Olu phononongo lwesigaba sesithathu sophando olungenamkhethe lubonisa ukuba ishedyuli ekhawulezayo ye-bleomycin sulphate, etoposide phosphate, kunye ne-cisplatin (BEP) isebenza ngamayeza xa kuthelekiswa neshedyuli esemgangathweni ye-BEP chemotherapy ekunyangeni abaguli abanesisu esiphakathi okanye esisesichengeni sokudumba kweeseli ezinwenwele kwezinye indawo emzimbeni (metastatic). Iziyobisi ezisetyenziswa kwi-chemotherapy, njenge-bleomycin sulphate, i-etoposide phosphate, kunye ne-cisplatin, zisebenza ngeendlela ezahlukeneyo ukunqanda ukukhula kweeseli zethumba, nokuba kungokubulala iiseli, ngokuzinqanda ekwahluleni, okanye ngokuzinqanda zisasazeke. Ukunika i-BEP i-chemotherapy ngokukhawuleza, okanye ishedyuli "ekhawulezayo" inokusebenza ngcono ngeziphumo ebezingalindelekanga ezimbalwa kunyango lwezigulana eziphakathi okanye ezinobungozi kumathambo eeseli zentsholongwane xa kuthelekiswa neshedyuli esemgangathweni.

Indawo: Iindawo ezili-126

I-Standard-Dose Combination Chemotherapy okanye i-High-Dose Combination Chemotherapy kunye ne-Stem Cell Transplant ekunyangeni abaguli abanesifo se-Germ Cell Tumors esibuyileyo okanye esichasayo.

Olu phononongo lwesigaba sesithathu sophando olungenamkhethe lusebenza kakuhle njani xa kusenziwa inhlanganisela ye-chemotherapy ngokuthelekiswa nedosi ephezulu kunye nokudityaniswa kweseli ekunyangeni abaguli abanezilonda zentsholongwane ezibuyileyo emva kwexesha lokuphucula okanye abangaphendulanga kunyango. Iziyobisi ezisetyenziswa kwi-chemotherapy, njenge-paclitaxel, ifosfamide, i-cisplatin, i-carboplatin, kunye ne-etoposide, zisebenza ngeendlela ezahlukeneyo ukunqanda ukukhula kweeseli zethumba, nokuba kungokubulala iiseli, ngokuzinqanda ekwahluleni, okanye ngokuzinqanda zisasazeke. Ukunika i-chemotherapy ngaphambi kokufakelwa kweseli yesiqu kuyeke ukukhula kweeseli zomhlaza ngokuzinqanda zisahlule okanye zibabulale. Ukunika izinto ezikhuthaza ikholoni, ezinje ngefilgrastim okanye i-pegfilgrastim, kunye nezinye iziyobisi ze-chemotherapy, inceda ukuhambisa iiseli ukusuka kumongo wethambo uye egazini ukuze ziqokelelwe kwaye zigcinwe. I-Chemotherapy ke inikwa ukulungiselela umongo wethambo lokufakelwa kweseli ye-stem. Iiseli zeziqu ziye zibuyiselwe kwisigulana ukuze zithathe indawo yeeseli ezenza igazi ezazitshatyalaliswe yichemotherapy. Akukaziwa ukuba idosi ephezulu yokudibanisa i-chemotherapy kunye nokufakwa kweseli kwe-stem kusebenza ngakumbi kunedosi esemgangathweni yokudibanisa i-chemotherapy ekunyangeni abaguli abane-refractory okanye ibuye yabuya ithumba leseli yentsholongwane.

Indawo: Iindawo ezingama-54

I-Durvalumab kunye ne-Tremelimumab ekunyangeni abaguli abanesifo seLungu leLungu eliBuyileyo okanye elichasayo

Isigaba sesibini sokuvavanywa kwesilingo sokuba i-durvalumab kunye ne-tremelimumab zisebenza njani ekunyangeni abaguli abane-germ cell tumors ezibuyileyo emva kwexesha lokuphucula okanye ezingaphenduliyo kunyango. I-Immunotherapy ene-monoclonal antibodies, enjenge-durvalumab kunye ne-tremelimumab, inokunceda amajoni omzimba ahlasele umhlaza, kwaye inokuphazamisa amandla eeseli zethumba ukukhula kunye nokusasazeka.

Indawo: Iindawo ezi-7

Ukufakelwa kweseli ye-Autologous Peripheral Stem Cell kwiGerm Cell Tumors

Ukhetho lonyango lwezigulana zeseli zentsholongwane ezibuyileyo okanye ezinqabileyo (GCT) zilinganiselwe. Unyango oluphezulu lwe-chemotherapy nge-stem cell Rescue (i-autologous stem cell transplant), xa inikwe ngokulandelelana, ibonakalisile ukuba iseti yezigulana inokuphiliswa. I-regimen ephezulu ye-chemotherapy ephezulu, nangona kunjalo, ayaziwa. Kolu vavanyo, siya kusebenzisa ii-tandem autologous transplants ezineerejimeni zokunganyangeki ezinqamlezileyo ukunyanga abaguli abanee-GCT ezibuyileyo / ezibonakalisayo.

Indawo: IYunivesithi yaseMinnesota / iZiko loMhlaza leMasonic, eMinneapolis, eMinnesota

I-Melphalan, iCarboplatin, iMannitol, kunye neSodium Thiosulfate ekunyangeni abaguli abane-CNS eQhelekileyo okanye eQhubekayo ye-Embryonal okanye yeJerm Cell Tumors.

Esi sigaba sokulinga se-I / II sophando lweziphumo ebezingalindelekanga kunye nedosi efanelekileyo ye-melphalan xa inikwa kunye ne-carboplatin, mannitol, kunye ne-sodium thiosulfate, kunye nokubona ukuba zisebenza njani na ekunyangeni abaguli abanesistim ephindaphindayo okanye eqhubela phambili ye-nervous system (CNS) embryonal okanye intsholongwane. amathumba eseli. Iziyobisi ezisetyenziswa kwi-chemotherapy, ezinje nge-melphalan kunye ne-carboplatin, zisebenza ngeendlela ezahlukeneyo ukunqanda ukukhula kweeseli zethumba, nokuba kungokubulala iiseli, ngokuzinqanda zisahlule, okanye ngokuzinqanda zisasazeke. Ukuphazamiseka kwesithintelo segazi nengqondo (i-BBBD) isebenzisa i-mannitol ukuvula imithambo yegazi ejikeleze ingqondo kunye nokuvumela izinto ezibulala umhlaza ukuba zihanjiswe ngqo kwingqondo. I-sodium thiosulfate inokunceda ukunciphisa okanye ukuthintela ukulahleka kokuva kunye neetyhefu kwizigulana ezenza ichemotherapy kunye ne-carboplatin kunye ne-BBBD.

Indawo: Indawo ezi- 2

I-Adjuvant Tumor Lysate Vaccine kunye ne-Iscomatrix kunye okanye ngaphandle kwe-Metronomic Oral Cyclophosphamide kunye ne-Celecoxib kwizigulana ezineempawu ezimbi ezibandakanya imiphunga, i-Esophagus, iPleura, okanye iMediastinum.

Imvelaphi: Kwiminyaka yakutshanje, umhlaza-testis (CT) antigen (CTA), ngakumbi ezo zifakwe kwiijeni kwi-X chromosome (CT-X genes), ziye zavela njengeethagethi ezinomtsalane kumhlaza we-immunotherapy. Ngelixa ukungalunganga kweembali ezahlukeneyo kuchaza ii-CTAs ezahlukeneyo, iimpendulo zomzimba kwezi proteni zibonakala zingaqhelekanga kwizigulana ezinomhlaza, mhlawumbi ngenxa yenqanaba elisezantsi, i-heterogenible antigen expression, kunye neeseli ze-T ezilawulayo zokuzikhusela ezikhoyo kwindawo zesifo kunye nokusasazeka kwenkqubo kwaba bantu . Kuyaqondakala ukuba, ukugonywa kwezigulana ezinomhlaza ezineeseli ezinesibindi ezibonisa amanqanaba aphezulu ee-CTA ngokudibeneyo neerejimeni eziphelisa okanye zithintela iiseli ezilawulayo ze-T ziya kubangela ukungakhuseleki kubanzi kwezi antigen. Ukuvavanya lo mbandela, abaguli abanomhlaza wamaphaphu kunye nomhlaza wokuqaqanjelwa ngumqala, imesotheliomas yesicelo, iisarcomas zethoracic, I-thymic neoplasms kunye ne-mediastinal germ cell tumors, kunye ne-sarcomas, i-melanomas, i-germ cell tumors, okanye i-epithelial malignancies metastatic to lungs, pleura okanye mediastinum ngaphandle kobungqina besifo (i-NED) okanye isifo eshiyekileyo esincinci (MRD) kulandela unyango oluqhelekileyo lwezifundo ezahlukeneyo ziya kuba Ugonywe i-H1299 cell cell lysates kunye ne-Iscomatrix adjuvant. Izitofu ziya kwenziwa kunye okanye ngaphandle kwe-cyclophosphamide yomlomo (50 mg PO BID x 7d q 14d), kunye ne-celecoxib (400 mg PO BID). Iimpendulo zeSerologic kwiindidi ze-CTA eziphindaphindayo kunye neempendulo ze-immunologic kwi-autologous tumor okanye i-epigenetically modified autologous EBVtransformed lymphocyte ziya kuvavanywa ngaphambi nasemva kwenyanga yesithandathu yokugonya. Iinjongo zokuqala: 1. Ukuvavanya ukuphindaphinda kweempendulo ze-immunologic kwii-CTAs kwizigulana ezinesifo se-thoracic emva kokugonywa nge-H1299 cell lysate / Iscomatrix (TM) izitofu zodwa xa kuthelekiswa nezigulana ezine-thoracic malignancies ezilandela ukugonywa nge-H1299 cell lysate / Iscomatrix vaccines ngokudibeneyo ne-metronomic cyclophosphamide kunye ne-celecoxibib . Iinjongo zesekondari: 1. Ukujonga ukuba ngaba umlomo we-cyclophosphamide kunye ne-celecoxib yonyango iyalinciphisa inani kunye neepesenti yeeseli ezilawulayo ze-T kwaye inciphise ukusebenza kwezi seli kwizigulana ezinesifo se-thoracic zisengozini yokuphindeka. 2.Ukuvavanya ukuba ngaba isitofu sokugonya i-H1299 cell lysate / Iscomatrix (TM) sonyusa impendulo ye-immunologic kwi-autologous tumor okanye i-epigenetically modified autologous lymphocyte e-EBV (B cells). Ukufaneleka: - Izigulana ezineseli encinci okanye umjelo weseli omncinci okanye umhlaza wamaphaphu (SCLC; NSCLC), umhlaza wesisu (EsC), i-mesothelioma enobungozi (MPM), i-thymic okanye i-mediastinal germ cell tumors, i-thoracic sarcomas, okanye i-melanomas, i-sarcomas, okanye i-epithelial malignancies metastatic to lungs, pleura okanye mediastinum ezingenabungqina beklinikhi yesifo esisebenzayo (i-NED), okanye isifo eshiyekileyo esincinci (i-MRD) esingafikeleleki ngokulula nge-biopsy engeyiyo eyokuhlasela okanye yokuphinda yenze / imitha ngokulandela unyango oluqhelekileyo olugqityiweyo kwiiveki ezingama-26 ezidlulileyo . - Izigulana kufuneka zibe neminyaka eli-18 okanye nangaphezulu zinenqanaba lokusebenza kwe-ECOG eyi-0. Izigulana zisenokungabikho kunyango lwenkqubo yokugonywa ngexesha lokugonywa. Uyilo: -Ukulandela ukubuyiswa kotyando, i-chemotherapy, okanye i-chemo / XRT, abaguli abane-NED okanye i-MRD baya kugonywa ngenaliti ye-IM nge-H1299 cell lysates kunye ne-Iscomatrix (TM) encedisayo inyanga nenyanga kwiinyanga ezi-6. - Amayeza okugonya aya kwenziwa kunye okanye ngaphandle kwe-cyclophosphamide yomlomo kunye ne-celecoxib. Ukurekhodwa kwenkqubo kunye nempendulo ye-immunologic kunyango kuya kurekhodwa. Ngaphambi nangemva kokugonywa kweempendulo ze-serologic kunye neeseli kwiphaneli esemgangathweni yee-antigen ze-CT kunye neeseli ze-autologous tumor (ukuba zikhona) kunye nee-lymphocyte eziguqulweyo ze-EBV ziya kuvavanywa ngaphambi nasemva kogonyo. Amanani / ipesenti kunye nomsebenzi weeseli ezilawulayo ze-T egazini elisecaleni ziya kuvavanywa ngaphambi, ngexesha nasemva kokugonywa. -Izigulana ziya kulandelwa eklinikhi ngokuskena okuqhelekileyo de isifo siphindaphinde.

Indawo: Amaziko kaZwelonke eKliniki, eBethesda, eMaldin