Cishe-umdlavuza / ukwelashwa / ukuhlolwa-klinikhi / izifo / i-extragonadal-germ-cell-tumors / ukwelashwa

Ukwelashwa Kwezilingo Zomtholampilo We-Extragonadal Germ Cell Tumor

Ukuhlolwa kwemitholampilo kuyizifundo zocwaningo ezibandakanya abantu. Ukuhlolwa kwemitholampilo kulolu hlu kungokwelashwa kwe-extragonadal germ cell tumor. Zonke izilingo ohlwini zisekelwa yi-NCI.

Imininingwane eyisisekelo ye-NCI mayelana nokuhlolwa komtholampilo ichaza izinhlobo nezigaba zezilingo nokuthi zenziwa kanjani. Ukuhlolwa komtholampilo kubheka izindlela ezintsha zokuvimbela, ukuthola, noma ukwelapha izifo. Ungahle uthande ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Khuluma nodokotela wakho ngosizo lokunquma ukuthi ngabe kukulungele yini.

Izilingo 1-7 kwezingu-7

Ukuqashwa Okusebenzayo, i-Bleomycin, i-Carboplatin, i-Etoposide, noma i-Cisplatin ekwelapheni iziguli zezingane kanye nabantu abadala abane-Germ Cell Tumors

Lesi sigaba sesivivinyo se-III sihlola ukuthi ukubhekwa okusebenza kahle kangakanani, i-bleomycin, i-carboplatin, i-etoposide, noma i-cisplatin isebenza ekwelapheni iziguli zezingane nezabantu abadala ezinezicubu zamagciwane. Ukuqapha okusebenzayo kungasiza odokotela ukuqapha izihloko ezinama-tumors amangqamuzana anobungozi aphansi ngemuva kokukhishwa kwesimila sabo. Izidakamizwa ezisetshenziselwa ukwelashwa ngamakhemikhali, njenge-bleomycin, i-carboplatin, i-etoposide, ne-cisplatin, zisebenza ngezindlela ezehlukene ukunqanda ukukhula kwamangqamuzana ama-tumor, kungaba ngokubulala amaseli, ngokuwavimba ekuhlukaniseni, noma ngokuwavimba ekusabalaleni.

Indawo: izindawo ezingama-435

Ukusheshisa noma i-BEP Chemotherapy esheshayo noma ejwayelekile ekwelapheni iziguli ezinesisu esiphakathi noma esibi kakhulu seMetastatic Germ Cell Tumors.

Lesi silingo sesigaba III esingahleliwe sihlola ukuthi uhlelo olusheshayo lwe-bleomycin sulfate, i-etoposide phosphate, ne-cisplatin (BEP) chemotherapy isebenza kanjani uma kuqhathaniswa neshejuli ejwayelekile ye-BEP chemotherapy ekwelapheni iziguli ezinesisu esiphakathi noma esinobungozi besimila segciwane esisakazekele kwezinye izindawo emzimbeni (metastatic). Izidakamizwa ezisetshenziselwa ukwelashwa ngamakhemikhali, njenge-bleomycin sulfate, i-etoposide phosphate, ne-cisplatin, zisebenza ngezindlela ezehlukene ukunqanda ukukhula kwamangqamuzana ezimila, kungaba ngokubulala amaseli, ngokuwavimba ekuhlukaniseni, noma ngokuwavimba ekusakazeni. Ukunikeza i-BEP chemotherapy ngesivinini esisheshayo, noma "esisheshisiwe" kungasebenza kangcono ngemiphumela engemihle ekwelapheni iziguli ezinesisu esiphakathi noma esinobungozi obuphansi besimila segciwane lesandulela ngculaza uma kuqhathaniswa nohlelo olujwayelekile.

Indawo: izindawo eziyi-126

I-Standard-Dose Combination Chemotherapy noma i-High-Dose Combination Chemotherapy kanye ne-Stem Cell Transplant ekwelapheni iziguli ezinamaqhubu abuye abuyele emuva noma aphikisayo.

Lesi sivivinyo sesigaba se-III esingahleliwe sisebenza kanjani ukuthi inhlanganisela yamakhemikhali ejwayelekile isebenza kanjani uma kuqhathaniswa ne-high-dose combination chemotherapy kanye ne-stem cell transplant ekwelapheni iziguli ezinamagciwane amangqamuzana egciwane abuye ngemuva kwesikhathi sokwenza ngcono noma angazange aphendule ekwelashweni. Izidakamizwa ezisetshenziselwa ukwelashwa ngamakhemikhali, njenge-paclitaxel, ifosfamide, i-cisplatin, i-carboplatin, ne-etoposide, zisebenza ngezindlela ezehlukene ukunqanda ukukhula kwamangqamuzana ezinhlungu, kungaba ngokubulala amaseli, ngokuwavimba ekuhlukaniseni, noma ngokuwavimba ekusakazeni. Ukunikeza i-chemotherapy ngaphambi kokufakelwa kwe-stem cell kumisa ukukhula kwamangqamuzana omdlavuza ngokuwavimba ekuwahlukaniseni noma ekubulaleni. Ukunikeza izinto ezivuselela ikoloni, njenge-filgrastim noma i-pegfilgrastim, kanye nezidakamizwa ezithile ze-chemotherapy, isiza ama-stem cells ukuthi asuke emnkantsheni wethambo aye egazini ukuze aqoqwe futhi agcinwe. I-Chemotherapy ibese inikezwa ukulungisa umongo wethambo wokufakelwa kabusha kwe-stem cell. Amaseli esiqu abese ebuyiselwa esigulini ukuze athathe indawo yamaseli akha igazi abhujiswa ngamakhemikhali. Akukaziwa ukuthi ngabe inhlanganisela yamakhemikhali ephezulu kanye nokufakelwa kwe-stem cell kuyasebenza yini ukwedlula i-standard-dose combination chemotherapy ekwelapheni iziguli ezinamagciwane amangqamuzana egciwane eliphikisayo noma abuye abuye.

Indawo: izindawo ezingama-54

I-Durvalumab ne-Tremelimumab ekwelapheni iziguli ezinama-tumor cell abuyele emuva noma aphikisayo

Lesi sigaba sesivivinyo sesi-II sihlola ukuthi i-durvalumab ne-tremelimumab zisebenza kahle kanjani ekwelapheni iziguli ezinamagciwane amangqamuzana egciwane abuye ngemuva kwesikhathi sokwenza ngcono noma ezingaphenduli ekwelashweni. I-Immunotherapy enama-antibody monoclonal, njenge-durvalumab ne-tremelimumab, ingasiza amasosha omzimba ukuthi ahlasele umdlavuza, futhi ingaphazamisa ikhono lamangqamuzana wesimila ukukhula nokukhula.

Indawo: izindawo ezingu-7

I-Autologous Peripheral Blood Stem Cell Transplant yamaGerm Cell Tumors

Izinketho zokwelashwa kweziguli ezibuyela emuva noma ezichasayo zamagciwane (GCT) zikhawulelwe. I-chemotherapy ephezulu ene-stem cell rescue (i-autologous stem cell transplant), uma inikezwa ngokulandelana, ikhombisile ukuthi i-subset yeziguli ingalapheka. Uhlobo oluhle lwe-chemotherapy ephezulu, noma kunjalo, alwaziwa. Kulolu vivinyo, sizosebenzisa ukufakelwa okuzenzakalelayo kwe-autologous ngama-regimens wokuvikela ukumelana non-cross ukwelapha iziguli ezinama-GCT abuyele emuva / aphikisayo.

Indawo: University of Minnesota / Masonic Cancer Center, Minneapolis, Minnesota

I-Melphalan, Carboplatin, Mannitol, ne-Sodium Thiosulfate ekwelapheni iziguli ezine-CNS Embryonal noma i-Germ Cell Tumors eziphindaphindayo noma eziqhubekayo.

Lesi sigaba sesivivinyo se-I / II sihlola imiphumela emibi kanye nomthamo omuhle we-melphalan lapho unikezwa kanye ne-carboplatin, mannitol, ne-sodium thiosulfate, nokubona ukuthi basebenza kahle kangakanani ekwelapheni iziguli ezinesistimu yezinzwa eziphindaphindayo noma eqhubekayo (CNS) embryonal noma igciwane izicubu zeseli. Izidakamizwa ezisetshenziselwa ukwelashwa ngamakhemikhali, njenge-melphalan ne-carboplatin, zisebenza ngezindlela ezehlukene ukunqanda ukukhula kwamangqamuzana ama-tumor, kungaba ngokubulala amaseli, ngokuwavimba ekuhlukaniseni, noma ngokuwavimba ekusabalaleni. Ukuphazanyiswa kwesithiyo se-Osmotic blood-brain barrier (BBBD) kusebenzisa i-mannitol ukuvula imithambo yegazi ezungeze ubuchopho nokuvumela izinto zokubulala umdlavuza ukuthi zithwalwe ngqo ziye ebuchosheni. I-sodium thiosulfate ingasiza ukunciphisa noma ukuvimbela ukulahleka kwezindlebe kanye nobuthi ezigulini ezelashwa ngamakhemikhali nge-carboplatin ne-BBBD.

Indawo: izindawo ezi-2

Umuthi wokugomela i-Adjuvant Tumor Lysate kanye ne-Iscomatrix Unayo noma Ngaphandle Kwayo iMetronomic Oral Cyclophosphamide neCelecoxib Ezigulini Ezinamalignancies Abandakanya Amaphaphu, I-Esophagus, iPleura, noma iMediastinum

Ingemuva: Eminyakeni yamuva nje, ama-antigen womdlavuza-i-testis (CT), ikakhulukazi lawo afakwe yizakhi zofuzo ku-X chromosome (CT-X genes), avele njengezinjongo ezikhangayo zomdlavuza we-immunotherapy. Ngenkathi ubudlova bama-histologies ahlukahlukene buchaza ama-CTAs ahlukahlukene, izimpendulo zokuzivikela kula maprotheni zibonakala zingavamile ezigulini ezinomdlavuza, mhlawumbe ngenxa yezinga eliphansi, elingenakulinganiswa le-antigen expression, kanye namaseli we-T we-immunosuppressive lawula ama-T akhona ngaphakathi kwezindawo ze-tumor nokusakazwa okuhlelekile kwalaba bantu . Ngokusobala, ukugonywa kweziguli ezinomdlavuza ezinamaseli wesimila aveza amazinga aphezulu ama-CTA ngokuhambisana nemithi eqeda noma evimbela amaseli wokulawula we-T kuzodala ukuvikeleka okubanzi kulawa ma-antigen. Ukuze uhlolisise lolu daba, iziguli ezinomdlavuza oyinhloko wamaphaphu nowokuqwala, ama-pleural mesotheliomas, ama-thoracic sarcomas, ama-thymic neoplasms nama-mediastinal germ cell tumors, kanye nama-sarcomas, ama-melanomas, ama-germ cell tumors, noma i-epithelial malignancies metastatic to the lungs, pleura noma mediastinum ngaphandle kobufakazi besifo (i-NED) noma isifo esisele esisele (MRD) kulandela ukwelashwa okujwayelekile okuhlukahlukene kugonywe ama-lysates esitokisi esine-H1299 nge-Iscomatrix adjuvant. Imithi yokugoma izonikezwa nge-cyclophosphamide yomlomo noma ngaphandle kwe-metronomic (50 mg PO BID x 7d q 14d), ne-celecoxib (400 mg PO BID). Izimpendulo ze-Serologic kuma-CTA amaningi ahlanganisayo kanye nezimpendulo ze-immunologic ku-autologous tumor noma i-epigenetically modified autologous EBVtransformed lymphocyte zizohlolwa ngaphambi nangemva kwesikhathi sokugoma sezinyanga eziyisithupha. Izinhloso Eziyinhloko: 1. Ukuhlola imvamisa yezimpendulo ze-immunologic kuma-CTA ezigulini ezine-thoracic malignancies ezilandela imigomo ngemithi yokugoma ye-H1299 cell lysate / Iscomatrix (TM) iyodwa uma iqhathaniswa neziguli ezine-thoracic malignancies ezilandela imigomo ngemithi yokugoma ye-H1299 cell lysate / Iscomatrix ngokuhambisana ne-metronomic cyclophosphamide ne-celecoxibib . Izinhloso Zesibili: 1. Ukuhlola ukuthi i-oral metronomic cyclophosphamide ne-celecoxib therapy yehlisa inani namaphesenti wamaseli wokulawula we-T futhi inciphise ukusebenza kwalawa maseli ezigulini ezinama-thoracic malignancies zisengozini yokuphindeka. 2.Ukuhlola ukuthi ngabe ukugonywa kwe-H1299 cell lysate / Iscomatrix (TM) kuthuthukisa impendulo ye-immunologic kwi-autologous tumor noma i-epigenetically modified autologous lymphocyte eguqulwe yi-EBV (B cells). Ukufaneleka: - Iziguli ezinamaseli amancane noma omdlavuza weseli wamaphaphu (SCLC; NSCLC), umdlavuza we-esophageal (EsC), i-malignant pleural mesothelioma (MPM), i-thymic noma i-mediastinal germ cell tumors, i-thoracic sarcomas, noma i-melanomas, i-sarcomas, noma i-epithelial malignancies metastatic to the lungs, pleura noma mediastinum ezingenabo ubufakazi bomtholampilo besifo esisebenzayo (i-NED), noma isifo esincane esisele (i-MRD) esingatholakali kalula nge-biopsy engeyona eyokuhlasela noma i-resection / i-radiation kulandela ukwelashwa okujwayelekile okuqediwe emasontweni angama-26 edlule . - Iziguli kufanele zibe neminyaka eyi-18 noma ngaphezulu ezinesimo sokusebenza se-ECOG esingu-0 2. - Iziguli kufanele zibe nomnkantsha owanele, izinso, isibindi, amaphaphu nokusebenza kwenhliziyo. - Iziguli kungenzeka zingabi semithini yokuvikela ukuzivikela ngesikhathi sokugoma kuqala. Idizayini: - Ngemuva kokululama ekuhlinzweni, i-chemotherapy, noma i-chemo / XRT, iziguli ezine-NED noma i-MRD zizogonywa ngomjovo we-IM nge-H1299 cell lysates kanye ne-Iscomatrix (TM) adjuvant njalo ngenyanga izinyanga eziyisithupha. - Imithi yokugoma izokwelashwa nge-metronomic oral cyclophosphamide ne-celecoxib. - Kuzoqoshwa ubuthi obusezingeni eliphezulu nempendulo ye-immunologic ekwelashweni. Izimpendulo ze-serologic kanye ne-cell zokugoma zangaphambi nangemuva kwephaneli ejwayelekile yama-antigen we-CT kanye namaseli we-autologous tumor (uma ekhona) nama-lymphocyte aguqulwe yi-EBV azohlolwa ngaphambi nangemva kokugoma. - Izinombolo / amaphesenti kanye nokusebenza kwamaseli wokulawula we-T egazini lomngcele kuzohlolwa ngaphambi, ngesikhathi nangemva kokugoma. - Iziguli zizolandelwa emtholampilo ngokuskena okujwayelekile kuze kube ukuphindaphinda kwezifo.

Indawo: Izikhungo Zikazwelonke Zempilo Clinical Centre, eBethesda, eMaryland