Cancer immunotherapy yog dab tsi?

Immunotherapy yog thaum ib feem ntawm tus neeg mob lub cev tiv thaiv kab mob siv los tiv thaiv kab mob thiab kis kab mob, qhov no yog mob qog noj ntshav. Qhov no yog ua los ntawm kev txhawb lub cev tiv thaiv kab mob kom ua haujlwm hnyav, lossis muab cov khoom tiv thaiv kab mob tiv thaiv kab mob los tiv thaiv kab mob.

Tus kws kho mob William Coley tau tshawb pom tias kev kis mob tom qab phais zoo li pab qee tus neeg mob qog noj ntshav. Tom qab ntawd nws tau sim kho cov neeg mob qog noj ntshav los ntawm kev kis kab mob rau lawv. Qhov no yog lub hauv paus rau niaj hnub immunotherapy, txawm hais tias tam sim no peb tsis kis tus neeg mob; peb qhib lawv lub cev tiv thaiv kab mob siv ntau txoj hauv kev los yog muab lawv cov cuab yeej tiv thaiv kab mob sib ntaus sib tua.

Qee hom kev tiv thaiv kab mob qog noj ntshav txhawb lub cev tiv thaiv kab mob tag nrho, thaum lwm tus siv lub cev tiv thaiv kab mob los tua cov qog nqaij hlav ncaj qha. Cov kws tshawb fawb tau tswj xyuas txoj hauv kev kom tau ib tus neeg lub cev tiv thaiv kab mob kom paub txog cov qog nqaij hlav cancer hauv lub cev thiab ntxiv dag zog rau nws cov lus teb.

Muaj peb hom kev tiv thaiv kab mob qog noj ntshav: monoclonal antibodies, tshuaj tiv thaiv kab mob qog noj ntshav, thiab tsis yog tshuaj tiv thaiv kab mob tshwj xeeb. Qhov ua kom yuam kev nrog kev tiv thaiv kab mob qog noj ntshav yog txheeb xyuas seb cov antigens nyob rau ntawm cov qog nqaij hlav cancer, lossis cov antigens twg koom nrog cov qog nqaij hlav lossis lub cev tiv thaiv kab mob.

Hom Immunotherapy thiab Lawv Daim Ntawv Thov Kev Kho Mob

Monoclonal antibodies yog tib neeg tsim los yog tsim los ntawm tus neeg mob cov qe ntshav dawb, thiab yog siv los tsom rau lub cev tiv thaiv kab mob lossis cov tshuaj tiv thaiv tshwj xeeb ntawm cov qog nqaij hlav cancer.

Thawj kauj ruam hauv kev ua cov tshuaj tiv thaiv kab mob monoclonal yog txhawm rau txheeb xyuas qhov tseeb antigen rau lub hom phiaj. Qhov no nyuaj rau mob qog noj ntshav vim muaj ntau cov antigens koom nrog. Qee cov qog nqaij hlav muaj zog dua rau cov tshuaj tiv thaiv kab mob monoclonal ces lwm tus tab sis, raws li ntau cov tshuaj tiv thaiv kab mob txuas rau qee hom qog nqaij hlav, cov tshuaj tiv thaiv monoclonal ua haujlwm zoo dua.

Muaj ob hom monoclonal antibodies; thawj yog conjugated monoclonal antibodies. Cov no muaj cov khoom siv hluav taws xob lossis cov tshuaj khomob uas txuas nrog cov tshuaj tiv thaiv kabmob. Cov tshuaj tiv thaiv kab mob tshawb nrhiav thiab txuas mus rau cov qog nqaij hlav qog noj ntshav uas cov tshuaj lossis cov khoom tuaj yeem muab ncaj qha. Txoj kev kho no tsis tshua muaj teeb meem ntau dua li kev siv tshuaj chemo lossis radioactive therapy.

Hom thib ob yog liab qab monoclonal antibodies thiab, raws li lub npe qhia, cov no tsis muaj tshuaj kho mob lossis cov khoom siv hluav taws xob txuas nrog rau lawv. Hom tshuaj tiv thaiv no ua haujlwm ntawm nws tus kheej, txawm hais tias lawv tseem txuas rau cov antigens ntawm cov qog nqaij hlav cancer nrog rau lwm cov hlwb uas tsis yog mob qog noj ntshav lossis cov proteins dawb ntab.

Qee qhov txhawb kev tiv thaiv kab mob los ntawm kev ua tus cim rau T-hlwb thaum txuas nrog cov qog nqaij hlav cancer. Lwm tus txhawb lub cev tiv thaiv kab mob tag nrho los ntawm kev tsom mus rau kev tiv thaiv kab mob. Ib qho piv txwv ntawm liab qab monoclonal antibodies (NmAbs) yog cov tshuaj "Alemtuzumab" ua los ntawm Campath. Alemtuzumab yog siv rau cov neeg mob uas muaj kab mob lymphocytic leukemia (CLL). Cov tshuaj tiv thaiv tsom rau CD52 antigen ntawm lymphocytes, suav nrog cov leukemia hlwb, thiab nyiam cov neeg mob lub cev tiv thaiv kab mob los rhuav tshem cov qog nqaij hlav cancer.

Cov tshuaj tiv thaiv kab mob qog noj ntshav, lwm hom tshuaj tiv thaiv kab mob monoclonal, tsom rau lub cev tiv thaiv kab mob rau cov kab mob thiab kab mob uas tuaj yeem ua rau mob qog noj ntshav. Siv tib lub hauv paus ntsiab lus ntawm cov tshuaj tiv thaiv ib txwm muaj, lub hom phiaj tseem ceeb ntawm cov tshuaj tiv thaiv kab mob qog noj ntshav yog ua raws li kev tiv thaiv kev tiv thaiv ntau dua li kev ntsuas kho mob.Cov tshuaj tiv thaiv kab mob qog noj ntshav tsis tawm tsam cov qog nqaij hlav ncaj qha.

Cov tshuaj tiv thaiv kabmob kheesxaws ua haujlwm zoo ib yam li cov tshuaj tiv thaiv kab mob hauv txoj kev uas lawv txhawb lub cev tiv thaiv kab mob, txawm li cas los xij nrog cov tshuaj tiv thaiv kabmob kheesxaws lub cev tiv thaiv kab mob yog tsom mus rau kev tawm tsam cov qog nqaij hlav cancer uas tsim los ntawm tus kabmob es tsis yog tus kabmob nws tus kheej.

Nws paub tias qee yam kab mob ntawm tib neeg papillomavirus (HPV) txuas nrog lub ncauj tsev menyuam, qhov quav, caj pas, thiab qee qhov qog nqaij hlav. Tsis tas li ntawd, cov neeg uas muaj kab mob siab B (HBV) muaj kev pheej hmoo ntau dua ntawm kev mob qog noj ntshav.

Qee zaum, txhawm rau tsim cov tshuaj tiv thaiv kab mob qog noj ntshav rau HPV, piv txwv li, tus neeg mob uas kis tus kab mob papilloma tib neeg yuav muaj cov qauv ntawm lawv cov qe ntshav dawb tshem tawm. Cov hlwb no yuav raug cuam tshuam rau cov khoom tshwj xeeb uas, thaum rov ua dua rau tus neeg mob lub cev tiv thaiv kab mob, yuav tsim kom muaj zog tiv thaiv kab mob. Cov tshuaj tiv thaiv uas tsim los ntawm txoj kev no yuav qhia tshwj xeeb rau tus neeg uas cov qe ntshav dawb raug coj los ntawm. Qhov no yog vim hais tias cov qe ntshav dawb yuav raug coded nrog tus neeg DNA tso cai rau cov tshuaj tiv thaiv tag nrho rau hauv lawv lub cev tiv thaiv kab mob.

Kev kho mob qog noj ntshav tsis tshwj xeeb tsis yog tsom rau cov qog nqaij hlav qog noj ntshav ncaj qha tab sis txhawb nqa tag nrho lub cev tiv thaiv kab mob. Hom kev tiv thaiv kab mob no feem ntau yog ua los ntawm cytokines thiab cov tshuaj uas tsom mus rau lub cev tiv thaiv kab mob.

Lub cev tiv thaiv kab mob siv cov chaw kuaj xyuas kom nws tus kheej los ntawm kev tawm tsam ib txwm lossis nws tus kheej hauv lub cev. Nws siv cov molecules los yog lub cev tiv thaiv kab mob uas tau qhib los yog inactivated los pib lub cev tiv thaiv kab mob. Cov qog nqaij hlav cancer tuaj yeem mus tsis pom los ntawm lub cev tiv thaiv kab mob vim tias lawv tuaj yeem muaj qee yam antigens uas ua raws li cov ntawm lub cev tus kheej lub hlwb kom lub cev tiv thaiv tsis txhob tawm tsam lawv.

Cytokines yog cov tshuaj uas qee lub cev tiv thaiv kab mob tuaj yeem tsim. Lawv tswj kev loj hlob thiab kev ua haujlwm ntawm lwm lub cev tiv thaiv kab mob. Muaj ob hom cytokines: interleukins thiab interferon's.

Interleukins ua raws li cov teeb liab tshuaj ntawm cov qe ntshav dawb. Interleukin-2 (IL-2) pab lub cev tiv thaiv kab mob hlwb loj hlob thiab sib faib sai dua, los ntawm kev ntxiv ntau dua lossis txhawb nqa IL-2 hlwb nws tuaj yeem ua rau lub cev tiv thaiv kab mob thiab kev vam meej tiv thaiv qee yam qog noj ntshav.

Interferon pab lub cev tiv thaiv kab mob, kab mob, thiab mob qog noj ntshav. Lawv ua qhov no los ntawm kev txhawb nqa lub peev xwm ntawm qee lub cev tiv thaiv kab mob los tua cov qog nqaij hlav cancer thiab tuaj yeem ua rau qeeb ntawm cov qog nqaij hlav cancer. Kev siv cov tshuaj interferon tau pom zoo rau cov qog nqaij hlav xws li cov plaub hau cell leukemia, mob myeologenous leukemia (CML), hom lymphoma, mob raum, thiab melanoma.

Dab tsi tshiab hauv Cancer Immunotherapy Research?

Immunotherapy nws tus kheej tsis yog qhov chaw tshiab, txawm tias nws siv rau kev kho mob qog noj ntshav. Tab sis raws li kev tshawb fawb ntau ntxiv rau qhov ua rau mob qog noj ntshav thiab yuav ua li cas thiaj li kuaj tau nws zoo dua, peb tuaj yeem tuaj yeem tiv thaiv tus kab mob thiab rov qab los.

Ntau lub tuam txhab tshuaj tau los nrog tshuaj los tawm tsam mob qog noj ntshav. Txawm hais tias tsis tau hais ntau ntau txog cov tshuaj thaum nyob rau theem kev npaj (rau kev ruaj ntseg), muaj kev sim tshuaj rau cov tshuaj uas ua pov thawj tias yuav kho mob qog noj ntshav. Ib qho tshuaj zoo li no yog CAR T-cell (Chimeric Antigen Receptor) therapy, monoclonal antibody siv los kho tus mob lymphoblastic leukemia.

Qhov kev kho no siv cov t-hlwb sau los ntawm tus neeg mob cov ntshav thiab genetic engineers lawv los tsim tshwj xeeb receptors rau saum npoo, chimeric antigen receptors. Tus neeg mob yog inoculated nrog hloov kho cov qe ntshav dawb, uas tom qab ntawd nrhiav thiab tua cov qog nqaij hlav cancer nrog ib qho antigen tshwj xeeb.

Dr. SA Rosenberg hais rau Nature Reviews Clinical Oncology tias CAR T-cell therapy tuaj yeem "ua qauv kho rau qee qhov B-cell malignancies". Lub Tsev Kho Mob Menyuam Yaus ntawm Philadelphia tau sim cov kab mob leukemia thiab lymphoma siv CAR T-cell therapy. Tag nrho cov cim qhia ntawm mob qog noj ntshav tau ploj mus los ntawm 27 ntawm 30 tus neeg mob, 19 ntawm 27 tus neeg tseem nyob hauv kev zam txim, 15 tus neeg tsis tau txais kev kho mob ntxiv lawm, thiab 4 ntawm cov neeg tau hloov mus rau lwm hom kev kho.

Qhov no txhais tau hais tias kev kho mob tau zoo, thiab nrog rau qhov kev zam txim siab zoo li no koj tuaj yeem tos ntsoov pom ntau CAR T-cell kev kho mob (thiab lwm tus nyiam) yav tom ntej. CAR T-cell therapy yog "muaj zog ntau dua li txhua yam uas peb tuaj yeem ua tiav [nrog rau lwm hom kev tiv thaiv kab mob uas tau txiav txim siab]" hais tias Dr. Crystal Mackall los ntawm National Cancer Institute (NCI).

Dr. Lee los ntawm NCI hais tias "kev tshawb nrhiav pom zoo tias CAR T-cell therapy yog ib qho txuas txuas rau cov pob txha pob txha hloov rau cov neeg mob uas tsis teb rau cov tshuaj kho mob lawm." Nrog rau cov tsos mob ntawm kev kho mob monoclonal antibody tsis hnyav dua li cov kws khomob, nws tab tom nrhiav kom tsim nyog thiab tsawg dua kev kho mob.

Mob ntsws cancer muaj qhov muaj sia nyob tsawg ntawm kwv yees li 15% tshaj li 5 xyoos piv rau kev mob qog noj ntshav mis 89%. Nivolumab yog ib qho tshuaj siv rau kev kho mob ntawm cov qog nqaij hlav tsis me me thiab melanoma. Nws tau sim ntawm ib pawg ntawm 129 nrog mob qog noj ntshav.

Cov neeg koom nrog tau muab ntau npaum li cas ntawm 1, 3, lossis 10mg / kg ntawm lub cev hnyav ntawm Nivolumab mus txog 96 lub hlis. Tom qab 2 xyoos ntawm kev kho mob, qhov ciaj sia taus yog 25%, ib qho kev nce zoo rau tus mob qog noj ntshav zoo li mob ntsws cancer. Nivolumab kuj tau sim rau cov neeg uas muaj melanoma, thiab cov kev ntsuam xyuas qhia tau hais tias muaj sia nyob nce los ntawm 0% nyob rau peb lub xyoos yam tsis muaj kev kho mob mus rau 40% nrog kev siv Nivolumab.

Cov tshuaj thaiv cov PD-1 antigen receptor ntawm cov qe ntshav dawb kom cov hlwb tsis cuam tshuam nrog nws; Qhov no ua rau nws yooj yim dua rau lub cev tiv thaiv kab mob txhawm rau txhawm rau kuaj mob qog noj ntshav thiab pov tseg nws raws li. Thaum lub sij hawm kev ntsuam xyuas nws tau pom tias cov neeg uas muaj PD-L1 tshuaj tiv thaiv teb rau cov tsis muaj, txawm tias qhov laj thawj tom qab nws tseem tsis tau paub.

Kuj tseem muaj DNA immunotherapy, uas siv cov plasmids ntawm tus neeg mob lub hlwb txhawm rau tsim cov tshuaj tiv thaiv. Thaum txhaj tshuaj tiv thaiv rau tus neeg mob nws hloov DNA ntawm qee lub hlwb kom ua tiav ib txoj haujlwm tshwj xeeb.