iiSMM
/ | ^ H ^ Hoi nghi ung thu Asco
NhiJng bifdc tien mdi trong dieu tri ung thif
pi nghi lan thfl 50 eua Hifip hfii ung thfl ldm - s a n g Hoa Ky (ASCO
*= American Society of Clinical (3ncology) dflde to chflc tai Chicago vdo thang 6 vfla qua, tgp hdp hang van chuyfin gia quic t l . Nhieu nghifin cflu ed b^n gdp phan lam hilu rd hcfn cdc cd ehfi' phat trien ung thfl.
Trong dilu tri, cd ra't nhieu nghifin cflu giup keo dai sfl sd'ng cua benh nhan ung thfl, nhd't la d cde trfldng hdp ung thfl da cd di can. Thach thfle d day Id kilm sodt dfldc sfl phdt t r i l n ung thfl di bifi'n cdc ung thfl di can thdnh bfinh man tfnh.
Ung thtf t i e n li#t tuye'n v a u n g thtf vri da co phtfcfng p h a p d i e u tri h i ^ u q u a hofn
Nghifin cflu CHAARTED v l ung thfl tien liet tuyln lfi thufic hormon giai doan di can dfldc Vien Quoc gia Y t l (NIH) vd Vifin Quoe gia v l Ung thfl thfle hifin. Thfl nghifim nay da theo doi 790 bfinh nhan, cho thl'y: ne'u phli hdp hda tri lifiu Doeetaxel vdi phfldng phap hormon ( n h l m giam boat dpng eae androgen) ed the kdo ddi hdn mfit ndm sfl sd'ng ciia hfnh nhan hi ung thfl tien lifit tuyln cd di can.
Phfldng phdp dilu tri ndy cd t h i la phfldng phdp chuin ddnh cho nam gidi hi ung thfl t i l n lift tuyfi'n lan tda md cd the chiu dfldc hda tri lieu.
Mfit nghien eflu khac gpi ten POEMS lien quan dfi'n ung thfl vu khdng lfi thude hormon gpi y: ed t h i giup cac benh nhan tre hi ung thfl vu, sau thdi gian hda tri Ufiu cd the ed eon dfldc nfi'u tifim m6i thdng mdt miJi Goserelin, mpt hormon tao mdn kinh tam thdi, Idm cdc buing trflng ngflng hoat ddng. Goserelin giam din 64% nguy cd suy ehflc nang budng trflng. Phfldng phdp ndy Id mfit giai phap dfi dang dp dung de bao ve kha nang sinh sdn so vdi vifie trieh vd ddng lanh noan bdo trfldc khi dp dung hda tri lifiu.
Kha n a n g d i l u t r i t n i n g d i c h t a n g do'i vdi c a c ca u n g thtf a c t i n h
Da cd cde phdn tfl dae bifit dang dfldc dp dung cho mfit so ung thfl.
Cde nhd san xuat dang dilu chfi' vd thfl nghiem khodng 900 phan tfl danh eho dilu tri trung dfch.
Cdc phdn tfl ndy nham vdo cac h i t thfldng d cac te bdo ung thfl, nham vdo eae thu t h i hay protein trong te'bao ung thfl. Cae bat thfldng ndy kilm sodt hodc kieh thich sfl phdt t r i l n ung thfl. Cae phan tfl dilu
Recepteurs
\\atiBg ^ * % » V L Herceplin '
^ ^ ^ ^ ^ ^ r D K
M^t sd tdbAo CO d mat ngoii rit nhieu th^i th4 ErbB2. Cac thu thi nay thuc diy cdc ti bio phdn chia rat nhanh THUOC & stfc KHOE sl508 (15.9.2014)
Herceptin gan vio cac thu thi ErbB2, dc che sU phat triin 6 at
eCia cac te bko
0 dieu che duac Glivec, Cong ty Novartis da nhan duac giai Galien nSm 2002 tri trung dfch, khdng tan cdng ede te' bao lanh, khong thay the' ede phfldng phap dieu tri cl dien (hda tri lieu, xa tri) md chi b l sung de tan cdng ung thfl, nha't la cdc trfldng hop ung thfl da cd di cdn.
Trong cdc phan tfl trung dieh, phdi k l cde khdng the ddn ddng vdi tifi'p to "mab" vd ede phdn tfl nhd "flc che^ vdi tie'p td' "inib". Cdc phdn tfl "mab" Mm ham sfl phdt trien cua thu the d be mat cdc te bdo ung thfl. Cdc phdn td "inib"
chui vao te'bdo ung thfl, ngan chgn hoat dfing cua te' bdo ung thfl.
Mfit so' dflde pham dieu t n trung dich da td ra rat hflfl hifiu nhfl Glivec (imatinib) ehi dinh cho bfinh baeh d u tuy man, flc ehe' enzym dot bie'n, tao sfl phdt trien 6 at cac bach eau, hay Herceptin (trastuzumab) giam dfi'n 50% nguy CO tai phat ung thfl vu ed thu the HER2 so vdi hda tri lieu.
Cac dfldc pham tan cong trung dich cdn cd kha nang tan cdng cac nang bfldu khang vdi cdc phfldng phap dieu tri co dien.
Lenvatinib han c h l sfl phdt t r i l n ung thfl dc tinh tuyfi'n gidp, khdng vdi iod phdng xa.
Dd'i vdi bfinh ung thfl dai trfle trdng di cdn (nhflng khdng cd dot biln KRAS), hai khdng the ddn ddng bevacizumab vd cetuximab phfi'i hpp vdi hda tri lieu, cd kha C
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r* nang keo dai sii song sdt de'n 29 thdng. Cufii eung, nhilu nghien cflu phfi'i hpp cdc difdc pham trung dieh de giai quye't cdc ca ung thfl khang vdi cdc phfldng phap dieu tri cl dien. Nhu vdy, phli hpp olaparib vdi cediranib ed t h i keo ddi thfim 17,7 thdng cupc so'ng cua bfnh nhan mic bfinh ung thu budng trflng dc tinh (so vdi bfinh nhan chi dung ddn thuan olaparib).
Mifin dich t r i lifu day htfa h e n Dfi'i vdi cdc benh ung thfl d tre em, dp dung cae phfldng phap dilu tri trung dieh gap nhieu trd ngai:
thuoc ehi hiYu hifiu trong mdt thdi gian ngin, vi vdi thdi gian, cdc te' bao ung thif khdng thufi'e, thufi'e gay tac dung phu nghifim trpng vd gia thanh cao.
Trong linh vflc ung thfl d tre em, nghifin eflu vl mifin dich tri lieu giup cd t h i tan edng cde t l bdo ung thfl. Cdc lymphfi bdo T binh thfldng ed kha ndng tieu buy cac t l bdo ung thfl. Tuy nhien, cac t l bdo ung thfl vdi thdi gian ed t h i ldm vfi hifiu cdc lymphfi bdo T. Cde nha khoa hpc dd nghifin eflu, dieu c h l cdc khang the dcfn ddng (cac khdng CTLA-4 va ede khdng PD-1/
khdng PD-LD) nham han e h l tdc dpng cua te' bao ung thfl dfi'i vdi lymphfi bao T.
IMien dich tri lifu ap d u i ^ cho u melanin di can, d£ic bift ac t i n h Thfl nghifim trong ndm nay cho thay; mien dich tri Ueu dem lai ket qua day hfla hen d cdc trfldng hop:
ung thfl than, hdng quang, phoi d giai doan phat trien cCuig nhfl trfldng hpp u melanin di can, dc tfnh. Tuy nhien, mien dich tri lieu dp dung trong ung thfl eung rdt dfie hai.
Trong tfldng lai, can phli hdp nhilu phflcfng thfle: dilu tri co dien, lifiu phap trung dich, mien dieh tri lieu,.. mdi mong chifi'n thdng ung thfl. Tuy nhifin, day chi la bfldc diu nghifin cflu. Trong khi chd ddi, d n thifi't dp dung hifin phdp dfl phdng:
40% cdc ea ung thfl d ngfldi trfldng thdnh cd t h i ngdn ngfla dfldc bing cdch thay dli hdnh vi- khdng hut thule Id, ngdn chan beo phi va cudc sing tmh tai.
-» TS. PHAM VAN TAT theo Sante magazine, 8.2014 26
Ngdy Tim mach the gidi 28,9
Tao mot moi ti
Oo
M
oi ndm, cde bfinh ly tim mach da efldp di mang sfi'ng khoang 17,5 trifiu ngfldi trfin todn the gidi. Dfl kifi'n de'n ndm 2030, con so ndy tang len 23 trifiu ngfldi. Gdnh nang bfinh ly tim maeh dang ngdy cdng gia tang, de lai nhflng hgu qua ndng n l eho mfii ea nhan, cho gia dinh vd cho toan xd hdi. Trflde thfle te nay. Lien dodn Tim mach T h i gidi (World Heart Federation) ngay tfl nam 2000, dd quye't dinh chpn ngdy chu nhdt culi eung eua thdng 9 la "Ngdy Tim mgch The gidi"(World Heart Day).
Chu de cua ngdy phdng chlng bfinh tim mach t h i gidi n a m 2014 la "Tqo mot mdi trUdng Idnh manh cho trdi tim", dam bao rang moi chflng ta diu ed t h i cd nhflng sfl lfla chpn cho trdi tim khde manh vdi ha't ky ndi chung ta sing, lam vifc va vui chdi bdng edeh giam nhflng ye'u to' nguy cd mae bfinh. Cde yeu to' nguy cd dan dfi'n bfinh tim mach vd dfit quy bao gom tang huylt dp, mflc cholesterol vd glucose trong mdu eao, hut thuoc Id, dn khdng du trdi edy vd rau qua, thfla cdn, beo phi va it vdn dpng.
huyet ap dinh ky di phat hiin sdm b^nh Benh tim mach thfldng bilu hien bang: khd thd, dau ngflc, ddnh trd'ng ngflc, ngd't xiu, tfm tdi. Kho thor khi gang sflc, nfi'u bfnh dien tie'n ndng thi khd thd xult hi^n khi van ddng nhe hoac ngay ca khi nghi ngdi. Dau ngflc, nhli mau cfl tim hoae edn dau that ngflc khdng on dinh xdy ra khi mpt trong cdc nhdnh cua ddng mach vanh bi tic nghen hodn toan hoac gin hodn toan. Trifu chflng dau ngflc trong nhoi mdu ea tim cung ed tinh chd't gifi'ng nhfl cdn dau that ngifc nhifng keo dai hem 20 phut, cd the xay ra khi nghl ngoi va khdng dap iing khi bfinh nhan dung mft so thulc giam dau thdng thfldng. Ddnh trd'ng ngifc hay nhip tim nhanh, nlu cdc Cdn nhip nhanh xua't hifn khi khdng lien quan de'n gang sdc, lai keo ddi nhilu phut Id bilu hifn benh tim ndng, cin dfldc kham vd dieu tri. Ngfldi mie bfnh tim mach d i ngat xiu vi cd cdc roi loan ve nhip tim. Cd t h i tim dap rdt chdm nfin khdng du khd ndng dfla mdu va dfldng khi len nudi nao. Ngifdc lai, nlu tim dap qud nhanh (nhieu hdn 150 lan/phflt) thi kha nang befm mdu Ifin nao cua tim ciing bj giam sut. Tim tdi thfldng xult hifn THUOC & SLfC KHOE s l 508 (15.9.2014)
