Kanser tedavisinde son y\u0131llar\u0131n en dikkat \u00e7ekici alanlar\u0131ndan biri olan imm\u00fcnoterapi, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin t\u00fcm\u00f6rlerle m\u00fccadelesini merkeze al\u0131yor. \u0130stinye \u00dcniversitesi T\u0131p Fak\u00fcltesi \u00d6\u011fretim \u00dcyesi Prof. Dr. N. Faruk Aykan, kanser ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemi aras\u0131ndaki karma\u015f\u0131k ili\u015fkiyi, imm\u00fcnoterapideki bilimsel geli\u015fmeleri ve bu tedavinin hangi hastalarda etkili oldu\u011funu anlatt\u0131.\u00a0<\/p>\n
\u0130stinye \u00dcniversitesi T\u0131p Fak\u00fcltesi \u00d6\u011fretim \u00dcyesi Prof. Dr. N. Faruk Aykan,\u00a0kanser ve ba\u011f\u0131\u015f\u0131kl\u0131k sistemi aras\u0131ndaki ili\u015fkiyi \u015f\u00f6yle \u00f6zetledi:<\/p>\n
\u201cBa\u011f\u0131\u015f\u0131kl\u0131k sistemi yani imm\u00fcn sistem organizmada kendinden olmayan\u0131 (non-self) kendinden olandan (self) ay\u0131rt eden ve kendinden olmayanlar\u0131n organizmaya zarar vermesini \u00f6nleyen bir s\u00fcper sistemdir. Kanser, asl\u0131nda organizman\u0131n kendi h\u00fccrelerinden olu\u015fan bir hastal\u0131k olmas\u0131na ra\u011fmen imm\u00fcn sistemin onu tan\u0131mas\u0131 ve ortadan kald\u0131rmas\u0131 kanser h\u00fccrelerinin farkl\u0131 yeni antijenlere (neoantijen) sahip olmas\u0131 ile ili\u015fkilidir. Kanser olu\u015fumu b\u00fcy\u00fck \u00f6l\u00e7\u00fcde genlerimizdeki mutasyonlarla ortaya \u00e7\u0131kar. Mutant genler mutant proteinler \u00fcretir ve bunlar kanser h\u00fccrelerinde normal h\u00fccrelerde bulunmayan neoantijenler olarak belirir. Bir t\u00fcm\u00f6rde antijen y\u00fck\u00fc ne kadar fazla ise imm\u00fcn sistem o kadar aktiftir. \u0130mm\u00fcn sistem h\u00fccrelerinin yo\u011fun oldu\u011fu t\u00fcm\u00f6rler \u2018s\u0131cak (hot)\u2019 t\u00fcm\u00f6rler olarak bilinir, bunlarda imm\u00fcnoterapinin etkisi tam tersi \u2018so\u011fuk (cold)\u2019 t\u00fcm\u00f6rlere g\u00f6re \u00e7ok daha fazlad\u0131r.\u201d<\/p>\n
\u201cOnkolojide \u00e7\u0131\u011f\u0131r a\u00e7an bir yakla\u015f\u0131m\u201d<\/strong><\/p>\n Son y\u0131llarda bu alandaki en \u00f6nemli geli\u015fmelere de de\u011finen\u00a0Prof. Dr. Aykan, \u015funlar\u0131 s\u00f6yledi:<\/p>\n \u201cSon y\u0131llardaki en \u00f6nemli bilimsel geli\u015fme 2018 Nobel T\u0131p \u00f6d\u00fcl\u00fcn\u00fc kazanan James P. Allison ve Tasuku Honjo\u2019nun negatif imm\u00fcn reg\u00fclasyonun bask\u0131lanmas\u0131yla kanser tedavisinin ke\u015ffi oldu. Konuyu biraz a\u00e7al\u0131m. V\u00fccudumuzda imm\u00fcn sistemin kanser h\u00fccreleriyle sava\u015fan T lenfositlerinden olu\u015fan bir ordusu mevcut. T lenfositlerine kanser h\u00fccrelerinin antijenleri lenf d\u00fc\u011f\u00fcmlerinde dendritik h\u00fccreler taraf\u0131ndan tan\u0131t\u0131l\u0131r. Aktifle\u015fen T h\u00fccreleri kanser dokusuna gider ve t\u00fcm\u00f6r h\u00fccrelerine sald\u0131r\u0131r. \u0130\u015fte bu iki olayda aktif T h\u00fccrelerini bask\u0131layan mekanizmalar ke\u015ffedildi. Lenf d\u00fc\u011f\u00fcmlerinde T lenfosit membran\u0131nda g\u00f6r\u00fclen CTLA-4 molek\u00fcl\u00fcn\u00fcn aktif lenfosite negatif sinyal g\u00f6nderdi\u011fi, t\u00fcm\u00f6r dokusunda ise t\u00fcm\u00f6r h\u00fccre zar\u0131nda ortaya \u00e7\u0131kan PD-L1 molek\u00fcl\u00fcn\u00fcn lenfositlerdeki PD-1 resept\u00f6r\u00fcne ba\u011flanarak benzer \u015fekilde aktif T h\u00fccrelerini bask\u0131lad\u0131\u011f\u0131 ortaya \u00e7\u0131kt\u0131. Bu ke\u015ffin ard\u0131ndan ila\u00e7 teknolojisi h\u0131zla anti-CTLA-4, anti-PD-1 ve anti-PD-L1 ila\u00e7lar (monoklonal antikorlar) geli\u015ftirmeye ba\u015flad\u0131 ve g\u00fcn\u00fcm\u00fczde \u00e7ok say\u0131da imm\u00fcnoterapi ilac\u0131 bir\u00e7ok klinik \u00e7al\u0131\u015fmada ara\u015ft\u0131r\u0131ld\u0131, etkinlikleri g\u00f6sterildi ve FDA taraf\u0131ndan onaylanarak kullan\u0131m alan\u0131na girdi. Bu onkolojide \u00e7\u0131\u011f\u0131r a\u00e7an bir yakla\u015f\u0131md\u0131r.\u201d<\/p>\n \u0130mm\u00fcnoterapinin di\u011fer tedavilerden fark\u0131<\/strong><\/p>\n \u0130mm\u00fcnoterapiyi klasik kanser tedavilerinden ay\u0131ran temel bilimsel farklar\u0131 da s\u0131ralayan Aykan,\u00a0\u201c<\/strong>En \u00f6nemli fark imm\u00fcnoterapi ila\u00e7lar\u0131n\u0131n direkt sitotoksik olmay\u0131p dolayl\u0131 olarak T lenfositleri \u00fczerindeki bask\u0131y\u0131 kald\u0131rmalar\u0131, b\u00f6ylece T lenfositlerinin t\u00fcm\u00f6r h\u00fccrelerini yok etme kapasitelerini artt\u0131rmas\u0131d\u0131r. Bir bak\u0131ma imm\u00fcnoterapi, \u2018T-lenfositler \u2013 T\u00fcm\u00f6r h\u00fccreleri\u2019 sava\u015f\u0131nda T lenfosit ordusuna destek olmaktad\u0131r. Kemoterapiden farkl\u0131 olarak sa\u011fl\u0131kl\u0131 \u00e7o\u011falan organizma h\u00fccrelerine direkt bir sitotoksik etkisi yoktur\u201d dedi.<\/p>\n \u201c\u0130mm\u00fcnoterapi ila\u00e7lar\u0131 baz\u0131 kanserlerde \u00e7ok etkili olurken baz\u0131lar\u0131nda hi\u00e7 etkili olmad\u0131\u201d<\/strong><\/p>\n Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi temelli yakla\u015f\u0131mlar\u0131n etkisini belirleyen ba\u015fl\u0131ca biyolojik fakt\u00f6rlerle ilgili de bilgi veren Aykan, \u015f\u00f6yle konu\u015ftu:<\/p>\n \u201cYap\u0131lan \u00e7al\u0131\u015fmalarda bu yeni imm\u00fcnoterapi ila\u00e7lar\u0131n\u0131n baz\u0131 kanserlerde dramatik yan\u0131tlar verirken baz\u0131lar\u0131nda hi\u00e7 etkili olmad\u0131\u011f\u0131 g\u00f6zlendi. Bunu belirleyen baz\u0131 biyolojik fakt\u00f6rler \u015funlar:<\/p>\n \u0130mm\u00fcnoterapi ile ba\u015far\u0131l\u0131 sonu\u00e7lar al\u0131nan kanser t\u00fcrleri<\/strong><\/p>\n \u0130mm\u00fcnoterapi ile ba\u015far\u0131l\u0131 sonu\u00e7lar al\u0131nan kanser t\u00fcrlerini s\u0131ralayan Aykan, \u201cYukar\u0131da belirtti\u011fim t\u00fcm\u00f6rlerin yan\u0131 s\u0131ra malign melanom, k\u00fc\u00e7\u00fck h\u00fccreli d\u0131\u015f\u0131 ve k\u00fc\u00e7\u00fck h\u00fccreli akci\u011fer kanserleri (NSCLCa ve SCLCa), b\u00f6brek kanseri (RCC), \u00fc\u00e7l\u00fc negatif meme kanseri (TNBC), karaci\u011fer kanseri (HCC), safra yolu kanserleri, ba\u015f boyun kanserleri, yemek borusu ve bir k\u0131s\u0131m mide kanserlerinde imm\u00fcnoterapi ile ba\u015far\u0131l\u0131 sonu\u00e7lar al\u0131nmaktad\u0131r\u201d dedi.\u00a0<\/p>\n Uygulamada hangi tip hastalarda olumlu cevap al\u0131nabildi\u011fine dair soruya ise Aykan, \u201cBu bahsetti\u011fim \u00f6zellikleri ta\u015f\u0131yan hastalar \u00f6rnek olarak verilebilir. Art\u0131k bir\u00e7ok Patoloji laboratuvar\u0131nda MSI ve PD-L1 ekspresyonu t\u00fcm\u00f6r materyalinde rutin olarak bak\u0131lmaktad\u0131r\u201d yan\u0131t\u0131n\u0131 verdi.<\/p>\n \u201cKombinasyon tedavileri halen ara\u015ft\u0131r\u0131l\u0131yor\u201d<\/strong><\/p>\n \u0130mm\u00fcnoterapinin ila\u00e7\/a\u015f\u0131 \u00e7al\u0131\u015fmalar\u0131na katk\u0131s\u0131na da de\u011finen Profes\u00f6r, \u201cG\u00fcn\u00fcm\u00fczde imm\u00fcnoterapi yeni bir disiplin olarak onkolojide yerini alm\u0131\u015ft\u0131r. COVID-19 salg\u0131n\u0131ndan sonra g\u00fcndeme gelen mRNA a\u015f\u0131lar\u0131 de\u011fi\u015fik kanser tedavilerinde de ara\u015ft\u0131r\u0131lmakta olup imm\u00fcnoterapi ile birlikte kombinasyon tedavileri halen ara\u015ft\u0131rma fazlar\u0131ndad\u0131r. Bireysel t\u00fcm\u00f6r antijenlerine kar\u015f\u0131 mRNA a\u015f\u0131s\u0131 + imm\u00fcnoterapi \u00e7ok daha iyi klinik sonu\u00e7lar alma potansiyeli ta\u015f\u0131maktad\u0131r\u201d dedi.<\/p>\n \u201c\u0130mm\u00fcnoterapide de ila\u00e7lar\u0131n kendine \u00f6zg\u00fc yan etkileri vard\u0131r\u201d<\/strong><\/p>\n T\u00fcm tedavilerde oldu\u011fu gibi imm\u00fcnoterapide de ila\u00e7lar\u0131n kendine \u00f6zg\u00fc yan etkileri oldu\u011funu belirten Aykan, s\u00f6zlerini \u015f\u00f6yle tamamlad\u0131:<\/p>\n \u201cBunlar tedavi veren hekimler taraf\u0131ndan yak\u0131ndan izlenmektedir. \u0130mm\u00fcnoterapi ila\u00e7lar\u0131n\u0131n yan etkileri daha \u00e7ok otoimm\u00fcnite ile ilgilidir; \u00f6rne\u011fin otoimm\u00fcn pn\u00f6moni, kolit, hepatit, hipotiroidi ve ciltte d\u00f6k\u00fcnt\u00fcler gibi. Bunun yan\u0131nda bu ila\u00e7lar\u0131n finansal toksisitesini g\u00f6zard\u0131 etmemek gerekir. \u00dclkemizde hen\u00fcz \u00e7ok k\u0131s\u0131tl\u0131 endikasyonda geri \u00f6deme vard\u0131r ama bunlar\u0131n d\u0131\u015f\u0131nda kullanmak isteyen hastalar i\u00e7in ger\u00e7ekten ciddi bir mali k\u00fclfet olu\u015fturmaktad\u0131r. Sa\u011fl\u0131k politikalar\u0131nda bunlar\u0131n dikkate al\u0131nmas\u0131 gerekmektedir.\u201d<\/p>\n \u00a0<\/p>\n Kaynak: (BYZHA) Beyaz Haber Ajans\u0131<\/p>\n","protected":false},"excerpt":{"rendered":" Kanser tedavisinde son y\u0131llar\u0131n en dikkat \u00e7ekici alanlar\u0131ndan biri olan imm\u00fcnoterapi, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin t\u00fcm\u00f6rlerle m\u00fccadelesini merkeze al\u0131yor.<\/p>\n","protected":false},"author":1,"featured_media":13043,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[2739,660,571,577,2740],"class_list":["post-13042","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-saglik","tag-hucreler","tag-ilac","tag-kanser","tag-tedavi","tag-tumorler"],"_links":{"self":[{"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/posts\/13042","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/comments?post=13042"}],"version-history":[{"count":1,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/posts\/13042\/revisions"}],"predecessor-version":[{"id":13044,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/posts\/13042\/revisions\/13044"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/media\/13043"}],"wp:attachment":[{"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/media?parent=13042"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/categories?post=13042"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bihavadis.com\/index.php\/wp-json\/wp\/v2\/tags?post=13042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n