Rak jajnika, jeden z najgroźniejszych nowotworów ginekologicznych, od lat stanowi wyzwanie dla medycyny. Jednak rok 2021 przyniósł przełom w leczeniu tej podstępnej choroby, dając nadzieję tysiącom kobiet na całym świecie.
Podstępna natura raka jajnika
Rak jajnika jest najgorzej rokującym nowotworem ginekologicznym, z najniższym wskaźnikiem przeżycia pięcioletniego wynoszącym zaledwie 44%. To piąty pod względem częstości nowotwór złośliwy u kobiet i czwarta przyczyna zgonów Polek na nowotwory. Jego podstępność polega na tym, że rozwija się bezobjawowo, a diagnozowany jest zwykle w zaawansowanym stadium.
Inhibitory PARP: Nowa era w leczeniu
Przełomem w leczeniu raka jajnika okazały się inhibitory PARP. Te innowacyjne leki stanowią tzw. leczenie podtrzymujące, które znacząco wydłuża okres remisji choroby. Dr hab. n. med. Radosław Mądry, kierownik Oddziału Ginekologii Onkologicznej w Szpitalu Przemienienia Pańskiego w Poznaniu, podkreśla: „Wprowadzenie inhibitorów PARP jest istotnym przełomem w leczeniu nowotworu jajnika, takim, jakiego nie było od wielu, wielu lat”.
Imponujące wyniki badań klinicznych
Badania kliniczne potwierdziły skuteczność inhibitorów PARP. W przypadku pacjentek z nawrotowym rakiem jajnika, leki te wydłużają życie o około 16 miesięcy. Jeszcze bardziej imponujące wyniki uzyskano, stosując inhibitory PARP od razu po operacji i chemioterapii u nowo zdiagnozowanych pacjentek.
Badanie SOLO1 wykazało, że u pacjentek z mutacjami w genach BRCA, które otrzymywały inhibitor PARP w pierwszej linii leczenia, czas do progresji choroby wydłużył się z 13 do 56 miesięcy. To bezprecedensowy postęp w ginekologii onkologicznej.
Rozszerzenie grupy beneficjentek
Kolejne badania, takie jak PAOLA1 i PRIMA, pokazały, że korzyści z inhibitorów PARP mogą odnieść nie tylko pacjentki z mutacją genu BRCA1/BRCA2. Istnieje grupa pacjentek z innymi przyczynami deficytu rekombinacji homologicznej, które również mogą skorzystać z tej terapii.
Wyzwania w dostępie do leczenia
Mimo obiecujących wyników, dostęp do inhibitorów PARP w pierwszej linii leczenia pozostaje ograniczony. Główną barierą są wysokie koszty terapii – miesięczna dawka kosztuje około 20 000 zł. W Polsce, dla chorych z mutacjami w genach BRCA, refundowany jest olaparyb, ale tylko w drugiej lub kolejnych liniach leczenia, po wznowie.
Perspektywy na przyszłość
Lekarze podkreślają, że kluczowe jest umożliwienie pacjentkom dostępu do inhibitorów PARP w pierwszej linii leczenia. Dr Mądry zaznacza: „Nie ma wątpliwości, że rozwój powinien pójść w kierunku rozpoczęcia leczenia w pierwszej linii, ale także rozwijania terapii w zakresie różnych inhibitorów”.
Historia pacjentki: nadzieja i determinacja
Historia 44-letniej Katarzyny pokazuje, jak ważna jest determinacja pacjentek w poszukiwaniu najlepszych metod leczenia. Dzięki własnej dociekliwości i uporowi, udało jej się uzyskać dostęp do inhibitora PARP w pierwszej linii leczenia poprzez Program Ratunkowego Dostępu do Technologii Lekowych.
Rok 2021 zapisze się w historii jako przełomowy w walce z rakiem jajnika. Inhibitory PARP dają nadzieję na znaczące wydłużenie życia i poprawę jego jakości dla pacjentek zmagających się z tą trudną chorobą. Kluczowe pozostaje jednak zwiększenie dostępności tych innowacyjnych terapii, aby mogły z nich skorzystać wszystkie potrzebujące pacjentki.
But how puny and harmless they now looked beside this huge and terrific incarnation of hate, of vengeance and of death. The man himself, for such I may call him, was fully fifteen feet in height and, on Earth, would have weighed some four hundred pounds. He sat his mount as we sit a horse, grasping the animal’s barrel with his lower limbs, while the hands of his two right arms held his immense spear low at the side of his mount; his two left arms were outstretched laterally to help preserve his balance, the thing he rode having neither bridle or reins of any description for guidance.
And his mount! How can earthly words describe it! It towered ten feet at the shoulder; had four legs on either side; a broad flat tail, larger at the tip than at the root, and which it held straight out behind while running; a gaping mouth which split its head from its snout to its long, massive neck.
A Wide Gallery
Like its master, it was entirely devoid of hair, but was of a dark slate color and exceeding smooth and glossy. Its belly was white, and its legs shaded from the slate of its shoulders and hips to a vivid yellow at the feet. The feet themselves were heavily padded and nailless, which fact had also contributed to the noiselessness of their approach, and, in common with a multiplicity of legs, is a characteristic feature of the fauna of Mars. The highest type of man and one other animal, the only mammal existing on Mars, alone have well-formed nails, and there are absolutely no hoofed animals in existence there.
Let’s check some lists
Behind this first charging demon trailed nineteen others, similar in all respects, but, as I learned later, bearing individual characteristics peculiar to themselves; precisely as no two of us are identical although we are all cast in a similar mold.
- This picture, or rather materialized nightmare, which I have described at length, made but one terrible and swift impression on me as I turned to meet it.
- Unarmed and naked as I was, the first law of nature manifested itself in the only possible solution of my immediate problem, and that was to get out of the vicinity of the point of the charging spear.
- Consequently I gave a very earthly and at the same time superhuman leap to reach the top of the Martian incubator, for such I had determined it must be.
- My effort was crowned with a success which appalled me no less than it seemed to surprise the Martian warriors, for it carried me fully thirty feet into the air and landed me a hundred feet from my pursuers and on the opposite side of the enclosure.
I alighted upon the soft moss easily and without mishap, and turning saw my enemies lined up along the further wall. Some were surveying me with expressions which I afterward discovered marked extreme astonishment, and the others were evidently satisfying themselves that I had not molested their young.
- Like its master, it was entirely devoid of hair, but was of a dark slate color and exceeding smooth and glossy.
- Its belly was white, and its legs shaded from the slate of its shoulders and hips to a vivid yellow at the feet.
- The feet themselves were heavily padded and nailless, which fact had also contributed to the noiselessness of their approach, and, in common with a multiplicity of legs, is a characteristic feature of the fauna of Mars.
- The highest type of man and one other animal, the only mammal existing on Mars, alone have well-formed nails, and there are absolutely no hoofed animals in existence there.
They were conversing together in low tones, and gesticulating and pointing toward me. Their discovery that I had not harmed the little Martians, and that I was unarmed, must have caused them to look upon me with less ferocity; but, as I was to learn later, the thing which weighed most in my favor was my exhibition of hurdling.
Here comes a video
He took me for his housemaid, she said to herself as she ran. Luckily for Alice, the little magic bottle had now had its full effect, and she grew no larger: still it was very uncomfortable, and, as there seemed to be no sort of chance of her ever getting out of the room again, no wonder she felt unhappy.
By this time she had found her way into a tidy little room with a table in the window, and on it (as she had hoped) a fan and two or three pairs of tiny white kid gloves
She took up the fan and a pair of the gloves, and was just going to leave the room, when her eye fell upon a little bottle that stood near the looking-glass. There was no label this time with the words 'DRINK ME,’ but nevertheless she uncorked it and put it to her lips. 'I know SOMETHING interesting is sure to happen,’ she said to herself, 'whenever I eat or drink anything; so I’ll just see what this bottle does. I do hope it’ll make me grow large again, for really I’m quite tired of being such a tiny little thing!’
It did so indeed, and much sooner than she had expected: before she had drunk half the bottle, she found her head pressing against the ceiling, and had to stoop to save her neck from being broken. She hastily put down the bottle, saying to herself 'That’s quite enough—I hope I shan’t grow any more—As it is, I can’t get out at the door—I do wish I hadn’t drunk quite so much!’
Alas! it was too late to wish that! She went on growing, and growing, and very soon had to kneel down on the floor: in another minute there was not even room for this, and she tried the effect of lying down with one elbow against the door, and the other arm curled round her head. Still she went on growing, and, as a last resource, she put one arm out of the window, and one foot up the chimney, and said to herself 'Now I can do no more, whatever happens. What WILL become of me?’
Luckily for Alice, the little magic bottle had now had its full effect, and she grew no larger: still it was very uncomfortable, and, as there seemed to be no sort of chance of her ever getting out of the room again, no wonder she felt unhappy.
