Friday, June 16, 2017

Miksei syövän yksilöllinen hoito toteudu?



Miksei syövän yksilöllinen hoito toteudu?

Jokainen ihminen erilainen. Jokainen kasvain on vielä enemmän erilainen muista kasvaimista sillä kaikissa kasvaimissa on mutaatioita eli muutoksia geeneissä. Mutaatiot erottavat syöpäsolut normaalisoluista. Mutaatioita on usein satoja jokaisessa kasvaimessa, ja ne ovat täysin erilaisia samankin elimen kasvaimissa. Kun kasvaimet vielä sijaitsevat eri ihmisissä, eli huomioidaan sekä ihmisten että kasvaimien väliset erot, on selvää että vaihtelu kasvaimien välillä on huomattavaa, vaikka ne sijaitsisivat samassa elimessä (esim. ”haimasyöpä”).

Jos potilaalla on syöpä joka ei ole leikkauksella parannettavissa, niin lääkevalinnat ovat kuitenkin pitkälle samanlaisia eri potilaille. Toki jonkin verran pyritään huomioimaan potilaan yleistilaa ja perussairauksia, niin ettei potilaan elämää lyhennettäisi liian raskaalla hoidolla. Tämä tehdään kuitenkin turvallisuuden näkökulmasta, ei tehon. Kullekin potilaalla annetaan niin järeä hoito kuin minkä hänen arvioidaan kestävän. Esimerkiksi haimasyövässä valitaan kolmen lääkkeen yhdistelmä jos potilaan kunto on hyvä (raskain hoito), tai kahden lääkkeen yhdistelmä jos kunto on kohtuullinen, tai pelkästään yksi lääke jos kunto on heikko. Hoito valitaan niistä lääkkeistä tai yhdistelmistä jotka ovat käytössä haimasyövässä, välittämättä kasvaimen erityispiirteistä.

Joissakin syöpätyypeissä ollaan hiukan edistyksellisempiä, mutta näitä esimerkkejä on vain muutamia. Vähemmistössä keuhkosyövistä on mutaatioita EGFR tai ALK geeneissä jolloin voidaan valita näihin kohdistettu täsmälääke. Rintasyövässä määritetään hormonireseptorit ja jos niitä on voidaan valita hormonihoidon tai sytostaatin väliltä. Joissakin rintasyövissä on Her2 tekijää jolloin voidaan käyttää tähän kohdistuvaa hoitoa. Osassa melanoomista on BRAF mutaatioita joita kohtaan on olemassa täsmälääke. Suuressa enemmistössä syövistä hoito valitaan kuitenkin pitkälti sillä perusteella että mistä elimestä se on lähtenyt liikkeelle (”mahasyöpä”, ”paksusuolisyöpä”, ”eturauhassyöpä”, ”munasarjasyöpä”).

Syöpien herkkyyttä eri lääkkeille on tutkittu vuosikymmeniä ja asiasta tiedetään paljon. Kaupallisesti on saatavilla useita testejä, joilla kasvaimien lääkeherkkyyttä voidaan mitata. Caris CMI ja OncoDNA Oncodeep ovat joitakin esimerkkejä. Niiden hintakin on kohtuullinen, noin 2000-6000€ testin laajuudesta riippuen. Kummatkin näistä testeistä ovat kaksiosaisia: a) arvioidaan kasvaimen herkkyyttä rutiinilääkkeille (solunsalpaajat, hormonit jne) ja b) etsitään kohteita (mutaatioita) täsmälääkkeille. Kumpikaan osio ei suoraan testaa kasvaimen herkkyyttä millekään lääkkeelle vaan kyseessä on kasvaimen ominaisuuksien molekyylitason analyysi ja siihen perustuva lääkeherkkyyden arvio tieteelliseen kirjallisuuteen perustuen.

Huomioiden että lääkehoidot voivat maksaa moninkertaisesti tämän verran joka kuukausi, kun lasketaan kokonaiskustannukset (henkilökunnan työ, haittavaikutusten hoito jne), kustannuksia ei voida pitää lääkeherkkyyden testaamisen esteenä. Hoitoja jatketaan usein jopa vuosia joten testin hinta on vain murto-osa hoidon hinnasta.

Joissakin maissa vakuutusyhtiöt ovat laskeneet että vaikka humanistiset arvot jätettäisiin huomiotta, on halvempaa antaa tehokasta lääkettä kuin tehotonta lääkettä ja sitten myöhemmin yrityksen ja erehdyksen kautta vasta päätyä tehokkaaseen lääkkeeseen. Ainakin USA:ssa ja Saksassa vakuutusyhtiöt korvaavat mainittuja lääkeherkkyystestejä ja niitä on tehty sadoille tuhansille potilaille.

On monia maita joissa lääkeherkkyystestejä ei käytetä kovinkaan laajasti esimerkiksi julkisen terveydenhuollon piirissä. Syy on se että näistä testeistä ei ole tehty laajoja, tuhansia potilaita käsittäviä (”vaiheen 3”) tutkimuksia. Kuten kirjassani (viite alla) olen kuvannut, kliinisten tutkimusten tekeminen on muuttunut jatkuvasti kalliimmaksi ja käytännössä ainoastaan isoilla lääkeyrityksillä on resurssit tehdä vaiheen 3 tutkimuksia. Tutkimukset eivät ole hyväntekeväisyystoimintaa, vaan niiden kulut laitetaan lääkkeiden hintoihin. Siksi uudet lääkkeet ovat säännönmukaisesti erittäin kalliita. Kliinisten tutkimusten muuttuessa yhä kalliimmiksi, lääkkeiden hinnat jatkavat nousuaan.

Lääkeherkkyystestien markkinoijat eivät ole katsoneet mahdolliseksi hinnoitella testiään niin että sillä voitaisiin kattaa tuhansien potilaiden tutkimukset. Pienempiä ”vaiheen 2” tutkimuksia on toki tehty paljon mutta näistä kertyvä näytön aste ei ole yhtä vakuuttavaa kuin vaiheen 3 tutkimuksista kertyvä evidenssi, eivätkä vaiheen 2 tutkimukset yleensä pysty muokkaamaan hoitokäytäntöjä. Tähän vedoten monet syöpälääkärit eivät käytä näitä testejä eivätkä välttämättä edes usko testin tuloksia vaikka testi olisikin tehty.

Ovatko nämä testit luotettavia? On selvää ettei niitä voi pitää tieteellisesti todistettuina vaiheen 3 tutkimusten puuttuessa. Käytännön lääkärin mielipiteeni on se että ne antavat valistuneemman arvauksen kunkin kasvaimen lääkeherkkyydestä kuin ”side silmillä" -menetelmä, eli tavanomainen tapa valita lääke kasvaimen lähtöelimen perusteella välittämättä kasvaimen ominaispiirteistä. Testien kyky ennustaa lääkeherkkyyttä ei ole läheskään 100% sillä mitatut asiat antavat vain todennäköisyyksiä. Testin tulos voi olla vaikka että kasvain on ”luultavasti herkkä lääkkeelle X”, mutta mitään takeita testi ei anna.

Tärkeä syy testien epätäydelliseen ennustearvoon on se että kasvaimet ovat monimuotoisia. Jos potilaalla on kymmeniä tai satoja etäpesäkkeitä, ne voivat edustaa useita eri ”klooneja”, vaikka kaikki alkoikin aikanaan yhdestä solusta (tästä lisää kirjassani). Kloonien lääkeherkkyys ja mutaatioprofiili voivat olla erilaisia. Testi voi kertoa ainoastaan siitä kudoksesta joka oli käytettävissä testiin. Tämä kudos ei tietenkään voi olla identtinen etäpesäkkeiden kanssa sillä edellä mainittu oli poistettu testiä varten ja jälkimmäiset ovat edelleen potilaassa.

Usein testiä varten käytettävissä on näyte patologian arkistosta, joka voi olla useammankin vuoden takaa, esimerkiksi syöpäleikkauksesta joka tehtiin tilanteessa jolloin luultiin että kasvain oli paikallinen. Optimaalisesti lääkeherkkyysanalyysi tehtäisiin tuoreesta näytteestä juuri siinä kliinisessä tilanteessa joka edeltää testin perusteella tehtävää hoitopäätöstä. Jos välissä käytetään jotakin hoitoa, se voi aiheuttaa taas muutoksia lääkeherkkyydessä jolloin testin luotettavuus kärsii.

Jos potilaalla on etäpesäkkeitä, ne voivat olla erilaisia toisistaan, mutta samassakin kasvaimessa on erilaisia alueita. Testi kuitenkin kertoo vain siitä kudoksesta joka sattui neulanäytteen kohteeksi. Käytännössä on yleensä parhaimmillaankin mahdollista tehdä vain yksi testi. Iso osa etäpesäkkeistä on valitettavasti sellaisia joista on vaikea saada edustavaa neulanäytettä. Esimerkiksi keuhko-, aivo- ja luustopesäkkeiden näytteenotto on haastavaa. 

Testien b-osion suhteen (täsmälääkkeiden kohteet) heikkous on se että täsmälääkkeet eivät ylipäänsäkään ole lunastaneet niille 1990-luvulla asetettuja (ylisuuria) toiveita. Yksi syy tähän on mainittu kasvaimien monimuotoisuus. Eli vaikka ”lääkittävä mutaatio” löytyisi, täsmälääke ei välttämättä anna mitään kliinistä tehoa.

Yhteenvetona, yksilöllisen syöpälääkehoidon suurin este on se että kasvaimet ja etäpesäkkeet ovat monimuotoisia, sisältäen erilaisia alueita, eikä yhden lääkeherkkyystestin tekeminen anna kattavaa kokonaiskuvaa levinneestä taudista. Kuitenkin testin tulos antaa jotakin tieteellisesti perusteltua informaatiota kasvaimesta ja sen lääkeherkkyydestä, ja ”lääkittävistä mutaatioista”.

Jokainen voi itse miettiä kumpi on parempi tapa valita lääkehoito: ”side silmillä” -menetelmä jolloin lääke valitaan kasvaimen lähtöelimen perusteella, vai se että pyritään testaamaan kasvaimen yksilöllistä lääkeherkkyyttä hyväksyen ja huomioiden testin epävarmuustekijät. Itse uskon että 10 vuoden kuluessa kasvaimien yksilöllinen testaaminen tulee rutiiniksi, ja käytännössä toimitaan niin että aina ennen hoidon vaihdosta tehdään uusi testi tilanteen päivittämiseksi.

Lupaava lähestymistapa on ”liukoinen biopsia” jolloin syöpäsoluja tai niiden perintöainesta kerätään verestä, jolloin ei tarvita kudosnäytettä. Tämä teknologia on kuitenkin vasta alkutekijöissään, eikä tiedetä ovatko verestä löytyvät syöpäsolut edustava otos kasvaimesta ja sen etäpesäkkeistä. Saatavilla on kuitenkin jo kaupallisia testejä jotka mahdollistavat liukoisen biopsian tekeminen. Liukoisen biopsian etu on helppo toistettavuus jolloin testiä voidaan käyttää myös hoidon tehon mittaamiseen.

Kokonaan ratkaisematta on lääkkeiden korvattavuus tilanteessa jossa hoitoa haluttaisiin antaa kasvaimen yksilöllisten piirteiden perusteella, välittämättä lähtöelimestä. Suomessa ei ole yhtään esimerkkiä lääkkeestä jolla olisi KELA korvattavuus saatavissa sillä perusteella että kasvaimesta löytyy lääkkeen kohde. Korvattavuuden edellytyksenä on aina että kasvain on lähtöisin tietystä määritetystä elimestä.  Harvinaisia syöpiä sairastavat potilaat ovat huomattavan epätasa-arvoisessa tilanteessa sillä heidän kasvaimistaan voi löytyä lääkkeiden kohteita mutta jos lääkehyväksyntä on jonkin toisen elimen kasvaimelle, ei KELA korvausta saa.

Yksilölliseen syövän hoitoon on valitettavan pitkä matka näistä käytännön ongelmista johtuen. Yksittäisillä potilailla lääkeherkkyysmäärityksiä tehdään nykyään Suomessakin. Niiden laajamittaisempi käyttöönotto edellyttäisi vaiheen 3 tutkimusten tekemistä, ja joitakin onkin meneillään. Mainittujen taloudellisten haasteiden lisäksi tutkimusten tekemistä vaikeuttaa juuri se syy minkä vuoksi niitä pitäisi tehdä; kun jokainen kasvain on yksilö, on vaikeaa ryhmitellä niitä niin että tutkimusasetelma olisi edustava. Tutkimukset voivat jäädä negatiivisiksi myös siksi että kontrolliryhmänkin potilaita hoidetaan ja ”side silmillä” -menetelmälläkin voi lopulta löytyä tehokas lääke yrityksen ja erehdyksen kautta.

Akseli Hemminki
Syöpätautien professori, syöpätautien ja sädehoidon erikoislääkäri

Hemminki A: Kuoleman Laakso. Voiko syöpää hoitaa kokeellisilla menetelmillä? Nomerta, Turku. Ilmestynyt englanniksi 2015 ja suomeksi 28.4.2016. http://www.nomerta.net/kirjat.php

35 comments:

  1. Kiitos mielenkiintoisesta kirjoituksesta.

    Kommentoin aihetta amatöörinä ja lähinnä aivosyövän osalta. Aihepiiri on tullut tutuksi läheisen sairastumisen vuoksi.

    Kasvaimen geenien määritys on tärkeää jo diagnosoinnin takia. Esimerkiksi WHO on 2016 päivittänyt glioomien määritelmät ja luokittelu tehdään nyt osin mm. IDH1-mutaation perusteella (https://braintumor.org/wp-content/assets/WHO-Central-Nervous-System-Tumor-Classification.pdf).
    Gliooman tapauksessa yleisimmillä mutaatioilla (mm.IDH1, 1p19q-kodeleetio, MGMT) on vaikutusta hoitosuosituksiin, näin vältytään antamasta turhaan hoitoa josta potilas ei välttämättä hyödy kuin marginaalisesti mutta kärsii kuitenkin sivuvaikutukset (http://www.esmo.org/Guidelines/Neuro-Oncology/High-Grade-Malignant-Glioma).

    Toki Suomessakin tehdään joitain analyysejä kasvaimesta, esim. edellä mainittu IDH1, mutta käytetty menetelmä voi antaa tulokseksi väärän negatiivisen. Syy on siinä että IDH1 tutkitaan perinteisesti menetelmällä, joka on tunnistaa IDH1-R132H-mutaation, mutta ei esimerkiksi IDH1-R132G-mutaatiota. MGMT-geeniä ei käsittääkseni oletusarvoisesti tutkita, vaikka sen merkitys aivosyövän kohdalla olisi merkittävä. MGMT kertoo herkkyydestä alkyloiville sytostaateille (mm. ensilinjan hoitona annettava temozolomidi ja myöhemmässä vaiheessa tarjottava lomustiini).
    Toki on myönnettävä että lääkevaihtoehdot ovat vähissä, joten ehkä ajatus on että parempi kokeilla jotain kuin jättää potilas ilman hoitoa. Mutta kyllä tässäkin mennään enemmän side silmillä ja toivotaan parasta.

    Aivosyövän tekee haastavaksi myös veri-aivoeste, joka estää tehokkaasti osalta lääkkeistä pääsyn kasvaimeen. Toki korkeamman asteen aivosyövissä veri-aivoeste on käsittääkseni jonkin verran häiriintynyt joka saattaa muuttaa tilannetta.

    Täsmälääkkeiden osalta näen haasteena sen että ne harvoin ovat tehokkaita yksinään. Jonkinlainen sopiva kombinaatio toisen lääkkeen kanssa voisi toimia, mutta ongelmaksi saattaa muodostua potilaalle aiheutuvat sivuvaikutukset. Lisäksi lääkkeiden sopiva annostus kombinaatiotapauksessa on todennäköisesti eri kuin monoterapiana. Eri lääkeyhdistelmien tutkiminen on toivottaman hidasta ja kallista eikä ehkä lääkeyhtiöiden intresseissä, joten hoitavan lääkärin lienee melko vaikeata poiketa standardiannostuksesta tai yhdistelmästä.

    Alla linkki esimerkkinä aiheesta, jossa palbociclib-lääke toimi medulloblastooman hoidossa, mutta hoidon loputtua kasvain todennäköisesti uusii. "It means that palbociclib, or drugs like it, could be used against medulloblastoma in combination with other drugs to treat resistant cells."
    (https://www.uq.edu.au/news/article/2017/08/potential-treatment-brain-cancer-drug-shrinks-tumours).

    Lääkkeet ja hoidot kehittyvät jatkuvasti, toivottavasti myös hoitosuositukset (meillä ja maailmalla) päivittyvät vastaavasti.
    Varsinkin huonon ennusteen syövissä tarvitaan uusia ajatuksia ja hoitomenetelmiä.

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      1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT  

      Delete
    8. This is real take it serious, who will believe that a herb can cure HERPES DISEASE in my body, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of HIV,cancer and herpes cure, i decided to email him, unknowingly to me that this will be the end of the HERPES DISEASE, he prepare the herb for me, and give me instruction on how to take it, at the end of the week which was seven days,he told me to go to the hospital for a check up, and i went surprisingly after it the doctor confirm me cure from HERPES disease I thought it was a joke, i went to other hospital the doctor there also confirm me cure from HERPES disease then i took my friend who was also HERPES patient to the Doctor after the taking of the herbs she was also confirm cure from HERPES disease .please I want every one with this virus to be free, that is why am dropping his email address,(drodukuherbalhealingcentre@gmail.com or his whatsap contact +2348124765093) you can visit his website https://drodukuherbalhealingcentre.weebly.com
       https://dr-oduku-herbal-healing-centre.business.site i want you to email him he is a great man. thank you for saving my life, and I promise I will always testify for your good work. you can also reach me clararose2128@gmail.com

      Delete
    9. This is real take it serious, who will believe that a herb can cure HERPES DISEASE in my body, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of HIV,cancer and herpes cure, i decided to email him, unknowingly to me that this will be the end of the HERPES DISEASE, he prepare the herb for me, and give me instruction on how to take it, at the end of the week which was seven days,he told me to go to the hospital for a check up, and i went surprisingly after it the doctor confirm me cure from HERPES disease I thought it was a joke, i went to other hospital the doctor there also confirm me cure from HERPES disease then i took my friend who was also HERPES patient to the Doctor after the taking of the herbs she was also confirm cure from HERPES disease .please I want every one with this virus to be free, that is why am dropping his email address,(drodukuherbalhealingcentre@gmail.com or his whatsap contact +2348124765093) you can visit his website https://drodukuherbalhealingcentre.weebly.com
       https://dr-oduku-herbal-healing-centre.business.site i want you to email him he is a great man. thank you for saving my life, and I promise I will always testify for your good work. you can also reach me clararose2128@gmail.com

      Delete
    10. This is real take it serious, who will believe that a herb can cure HERPES DISEASE in my body, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waiting for is death because i was broke, one day i hard about this great man who is well know of HIV,cancer and herpes cure, i decided to email him, unknowingly to me that this will be the end of the HERPES DISEASE, he prepare the herb for me, and give me instruction on how to take it, at the end of the week which was seven days,he told me to go to the hospital for a check up, and i went surprisingly after it the doctor confirm me cure from HERPES disease I thought it was a joke, i went to other hospital the doctor there also confirm me cure from HERPES disease then i took my friend who was also HERPES patient to the Doctor after the taking of the herbs she was also confirm cure from HERPES disease .please I want every one with this virus to be free, that is why am dropping his email address,(drodukuherbalhealingcentre@gmail.com or his whatsap contact +2348124765093) you can visit his website https://drodukuherbalhealingcentre.weebly.com
       https://dr-oduku-herbal-healing-centre.business.site i want you to email him he is a great man. thank you for saving my life, and I promise I will always testify for your good work. you can also reach me clararose2128@gmail.com

      Delete
    11. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
      Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER  

      Delete
    12. I have been suffering from herpes over 3 years of my marriage and it was really difficult and heartbreaking for me because the symtoms were very terrible and difficult for me, i search for cure, went to different hospital but still no hope untill i saw a testimonies of someone who cure of herpes by Dr ohunyom i took the chance to contact the Dr ohunyom who have the natural cure to herpes, he assure me of his herbal medication which i listen to his advice and i bought his herbal medication and i used it as instructed by the Dr ohunyom, in a month time i went to the hospital for scan and they confirm that there is no trace or sign of herpes in me and now am happy and gladly with my family. contact Dr ohunyom on whatsapp +2349060579973 or for more information and advice contact him via email:drohunyom@gmail.com Thanks ,

      Delete
  2. Haluan käyttää tätä mahdollisuutta jokaiselle kiitokselle DR MUSTAFAlle
    Nimeni on Anita Jackson, ja olen niin iloinen voidessani jakaa tämän todistuksen siitä, miten Dr.Mustafa paransi minua sukuelinten herpes. Löysin sukuelinten herpes noin 4. toukokuuta 2015, ja sen jälkeen olen etsinyt keinon estää tämän viruksen kehossani, mutta mitä enemmän yritän, sitä enemmän minulle kerrottiin, ettei ratkaisua ole. Muutama kuukausi sitten sain eräiltä ihmisiltä todistuksen siitä, miten heitä voitaisiin parantaa. Dr.Mustafa HERPES Virus-ilta, kuulin siitä myös tiedotusvälineissä, nuori nainen todisti myös, että Dr.Mustafa paransi suuhunsa. Minulla ei ollut muuta toivoa kuin ottaa yhteyttä tohtori Mustafaan ja kokeilla häntä. Otin häneen yhteyttä ja kerroin hänelle, mitä olen menossa läpi. Hän sanoi voivansa parantaa minua lähettämällä minulle kasviperäisen lääkkeen, jonka minun pitäisi maksaa. Tein niin kuin hän kysyi, ja hän lähetti lääkkeen lupauksella. Otin tämän kasviperäisen lääkkeen 1 viikon ajan ja oli selvää, että hänen lääkkeensä oli todellinen, koska herpes alkoi selvittää kehon. Myöhemmin 2 viikon kuluttua menin lääketieteelliseen tutkimukseen ja oli yllättynyt, kun lääkäri kertoi minulle, että hän ei enää löytänyt jälkiä viruksesta. Aluksi, kun hän kertoi minulle, että olin niin järkyttynyt ja vielä uskonut, kunnes hän antoi minulle testitulokseni. Minun tarinani olisi lyhyt, olen nyt vapaa herpesistä, suruista monien kuukausien jälkeen, ja tauti on kadonnut, kiitän Jumalaa siitä, että hän on johtanut minut tähän miehen luo, ja haluan johtaa sinut hänelle, jos sinulla on sairaudet, kuten HIV, HPV, B-hepatiitti, astma, syöpä, diabetes, COLD, TOOTH ACHE ja FIBROID. Voit lähettää sähköpostia hänelle Herbalremedies21@gmail.com tai whats osoitteessa +2347010821863.

    ReplyDelete
  3. HOW I GOT CURED OF HERPES WITH THE HELP OF A GREAT SPELL CASTER DR BEN CALL/WHATSAPP +2348140111921

    I am so grateful to the great Dr BEN i for curing my herpes disease,for 4 years ago i was having this infection that made me look so horrible, since i have been having this disease i have been in a complete agony weeping everyday, i have gone to several places trying to get a cure but nothing was change, i had to search for solution in the internet, luckily i came across this testimony of how Dr BEN a cured a lady from this terrible affectio so i decided to contact him through his email voodoospelltemple80@gmail.com i told him exactly how i was feeling and he assure me that he will help me to get cured from my disease, i believed him and obeyed all his instruction that he gave to me, afterwards he prepare a cure for me and when i received it and started using it just as he has promised me, i was cured totally within 2 weeks of usage. contact him at his email: voodoospelltemple80@gmail.com Whatsapp +2348140111921



    HOW I GOT CURED OF HERPES WITH THE HELP OF A GREAT SPELL CASTER DR BEN CALL/WHATSAPP +2348140111921

    I am so grateful to the great Dr BEN i for curing my herpes disease,for 4 years ago i was having this infection that made me look so horrible, since i have been having this disease i have been in a complete agony weeping everyday, i have gone to several places trying to get a cure but nothing was change, i had to search for solution in the internet, luckily i came across this testimony of how Dr BEN a cured a lady from this terrible affectio so i decided to contact him through his email voodoospelltemple80@gmail.com i told him exactly how i was feeling and he assure me that he will help me to get cured from my disease, i believed him and obeyed all his instruction that he gave to me, afterwards he prepare a cure for me and when i received it and started using it just as he has promised me, i was cured totally within 2 weeks of usage. contact him at his email: voodoospelltemple80@gmail.com Whatsapp +2348140111921

    ReplyDelete
  4. HOW I GOT CURED OF HERPES WITH THE HELP OF A GREAT SPELL CASTER DR BEN CALL/WHATSAPP +2348140111921

    I am so grateful to the great Dr BEN i for curing my herpes disease,for 4 years ago i was having this infection that made me look so horrible, since i have been having this disease i have been in a complete agony weeping everyday, i have gone to several places trying to get a cure but nothing was change, i had to search for solution in the internet, luckily i came across this testimony of how Dr BEN a cured a lady from this terrible affectio so i decided to contact him through his email voodoospelltemple80@gmail.com i told him exactly how i was feeling and he assure me that he will help me to get cured from my disease, i believed him and obeyed all his instruction that he gave to me, afterwards he prepare a cure for me and when i received it and started using it just as he has promised me, i was cured totally within 2 weeks of usage. contact him at his email: voodoospelltemple80@gmail.com Whatsapp +2348140111921

    ReplyDelete
    Replies
    1. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
      He can still be able to help you with this herbs medicine:
      1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT  

      Delete
    2. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
      Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER 

      Delete
  5. Just wanna say a big thank you Rebecca john for introducing me to Dr Azago the great HERBALIST that helped me prepare home remedies that cured my herpes simplex virus (HSV1&2)
    I was infected with herpes for the past two years and i was not happy all day so i was desperate to get a cure so that i can live normal and get healthy.
    One day i was less busy so i decided to make latest research on herpes cure and i found a site were everyone was talking about Dr Azago and has ability to cure Herpes, HIV, HPV, Cancer, ALS, COPD, Anthrax, genital wart, cold sore, Arthritis and all manners of diseases and virus.
    So i discussed with Rebecca John and she explained to me that its very easy working with Dr Azago so i contacted Dr Azago via email drazagoherbalcure@gmail.com and he helped me just as he has helped others now I am now cured from herpes am very happy now.
    and i can also assure you that he can also help you. so if you need the service of DR Azago kindly contact him drazagoherbalcure@gmail.com or whatsapp +2347051417546

    Am Lizzy moore here is my private email to know about him Lizzymoore111@gmail.com

    ReplyDelete
    Replies
    1. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
      He can still be able to help you with this herbs medicine:
      1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT    

      Delete
  6. I am here to say thanks you to Dr Lucky my wife was
    was have herps diseases over 4 months and I went
    to the hospital for medication thinking that it was a
    little sickness but hearing from the doctor I was
    afraid that am going to loose my wife because the
    doctor said there was no cure but I should try and
    contact a herbal doctor I have it a try and contacted
    Dr Lucky I did all necessary things and got my
    medicine through dhl services I gave it to my wife
    behold in a week time the symptoms was gone and
    after two good weeks my wife was free from hero's
    diseases brother and sisters out there who don't
    believe in herbal medicine stop deceiving your self
    and contact Dr Lucky on this email
    ( drLuckyherbalcure@gmail.com ) or message him
    on WhatsApp on
    this same +2348154637647 he is here to help
    spread this good new please and God in heaven
    will bless you amen,
    him can also cure
    {1}HIV And AIDS
    {2} HPV
    {3}Diabetes
    {4} Hepatitis
    {5} Vitiligo
    {6} Blood Cancer etc.

    ReplyDelete
    Replies
    1. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
      He can still be able to help you with this herbs medicine:
      1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT  

      Delete
  7. I was diagnose with human papilloma virus (HPV) 4 years ago and i met a doctor he told me there is no cure and i have be taking some medication the warts multiplied when trying to removed them and it got me embarrass and pains, luckily few weeks ago i was recommend to Dr Onokun for natural treatment after one week i got 100% cure and all the wart and pains got disappeared, i sheared this post because its part of my life experience, encase anyone need speedy help about this cure email Dr Onokun via, dronokunherbalcure@gmail.com

    ReplyDelete
    Replies
    1. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
      Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER 

      Delete
  8. Hello, everyone! I,m here to explore blogs and forum about the wonderful and most safe cure for (Herpes Virus).
    I was positive to the deadly virus called herpes and i lost hope because i was out casted and rejected even by my closet friends.
    i searched on-line to know and enquirer about cure for Herpes and i read someone testimony on how he was cured from Herpes so i decided to contact the same herbalist because i know that nature has the power to heal everything.
    i contacted him to know how he can help me and he told me never to worry that he will heal me with the natural herbs from God!
    after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via DHL and it got to me after 3 days!
    i used the med as he instructed me (MORNING and EVENING) and i was cured!
    its really like a dream but i am so happy!
    thats the reason i decided to also add more comment of Him so that more can be saved just like me!
    and if you need his help, you can email him on nativehealthclinic@gmail.com or whatsapp +2348140073965
    I,m neme amber and you can get intouch with me via nemeamber@gmail.com..
    Contact him for help atHerpes virusHIV/AIDS CANCER COPD BRAIN TUMOR All kind of virus and disease

    ReplyDelete
  9. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT  

    ReplyDelete
    Replies
    1. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
      Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER 

      Delete
  10. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT  

    ReplyDelete
  11. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
    Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER 

    ReplyDelete
  12. Dr Oselumen God will continue to bless you more abundantly, for the good works you are doing in peoples life, I will keep on testifying about your good work, I was healed from HIV/AIDS through the help of Dr Oselumen. I saw a blog on how Dr Oselumen  cured people with his natural herbal treatment, i did not believe but i just decided to give him a try, I contacted him and he prepare the herbs for me which i took, after taking it, he told me to go for check up, could you believe that i was confirm HIV/AIDS negative after the test,and i went to a different hospital and it was also negative, i am so happy.If you have any problem or you are also infected with any disease, kindly contact him now with his email: droselumen@gmail.com you can also call him or whatSApp number +2348054265852.
    he can also cure any virus LIKE.HERPES WARTS, AUTISM, CANCER ,ALS,HPV WATRS.

    ReplyDelete
  13. I can’t believe this is really true I never believe there is cure to this hsv 2 because all the hospital have told me there is no cure to it, few months ago I saw this man email DR.Ohunyom on internet from a testimony share by someone who he help with his herbal cure I contact his email and ask for his help also, that is how he inform me about the cure process and this man sent me a herbal medicine which I took according to the way he instructed for 2 week I can’t believe when I go for test my result come out negative i am so happy to share this to the world there is real cure to herpes you can also contact DR.Ohunyom through his email now drohunyom@gmail.com and also WhatsApp him +2349060579973 and He also have herbs medicine to cured the following diseases;
    Diabetes, Lupus, HPV, Gout, Hepatitis A,B, Infertility, HIV/AIDS, CANCER  

    ReplyDelete
  14. I have been suffering from herpes over 3 years of my marriage and it was really difficult and heartbreaking for me because the symtoms were very terrible and difficult for me, i search for cure, went to different hospital but still no hope untill i saw a testimonies of someone who cure of herpes by Dr ohunyom i took the chance to contact the Dr ohunyom who have the natural cure to herpes, he assure me of his herbal medication which i listen to his advice and i bought his herbal medication and i used it as instructed by the Dr ohunyom, in a month time i went to the hospital for scan and they confirm that there is no trace or sign of herpes in me and now am happy and gladly with my family. contact Dr ohunyom on whatsapp +2349060579973 or for more information and advice contact him via email:drohunyom@gmail.com Thanks ,

    ReplyDelete
  15. i already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have go to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr ohunyom, in the net from a lady called Angela i contacted him and he reassured me with him herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally fee from #Herpes. i want to say a very big thank you to DR ohunyom for what he has done in my life. feel free to leave him a message on email drohunyom@gmail.com and also WhatsApp him +2349060579973..
    He can still be able to help you with this herbs medicine:
    1...ALS CURE/DIABETES CURE/EPILESY/HPV CURE/LUPUS/HEPATITIS/CANCER/GOUT    

    ReplyDelete
  16. I'M Kelly FROM KENTUCKY.
    I wanna thank God for Using Dr. Odey Abang to restore my son's Happiness. He came from school crying that he was diagnosed of Herpes and his teacher and the Physician Therapist told him he could not get a cure rather living on drugs, he never talk to us about it anymore not knowing he plans committing suicide . I had to monitor him and explain to him that he should manage the prescribes ACYCLOVIR, , FAMCICLOVIR and the VALACYCLOVIR.
    4 months later, he told me about an Herbalist who he heard curing people from online and he sents through the DHL service. Not quite long,he brought his phone, had to speak with the Herbalist and explain how my son had really felt and desperate in need of the cures, he assured me with no site effects after taking the medicine and promise to do as he said, 5 days later, t medicine arrived, applied as instructed and within two weeks to finish,I had my son told me he was wondering why all this while,they have not approved the cures of which doctor ODEY told him he Cures.
    Rest assured, after the checkup, he tested negative and his smiles was being restored.
    supriesed Herpes could be Cured!!!☔💯
    If you're in trouble of health
    HIV/AIDS, DIABETES, Herpetites, KIDNEY PROBLEM, INFERTILITY, INFECTIONS, IRREGULAR MESTURATION, WEEK ERECTION, CANCER ETC
    ALL THIS ARE CURABLE WITH HERBAL REMEDIES BY FROM DR. ODEY ABANG
    Kindly contact him for more information on health and Safety solutions @
    odeyabangherbalhome@gmail.com

    ReplyDelete
  17. Hello, everyone! I'm here to explore blogs and forums about the wonderful and most safe cure for (Herpes Virus). I was positive about the deadly virus called herpes and I lost hope because I was outcast and rejected even by my closest friends. I searched on-line to know an enquirer cure for Herpes and I read someone's testimony on how he was cured from Herpes so I decided to contact the same herbalist because I know that nature has the power to heal everything. I contacted him to know how he can help me and he told me never to worry that he will heal me with the natural herbs from God! After 2 days of contacting him, he told me that the cure has been ready and he sent it to me via DHL and it got to me after 3 days! I used the med as he instructed (MORNING and EVENING) and i was cured! it's really like a dream but I am so happy! That's the reason I decided to also add more comments on Him so that more can be saved just like me! and you can get in touch with him via email chiefdrlucky@gmail.com or WhatsApp  +2348132777335 Kindly visit website https://chiefdrluckyherbaltherapy.wordpress.com/

    ReplyDelete