请大家关注我妈妈减量服用易瑞沙的尝试和一篇非常有用的文章
我在这个论坛上受益非浅，刚注册成功，这个贴子包含了我的对易瑞沙特罗凯服用的思考，希望对大家有帮助。先介绍母亲情况，７１岁，体质弱，身高１５８CM， 体重１０３斤。今年八月初确诊肺腺癌（中分化）四期脑转。EGFR 检测阳性
从知道妈妈得癌症那天起，整整三个半月了。
这三个月半里，我的心里所经受的风浪，所经历的切肤之痛,恐怕癌症患者亲友最能体会。吃易瑞沙总算完全确认有效，易瑞沙起码部分通过了吓人的血脑屏障，脑转移得到控制,肿瘤缩小，各项指标除了一项别的都恢复正常。我心里石头落地。
只吃半颗，是妈妈经过摸索自己坚持的，半颗她状态很好，无任何不适，服用一个月后腿上长了几点红点。试每天０.７颗一个星期不到,胃有时会有点不舒服。我们只好一退再退，既然没别的办法，就只有试试了。不过我还是有一定的信心。妈妈体质敏感。我又找到了AstraZeneca的一篇文章, 说５０MG 有人有效，１００MG几乎所有人有效果(满足条件的人群里), 150MG 则观察到显著效果。那每天半颗也有１２５MG了，即使效果没有１５０MG显著，应该也有效果吧。后来检测证明确实效果很好。
下面是妈妈试用特罗凯和易瑞沙的过程，希望对病友们有帮助。
我们开始首先试用特罗凯，由于对它的副作用估计不足，一开始就吃一片，第二天又吃一片。，我们开始很高兴认定它有效时（皮疹第二天就出来了），妈妈出现严重的皮疹, 只好停药。过了几天，出现更多的副作用。妈妈呕吐得很厉害，一天无数次，有时甚至来不及找东西接着。我放了许多的塑料袋在旁边，可是有时还不够用。呕吐完了也还不好受，躺在床上还在呻吟。当然是没有心情理会旁人的了。我坐在旁边默默注视着她难受的样子，觉得心都要碎了。
而且让我担心的是，特不行，是不是易也不行呢？特减量行不行？都一周了，副作用皮疹都没有消失，按照特的半衰期,也许１／６的特妈妈都不能耐受。因为按照１／６量吃，五六天恐怕就达到一颗特的量了，何况，妈妈年纪大，代谢应该慢一些吧。医生反对用易（认为特反应厉害，易也一样），建议特减半试试。可如果减半不行，妈妈还经得住折腾吗？我查了网上很多资料，终于认定，特副作用太大（药性是易的五倍），减量到１／６又可能无效，１／２不能考虑。１／６片效果也许不如一片易。先吃一点易试试，从１／５片先试起，看过不过敏。(（我不知道我的决定是否正确，也许１／２我妈能耐受，或者１／３的特更好？不管如何，只能摸着石头过河了）
第二天妈妈感觉好多了，早上就吃了１／５易,没有不良反应。第二天妈妈勇敢地吃剩下的那片，还没反应，我高兴极了。又试每天０.７颗一个星期不到,胃有时会有点不舒服。半颗她状态很好. 后来一直吃半颗瑞沙.
我有几个问题一直在思考，我们在易出现不能控制脑转迹象时还想用特罗凯，可是多大的量会合适呢？有没有病友减量到一半或三分之一特罗凯的呢？我在国外论坛听了很多由１５０MG 减到１００MG 的例子，可是有没有三分之一有效的呢？一半对我妈妈应该会有效，我只是担心副作用仍然太大。
刚刚找到一个隔天１００MG特罗凯的例子, 相当于１／３了。
“My 84 yr. old Mom also has stage IIIB NSCLC-this is her 3rd year of chemo. She was started on Tarceva recently for her lung and liver met. I am interested to hear that your Mom has had good results from the med. My Mom had to cut back to 100 mg every other day because of bad diarrhea and rash on face, neck and scalp which was painful. The rash has improved with a steroid cream. The diarrhea is not pleasant. She's having bad abdominal cramps right now. She's taking lomotil which helps. Does anyone have info on how long the diarrhea lasts and any food suggestions to diminish it? Thanks. This is the best web site I have found so far. I am an RN and care for pts. where side effects of meds differ. All the drug sites in the world give you some info but it's only statistics and not real stories. Every person reacts to medication differently. I look forward to learning from all of you.
“
关于易瑞沙服用剂量问题:
文章地址如下: http://clincancerres.aacrjournals.org/content/10/14/4607.full 值得一看。
“Development of the Novel Biologically Targeted Anticancer Agent Gefitinib
Determining the Optimum Dose for Clinical Efficacy”
这段时间看了很多，据说日本的服用易瑞沙特罗凯的发法很前沿，他们不一定一天一颗，可能减量到一半，CEA 长了，有耐药迹象了，又变为两天各自一片，第三天不吃，然后又两天各自一片，第三天不吃，如此反复，还可能加到每天一片，或者在脑转后加特罗凯，如两天易，一天特，总之相当灵活，病人也撑很长时间（四五年，五六年的都有），这对我们只敢一天一片易吃到耐药实在很有启迪作用。
另外，文献说特罗凯＋西乐葆对延迟耐药有效果，由于易瑞沙特罗凯的相似性，我想会不会易瑞沙＋西乐葆对延迟耐药也有效果呢？
对延迟易耐药，大家有没有做过易瑞沙＋西乐葆尝试呢?
有没有病友减量到一半或三分之一特罗凯的呢?
若有，万望分享经验.
以后我会时时更新我在使用易和特上的发现，若大家觉得有用，就多发言，多讨论吧，让我们一起为我们的至亲努力！
我不甘心，我不相信，我一定要用尽我的力量找到办法！ 谢谢不甘心的我，给我们提供重要的治疗经验，我母亲吃易2个月，副作用非常厉害，但是效果很好，现在我想采取你的建议，给她减半试试 有医生做过试验，隔天服易，据说效果一样。 谢谢LZ的分享
我母亲已经吃了14瓶易，还比较稳定，现在最担心就是耐药
我们中间停过大半个个月，但病情出现反复，后来不敢减量了。但是药物副作用还是比较大的，近期眼睛又出现了模糊不清的情况，比较担心。
看到LZ介绍的日本的服用方法，觉得可以试试
LZ，定期复查很关键，便于调整用量。 得了这个病 真是不幸 可我母亲吃易瑞沙有效（基因检测也属敏感）病友们都说是万幸 哎~关于LZ易瑞沙减量 我很有兴趣 我最近把妈妈的病例托朋友带到日本 咨询下这个问题 隔天服用特１５０MG的例子，改善近半年，７个月后恢复每天１５０MG。 原来每天特１５０MG副作用太大，隔天吃特７个月后，他变得能耐受每天特１５０MG。
个人想法，我觉得由于每个人对药的反应不一样，不一定要按药品说明书上的量吃。如易，根据研究，由１５０MG 加到２５０MG只是受益人群略多了，但副作用大很多，临床改善却与１５０MG 差不多，既然如此，我已经知道妈妈会从易受益，似乎就没有必要让她承受副作用而症状改善不大。何况，无论易还是特，如果一开始是一半量，若有耐药迹象后还可加量，似乎又多了一条路。
http://jco.ascopubs.org/content/23/30/7738.full?ijkey=2086b1053a597a68a6324d806617f9a1d47c34e0&keytype2=tf_ipsecsha
CT-guided fine-needle aspiration (FNA) in May 2004 showed cells compatible with NSCLC, cell type not specified. In June, treatment was started with carboplatin/paclitaxel and zoledronic acid. He received four cycles, and had a brief, partial response (PR) manifested by less cough, reduced anterior chest pain, and an improved chest x-ray appearance. However, by August, disease had progressed in the same thoracic sites, and in September, he was found to have a single, 8-mm brain metastasis. He received radiation to the rib and whole brain and was started on gefitinib, 250 mg/d. He had neither rash nor diarrhea and had no response in the chest. He was then given two courses of Alimta in November to December, again without response. At that time, PS was 3 and he was, therefore, transferred from home to nursing home in December. An anterior-posterior (AP) chest x-ray in early January showed a large, right upper lobe (RUL) mass, with 1 to 2 additional masses inferiorly, as well as smaller left upper lobe (LUL) masses (Fig 1, see three arrows, LUL masses not visible). Early in January 2005, erlotinib, 150 mg/d, was started. Within 1 week, he developed rash and diarrhea, had disappearance of his chest pain, but now had a PS of 4. Erlotinib was held for 1 week until toxicity improved, and was restarted at 150 mg, every other day. By mid-March 2005, the only toxicity was mild rash on the dorsum of his hands. PS was 2. AP chest x-ray showed a significant decrease in the size of the RUL mass and virtual disappearance of the inferior lesions on the right. Further decrease was noted at the end of April 2005, after almost 4 months of erlotinib. (Fig 2, see 2 arrows), and further decrease was noted one month later. However, 2 months later, there was slight growth of the RUL mass, and the LUL mass had reappeared, though he remained at PS2. Erlotinib was increased to 150 mg/d. His rash briefly worsened but then receded without treatment. Two months later, an AP chest x-ray showed that the two masses had stabilized.
[ 本帖最后由 learning 于 2010-11-24 23:01 编辑 ]
让我们一起加油吧
“不甘心的我”，您好。我的妈妈去年年底查出肺腺癌，现在手术一年了。当时未发现转移，可在今年10月份，腋下淋巴结转移了，已经切除了。我们也在考虑用易瑞沙或特罗凯。你母亲用的药都是英国产的吗？非常感谢分享
我妈妈现在是隔天一粒易瑞沙。作出这个决定是我看到过一个对照试验，这种服法和一天一粒在生存期上，没有统计意义上的差别，数字略微好看些，但是没到有统计意义上的差别。这个结果我以前在论坛里贴过。
另外，我印象中，一粒特罗凯的量相当于2个易瑞沙了。
供参考。