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发表于 2007-8-19 02:08:29
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来自： 美国
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<p> 为亲人作治疗的决策是一件大事，尤其第一轮战斗很关键。我想我们做的有点草率。好在我们并没有过渡化疗。也许还有机会追求奇迹。但奇迹绝不来源于化疗。</p><p>下面是我与Boston的ＭＧＨ医院的医生的email.因我并没有告知我会把我们的私人email公众化，所以我在这里隐去医生的名字。我只是想我们中国的病人很不幸地需要做太多的个人决策，因没有一个标准化的最佳的治疗方案。因此我们需要各方面的信息。请看email_____</p><p></p><p>----- Original Message ----<br/><br/>Subject: RE: question about Iressa and Tarceva for decision making<br/><br/></p><style type="text/css"></style><div><span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2">see answers below</font></span></div><blockquote><div class="OutlookMessageHeader" dir="ltr" align="left"><font face="Tahoma" size="2">-----Original Message-----<br/><br/><b>Subject:</b> question about Iressa and Tarceva for decision making<br/><br/></font></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Hi, Dr. ,</div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">How are you doing?</div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">I've been back for 2 weeks, but haven't been back to work yet. Right now I'm taking care of my two kids, and meanwhile taking care of my mother by calling back to China and telling them what to do next. </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Can I ask you a few more questions please? </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Question 1. Should we start with Iressa or Tarceva? Is Tarceva better than Iressa? <span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> Either is fine. Iressa may have fewer side effects. </font></span></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Question 2. Do EGFR targetted agents (like Iressa and Tarceva) give patients longer life, or just improve the life quality? <span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> Longer life and better quality. </font></span> I heard that once Iressa/Tarceva resistance happens, the tumor would grow even faster in a crazy way, which means that the overall survival time for a patient is the same, no matter whether he take the EGFR targetting drug or not. Is this true? <span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> No </font></span> Tarceva has shown survival prolongation, but not Iressa, is this true?<span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> In unselected Caucasian populations, but not in Asians nor in non-smokers. </font></span></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Question 3. What would you do to the patient once the drug resistance happens? What's the standard treatment here in the U.S.? <span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> We have clinical trials of new EGFR agents in the US. There are also other chemotherapy drugs </font></span></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Question 4. Which chemotherapy plan (the drug combinations) is the most commonly used for adenocarcinoma (age 66, female) in the practice here? <span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> Many different ones used. </font></span>How do you feel about NP plan?<span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> don't know what NP means </font></span></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">Question 5. About the time to start Iressa. In China, doctors apply Iressa (or Tarceva) as 3rd line treatment for NSCLC, since anyway Iressa resistance would happen, and once it happens, the disease would progress really fast, so they start Iressa after all other treatments fail, in which way the patient's survival time could be the maximum length. This is different than here, that the EGFR targetted drug is used as 1st line treatment. Does this mean that the survival time here would be shorter?<span class="313542213-11072007"><font face="Arial" color="#0000ff" size="2"> No - we think survival can be prolonged w/ iressa, especially if there is an EGFR mutation. the thing about the disease progressing faster is just not true. </font></span></div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">I greatly appreciate your help!</div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;">sincerely,</div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"> </div><div style="FONT-SIZE: 12pt; FONT-FAMILY: times new roman, new york, times, serif;"></div></div></blockquote> |
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