易瑞沙耐药后有人用键择有效吗？grace最近的一篇新文章

xiwangzairenjia

最近看到的grace上的一篇文章，不知道有没有理解错。不过提到从台湾的数据看来，病人如果有EGFR基因突变，在易瑞沙耐药后，采用键择加铂类效果最好。比起他的化疗方案还要好，包括泰素帝。但是其他的方案比较中，没有包括力比泰，所以不太清楚和力比泰的比较。

Dr. Garfield

As more and more oncologists become aware of the importance of testing for at least the EGFR mutation in tumor, and soon, perhaps, in blood, it seems likely that more patients will have their first systemic treatment for advanced non-small cell lung cancer (NSCLC) be an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), usually Tarceva (erlotinib), until Iressa (gefitinib) is re-approved (perhaps).  This is because the presence or absence of the mutation seems more important than clinical features in predicting a benefit from the TKI, as Dr. West described in the wake of the evidence from the IPASS trial.  In that regard, a recent paper from a group of investigators in Taiwan discusses what second-line treatment should be considered after progresssion following first line Iressa in patients with advanced NSCLC.  A total of 195 patients were included in this retrospective analysis, of whom 95 had tissue for testing for the EGFR mutation (61 with a mutation, 34 without).  Although these findings may not be directly transferable to a North American or European population who would be receiving the very similar TKI, Tarceva, they are still of some interest.

Those with the EGFR mutation who progressed while on Iressa got a greater survival benefit with Gemzar (gemcitabine) plus a platinum-containing regime than any other regimen, including single-agents Navelbine (vinorelbine), a taxane (such as Taxol (paclitaxel) or Taxotere (docetaxel)), or any of those combined with a platinum, or Tarceva was given in some patients.  However, it is of interest that none received an Alimta (pemetrexed)-containing regimen, so this remains an unknown.  On the other hand, those patients who did not have an EGFR mutation did just as well with a single chemotherapeutic agent as with a doublet containing a platinum, and no one treatment emerged as especially better than another.

雨露甘泉

要是在服用易瑞沙之前已经用过健泽+顺铂，在易耐药后还可以用健泽+顺铂吗？谢谢了！

kubuqi

grace同好，握手。

步行者

当时GP如果有效,看缓解时间
如果无效,当然不能再用了

xiwangzairenjia

GP我妈妈打过一个疗程，化疗期间一共用过3个方案，总共打过5个疗程。其实从影像和cea上来说，GP是有效果的。但是我妈妈打GP的时候副作用很大很大。全身乏力，血管受影响。大的副作用令到妈妈都不愿意继续打化疗而是吃易瑞沙了。

不知道大家帮家人打GP的时候，副作用大不大？到底是GP的副作用还是之前几次化疗副作用的叠加？

共创奇迹

原帖由 xiwangzairenjia 于 2009-9-24 15:12 发表
GP我妈妈打过一个疗程，化疗期间一共用过3个方案，总共打过5个疗程。其实从影像和cea上来说，GP是有效果的。但是我妈妈打GP的时候副作用很大很大。全身乏力，血管受影响。大的副作用令到妈妈都不愿意继续打化疗而是吃 ...

我爸爸刚发现病情的时候一线化疗是用的GP方案（两个疗程），反应也很大，而且没有什么效果。我爸主要是出现类似流感的症状，全身酸痛还打摆子，反正是很痛苦。搞得易耐药后爸爸倾向于后续放疗，幸亏后来阻断了他这个念头。现在我们是用紫杉醇+卡铂，刚打一个疗程，应该是有效，CEA下降了25，还没有影像评估，等这次做完后。也不好受，但是爸爸自我感觉比用GP来说还是好受一些。

不过我爸爸用易前并没有进行EGFR突变检测，所以不知道到底是属于文章中提到的哪一种。如果是没有突变的话，那么用哪种方案好像没多大关系，不知道我爸是不是这种。你们做过了EGFR基因突变检测吗？另外你们是鳞还是腺呢？而且这个EGFR基因突变检测不能只依靠一次的结果，因为会在治疗后发生改变，那么在耐药后准备化疗前还要做一次才行吧。

[ 本帖最后由 共创奇迹 于 2009-9-24 18:25 编辑 ]

xiwangzairenjia

我妈妈是腺癌。当时做基因突变检测。但是检测报告没有人看得懂。下次我找到了，抄录下来一下。

谢振飞

GP方案是建择+顺铂吗？？？