妈妈怀疑是脑膜转，赠已停的40粒英国易瑞沙，求特罗凯想试试论坛说的特罗凯脉冲。

g.ck

头晕，头晕，眼花，流眼泪，有点粘稠的白色痰，呕吐，无力，消瘦，大便又粗又干，一礼拜一次。
求助  QQ1540360

雨花石

你好！首先愿你妈妈创造奇迹，愿我们论坛里的所有病友身体健康。我也非常希望得到你的帮助，具体信息我已经发了站内消息给你。QQ 1228144109

雨花石

千山暮雪

我不善言辞，由于经济压力，希望可以得到楼主的赠药，不想独揽，希望得到部分也可以，谢谢。

zqxlqt

g.ck：
    你好！我妈妈也是肺腺癌，4年2个月了。两度脑转移，现第3、4胸椎也转移了。所有最好的化疗和放疗都用过了。医生建议，要么就用英国版的易瑞莎，要么就用特罗凯，正苦恼着。现将在网上看到的特罗凯冲击疗法转载给你，希望会对你有所帮助。

zqxlqt

最初知道特罗凯脉冲，是从安安的帖子里，后来特地找安安咨询了具体用法，实际就是：第一天吃4粒特罗凯，停三天，然后继续吃4粒，停三天，这样反复下去 ，一般肯定不建议这么用，只是在危急的时候尝试尝试吧，在多发脑转，又无法再次全脑放疗的情况下，或者存在脑膜转移的情况下，还是值得一试的，今年，我就知道身边有三个病友用了这个方法，稳定下了形势。这里也附上yezi给的特罗凯脉冲的一些英文资料，供大家参考。

An Effective Treatment for (some patients with) Leptomeningeal Carcinomatosis in Lung Cancer?
January 31, 2010 - 2:34 pm
Dr. West
Leptomeningeal carcinomatosis, also referred to as carcinomatous meningitis, is an uncommon but certainly not rare complication in lung cancer that I consider to be among the most dreaded.  This occurs when cancer cells are in the cerebrospinal fluid (CSF) that bathe and cushion the brain and spinal cord, and cancer cells deposit on the meninges, the lining around the brain and spinal cord.


Meningeal carcinomatosis is a diagnosis that I need to consciously remind myself to think about when I see a patient with lung cancer experience a rapid clinical decline that isn’t associated with radiographic evidence of significant progression in the extracranial cancer we’ve been following, or when I see a patient with a constellation of neurologic signs and symptoms that just don’t fit together for an anatomically-based lesion like a brain metastasis, stroke, or peripheral neuropathy.
One central reason that leptomeningeal carcinomatosis is also especially dreaded because we really tend to do so poorly in treating it.  Craniospinal radiation therapy (RT) has been tried, and there is the option of giving chemotherapy directly into the CSF through a series of lumbar puncture (spinal tap) procedures or through an Ommaya reservoir that is implanted into the skull to deliver chemo right into the fluid collections inside the center of the brain.  Unfortunately, none of these options has been effective (particularly in lung cancer, though results in breast cancer treatment have been more favorable), and most thoracic oncology experts and general oncologists have favored a focus on comfort care as the primary intervention.
I was intrigued at a meeting about a year ago to have heard in a conversation with Dr. Mark Socinski, renowned thoracic oncologist at UNC Chapel Hill, about a case (sebsequently described in a case history in the Journal of Clinical Oncology) of a never-smoking woman who had initially responded on Tarceva (erlotinib), then progressed and switched to chemo with Avastin (bevacizumab), and then developed worsening double vision and was ultimately diagnosed with meningeal carcinomatosis after a lumbar puncture (LP, or “spinal tap”) confirmed cancer cells in her CSF (positive “cytology”).
On the basis of a trial they were doing at University of North Carolina at Chapel Hill, giving “pulsed” Tarceva at 600 mg by mouth given one day every 4 days (so the same total amount as the normal daily administration, but four pills one one of every four days only), he started her on this, and she had symptomatic clearance and resolution/normalization of her cytology on a repeat LP.   She tolerated this well and continued to feel better for many months.
I filed this information away but unfortunately had occasion to consider it again very recently. A patient of mine, a 41 year old Caucasian woman with a remote prior smoking history, had initially presented with brain metastases as well as chest and bone disease, biopsy-proven as lung adenocarcinoma, and after initial whole brain RT and palliative RT to her painful hip lesion, I started her on chemo-based first line treatment.  She had a very nice partial response, but she eventually became weary of it (I started here on cisplatin-based chemo), and I switched her to maintenance Alimta (pemetrexed). She did very well on that for about 14 months, barely noticing side effects, and doing things like asking if she can go to the gym on the same day as her chemo (so clearly feeling well).
She showed modest but convincing progression several weeks ago, and we talked about further options. At that point, a leading consideration was Tarceva-based treatment, and we were actually planning to have her pursue a trial of Tarceva/Avastin (which now allows patients with treated, asymptomatic brain mets), when the screening head MRI showed diffuse meningeal enhancement highly consistent with meningeal carcinomatosis.   Because she had a history of Lyme disease and had undergone several LPs in that work-up, she didn’t want another if it wasn’t likely to change management. At right around that time, I had sent off her tumor for EGFR mutation testing, and she has an exon 19 deletion, a known activating mutation very often associated with good responses.
She started on tarceva, initially at the standard 150 mg daily dosing, since I knew that some patients with brain metastases had had very good responses of brain metastases to EGFR inhibitors.  Over the next week, she had two transient episode of difficulty getting words out (known as an expressive aphasia) that resolved spontaneously after several minutes.   At that point, I had her switch to the 600 mg every four day dosing schedule.   It’s now been another couple of weeks, and she hasn’t


            

zqxlqt

had any recurrences of neurologic symptoms. I’ll be following her closely and repeating scans soon.
I’m optimistic that this is a truly valuable treatment for at least some patients with meningeal carcinomatosis. Dr. Socinski tells me that he has had a second patient who responded well in a similar situation.  I’m not sure if this is a beneficial effect we’re likely to only see in patients who have an EGFR mutation, but it’s certainly an option I’m inclined to consider again for a situation in which it’s hard to find any treatments to be very hopeful about.  I wanted to highlight this in case anyone else out there sees a similar case and might see if this approach of pulsed erlotinib can provide a benefit.

Dr. West January 31, 2010 - 8:55 pm
There’s a very small amount of evidence on “pulsed” tarceva out there. One advantage would be that higher doses may achieve therapeutic concentrations in the CSF, but I don’t know of any oncologist advocating this relatively untested approach as an off-protocol alternative to standard daily dosing. I might consider it in patients who have already received whole brain radiation and now have progressing metastases. However, while I’m pretty optimistic about this approach for patients with an EGFR mutation (very limited numbers thus far, but encouraging), I’m more guarded about whether it will offer much to patients who don’t have an EGFR mutation.



Dr. West, April 27, 2010 - 9:00 pm
One benefit of the pulsed schedule that I related from the published experience from Dr. Socinski is that the total dose of Tarceva is the same as the normal schedule of 150 mg by mouth daily. I think it could well add another wrinkle to have a schedule of 1500 mg every 7 days, effectively requiring a far greater than standard dose that could leave many insurers unenthusiastic or completely unwilling to cover the added cost of a treatment plan that doesn’t have any established place yet. However, if there were to be evidence that the higher dose was more effective, it would change the situation and make me far more inclined to pursue that challenge. Right now, however, I don’t think there’s reason to conclude that the 1500 mg every 7 day schedule is superior to 600 mg every 4 days.

zqxlqt

Regardless, I wish you both good luck on the upcoming MRI scan.


Carcinomatous Meningitis in Non–Small-Cell Lung Cancer: Response to High-Dose Erlotinib
1.        Nirav Dhruva and
2.        Mark A. Socinski
+ Author Affiliations
1.        Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
A 56-year-old woman who never smoked presented with cough and progressive dyspnea. Chest x-ray and computed tomography (CT) scan revealed right pleural effusion and innumerable small pulmonary nodules (Fig 1A). CT scan of the abdomen, bone scan, and magnetic resonance imaging (MRI) of the brain were negative for distant disease. Poorly differentiated adenocarcinoma was established by transbronchial biopsy. Given her never smoker status and stage IV disease, she entered into a clinical trial and received erlotinib (150 mg daily) alone. She had a dramatic response of her pulmonary disease (Fig 1B) with complete resolution of her cough and dyspnea. She remained on erlotinib for 7 months, at which point her cough returned, and her chest CT scan revealed an increase in the size and number of pulmonary nodules. Erlotinib was discontinued, and she received treatment with carboplatin, paclitaxel, and bevacizumab for six cycles followed by an additional two cycles of bevacizumab alone with minimal response radiographically, but her cough resolved. The patient then developed diplopia, and left cranial nerve IV palsy was demonstrated. Subsequent brain MRI revealed diffuse leptomeningeal disease most prominent near the cerebellum. She received a course of whole-brain radiotherapy to a dose of 30 Gy. As her systemic disease was still in a minor response without evidence of disease progression, bevacizumab was continued every 3 weeks. Four months later, her chest CT and brain MRI (Fig 2A) were stable; however, her diplopia worsened, and she developed mild ataxia. A lumbar puncture (LP) was performed revealing findings consistent with carcinomatous meningitis (Table 1, LP 1). Given the stability of her systemic disease, bevacizumab was continued. Erlotinib was added at a dose of 600 mg orally every 4 days based on an ongoing phase I trial at the Lineberger Comprehensive Cancer Center (Chapel Hill, NC).1 Her CNS symptoms improved along with her performance status. Subsequent LPs done 3 and 6 months later revealed improvements in her biochemical parameters as well as clearing of her malignant cells (Table 1; LP 2, 3). A repeat brain MRI at 6 months after erlotinib initiation displayed resolution of the leptomeningeal findings, which were most notable on the coronal T1–weighted images (Fig 2B). The patient remained on erlotinib at 600 mg orally every 4 days for a total duration of 10 months with minimal skin and gastrointestinal toxicity. She continued to have minimal diplopia and ataxia with relatively good performance status. During this time, her cough worsened coincident with disease progression on her chest CT despite changes in treatment with addition of pemetrexed and then gemcitabine. She was placed on hospice and passed away shortly thereafter, 28 months from initial diagnosis of stage IV disease.