[求助]特罗凯请教

johnsonqu

橙子，你姥姥用的是正版的特罗凯吗？可以问问他们的医药代表，有些副作用的处理，他们比医生还清楚呢。
上次我询问特罗凯的时候，上海中山医院的那个医药代表是这样跟我说的...

以马内利

先前也为母亲准备了印版特罗凯，但是后来没有来得及服用，我个人还是比较信任的，只是在易瑞沙耐药之后服用特罗凯的有效率确实太低了。

meggie_sh

特罗凯团购得事情组织的怎么样了？有眉目了吗？

lovemum2

妈妈服用了2个月英国产Iressa6个月印度版Iressa，从CT检查和医生诊断结果看，从一开始就被论定为无效。可服用两周后，自身感觉有好转，后来我也一直“自欺欺人”地认为，即使没有人家那么有效，只要能稍微有所控制或能减缓发展都算是功效了，因为，毕竟妈妈从2004年底查出肺癌晚期时（那时候已经转移至纵膈淋巴），已经做过了十次化疗，也试过力比泰，30天的诺利刀放疗，10天的全脑放疗，30天的肺部普通放疗，还有脑部伽马刀。真的没有太多的选择了。

大家都在问的是如果Iressa耐药特罗凯是否还有效，可我想知道的是如果Iressa无效特罗凯是否会有效。

真的很急，祈求大家帮忙。

jimmy112199

QUOTE:

以下是引用lovemum2在2007-10-30 16:54:13的发言：

妈妈服用了2个月英国产Iressa6个月印度版Iressa，从CT检查和医生诊断结果看，从一开始就被论定为无效。可服用两周后，自身感觉有好转，后来我也一直“自欺欺人”地认为，即使没有人家那么有效，只要能稍微有所控制或能减缓发展都算是功效了，因为，毕竟妈妈从2004年底查出肺癌晚期时（那时候已经转移至纵膈淋巴），已经做过了十次化疗，也试过力比泰，30天的诺利刀放疗，10天的全脑放疗，30天的肺部普通放疗，还有脑部伽马刀。真的没有太多的选择了。

大家都在问的是如果Iressa耐药特罗凯是否还有效，可我想知道的是如果Iressa无效特罗凯是否会有效。

真的很急，祈求大家帮忙。

文献介绍，有人 用IRESSA无效后，用 TARCEVA有效(详见所付英文文摘)

ournal of Clinical Oncology, Vol 23, No 30 (October 20), 2005: pp. 7738-7740
© 2005 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.02.4471

DIAGNOSIS IN ONCOLOGY

Modern Treatment of Lung Cancer

CASE 2. Response to Erlotinib After Failure of Gefitinib in a Patient With Advanced Non–Small-Cell Lung Carcinoma

David H. Garfield

Department of Medicine, University of Colorado Health Sciences Center, Aurora, CO

An 80-year-old white man presented with a 1-month history of cough and right-sided, nonpleuritic, anterior chest wall pain. Chest x-ray and computed tomography (CT) scans in May 2004 demonstrated bilateral upper lobe masses, larger on the right (8.5 cm) than the left side, with invasion of a right rib anteriorly. Performance status (PS) was 1. Medical history was pertinent for 40 to 60 pack-years of smoking until 30 years prior. His father, mother, and sister all were said to have died of lung cancer. 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.

lovemum2

Jimmy太谢谢你了，我现在的心跳一下子变得很快很快，就好像溺水的人抓到了一根救命稻草一样

妈妈的状况已经很差很差，我没有选择，再贵哪怕卖了房子也得给妈妈买这个药来试用一下了。

不知道上海哪里有正规而又价格相对便宜的特罗凯可卖？远水解不了近渴，现在肯定来不及买印度版了。

lovemum2

Erlotinib Helps in Lung Cancer after Gefitinib Failure
By David Douglas

NEW YORK JUL 05, 2007 (Reuters Health) - Acquired resistance to a particular epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor in patients with non-small-cell lung cancer may be overcome by use of a different tyrosine kinase inhibitor, according to Korean researchers.

As senior investigator Joo Hang Kim told Reuters Health, "Strategies for EGFR-targeted cancer therapies include small molecule EGFR inhibitors such as gefitinib (Iressa) or erlotinib (Tarceva). Although gefitinib showed dramatic responses in some patients, almost all patients ultimately experienced disease progression. Currently, there are no further treatment options for these patients."

Dr. Kim and colleagues at Yonsei University College of Medicine, Seoul, sought to determine whether a switch in therapy might help. The team studied 21 patients with advanced non-small-cell lung cancer who had progressed after gefitinib treatment and were then treated with standard doses of erlotinib.

The objective response rate was 9.5%, and 29% of patients had a response or stable disease, the team reports in the June 20th issue of the Journal of Clinical Oncology. The median time to progression was 60 days and the median overall survival was 158 days. Higher efficacy was observed in patients with wild-type EGFR who had stable disease on gefitinib.

"Our results are surprising," continued Dr. Kim, "because both gefitinib and erlotinib share the same mechanism of EGFR blockade and may be cross-resistant. Our results clearly imply that acquired resistance to an EGFR inhibitor can be overcome by a different EGFR inhibitor."

The investigators also emphasize "personalized and tailored lung cancer therapy based on molecular profiling in the era of targeted agents."

[此贴子已经被作者于2007-10-31 14:05:41编辑过]

lovemum2

在Jimmy的启发下，上网去搜，竟然发现了这则消息，很激动

[此贴子已经被作者于2007-10-31 14:08:04编辑过]