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心灵的歌

jimmy112199，你好，我看了你给我的关于反映停的资料，因为我的英文不是很好，我想问一下，文献上说的用反映停是单一剂量，这是不是说不吃易瑞沙，光吃反映停呢？如果是的话，那么服用的时间和剂量应该是多少呢？恳请解答，谢谢

jimmy112199

心灵的歌：
   1) 文献仅讨论脑癌，对原发病灶IRESSA不能停，
   2) 耐药的原因是癌细胞再次变异，绕过了靶点，但仍有一部分没有变异的被挡住了，如果停了IRESSA，这部分被挡住的 癌细胞就会迅速扩散。所以耐药后，停与不停IRESSA，病情都在恶化，但恶化的“速度”是不一样的。
   3) 关于反映停剂量。。没有肺癌脑转的文献，但下面文献给出的用“蒂清”和“反映停。治疗黑色素癌脑转移的剂量和效果

Cancer. 2005 Jun 15;103:2590-7 15861414  [Cited: 1]     

Temozolomide plus thalidomide in patients with brain metastases from melanoma: a phase II study.
蒂清加反映停治疗，来自黑色素瘤的脑转移瘤的二期研究
   
 Wen-Jen Hwu , Eric Lis , Jennifer H Menell , Katherine S Panageas , Lynne A Lamb , Janene Merrell , Linda J Williams , Susan E Krown , Paul B Chapman , Philip O Livingston , Jedd D Wolchok , Alan N Houghton
BACKGROUND: Temozolomide plus thalidomide is a promising oral combination regimen for the treatment of metastatic melanoma. The current Phase II study examined the efficacy and safety of this combination in chemotherapy-naive patients with brain metastases. METHODS: Patients with histologically confirmed metastatic melanoma and measurable brain metastases received temozolomide (75 mg/m2 per day for 6 weeks with a 2-week break between cycles) plus concomitant thalidomide (200 mg/day escalating to 400 mg/day for patients < 70 years or 100 mg/day escalating to 250 mg/day for patients > or = 70 years). The primary end point was tumor response in the brain assessed every 8 weeks.患者经病理证实的转移性黑素瘤和可衡量的脑转移瘤，收到了蒂清（ 75MG，每天2次，6周，然后休息2周） ，另加伴（反映停
200毫克/天逐步升级至400毫克/天，--对患者< 70岁，或100毫克/天逐步升级至250毫克/天，--对患者>= 70岁）
。主要终点是肿瘤在大脑中反应，每8周评估一次)(RESULTS: Twenty-six patients with a median age of 60 years were treated. All patients had progressive brain metastases: 16 were symptomatic and 25 had extensive extracranial metastases. Eight patients had received whole-brain radiotherapy, 4 had received stereotactic radiotherapy, and 8 had received craniotomy with resection of hemorrhagic lesions. Fifteen patients completed > or = 1 cycle (median, 1 cycle; range, 0-4 cycles), and 11 discontinued treatment before completing 1 cycle (7 for intracranial hemorrhage, 2 for pulmonary embolism, 1 for deep vein thrombosis, and 1 for Grade 3 rash). Of 15 patients assessable for response, 3 had a complete or partial response (12% intent to treat) and 7 had minor response or stable disease in the brain. However, 5 of these 10 patients had disease progression at extracranial sites. The median survival period was 5 months for all 26 patients and 6 months for the 15 assessable patients. CONCLUSIONS: Temozolomide plus thalidomide was an active oral regimen for patients with brain metastases from malignant melanoma.
Mesh-terms: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols, therapeutic use; Brain Neoplasms, drug therapy; Brain Neoplasms, secondary; Dacarbazine, administration & dosage; Dacarbazine, analogs & derivatives; Disease-Free Survival; Female; Humans; Male; Melanoma, drug therapy; Melanoma, secondary; Middle Aged; Neoplasm Staging; Research Support, Non-U.S. Gov't; Skin Neoplasms, drug therapy; Skin Neoplasms, pathology; Survival Rate; Thalidomide, administration & dosage; Treatment Outcome;

[此贴子已经被作者于2007-11-6 15:03:01编辑过]

amei

谢谢jimmy,请问效果如何，脑瘤有得到有效控制么？

以马内利

谢谢jimmy112199,我之前咨询韩宝惠医生也是建议即便易瑞沙耐药依然继续服用，停服进展会更快。

只是没想到蒂清也可以和反应停联用，但看到文中是说黑色素癌脑转移的情况，治疗效果的评估是不是和肺癌脑转移的一致呢？

jimmy112199

QUOTE:

以下是引用amei在2007-11-6 15:49:04的发言：
谢谢jimmy,请问效果如何，脑瘤有得到有效控制么？

12%部分或完全响应，30%稳定，50%无效。
中位生存期，5个月， 可评估的，6个月。

amei

谢谢jimmy，不知道反应停是否有静脉血栓的副作用呢？

jimmy112199

是的，凡是从血液方面入手的抗癌药物，如 AVASTIN， 反应停，施乐葆，恩度等，都有心血管的副作用。

amei

jimmy还要请教你一下：

    我妈妈现在有静脉血栓，现在服用剂量是200mg，不知道是不是反应停需要减量，还是继续这么服用呢？现在效果不错，不知道如果减量会不会影响效果，另外静脉血栓已经形成了，如果还是以这个剂量服用的话，会不会加重形成静脉血栓呢？会不会人体适应了这个剂量也就不会再继续形成血栓呢？