易瑞沙耐药后的解决方案，请大家都来找出路

jli999 · 发表于 2007-7-20 12:51:16

非常感谢jimmy112199提供的译文。这个信息对于易瑞沙耐药后的患者太重要了，在此之前大家知道的都是IRESSA及它赛瓦因为针对的是同一靶点，所以易瑞沙耐药后通常不再建议用它赛瓦。另外，关于EGFR突变,研究者的结论是“非小细胞肺癌患者用IRESSA有效，并没有EGFR突变的，癌症进展后.似乎会得益于它赛瓦”，说明没有EGFR突变的，易瑞沙仍可能有效；而没有EGFR突变的，IRESSA耐药后它塞瓦的有效率可能更高。       加油啊!尽管目前的这些研究和数据只能作为一种参考，但对我们仍是不小的鼓舞。再次表示感谢！

我爱妈妈 · 发表于 2007-7-20 14:30:12

TO：东方谢谢你的关心。昨天妈妈来北京看了中医专家，我也看到了CT片子。上面写道（大概内容）：1、左肺上叶下舌段仍见不规则肿物影，边界不清，肿瘤较前略有缩小；2、左肺仍见多发结节状，高密度影；考虑转移瘤，大小、数目大部病变同前相仿，左肺上叶结节较前略有增多，右肺上叶前段见一结节，考虑转移。3、右肺下叶后基底段见斑片状高密度影，考虑炎性病变。4、纵隔4R、<chmetcnv wst="on" tcsc="0" numbertype="1" negative="False" hasspace="False" sourcevalue="4" unitname="l">4L</chmetcnv>、5区、7区见多发性小结节，大者径小于<chmetcnv wst="on" tcsc="0" numbertype="1" negative="False" hasspace="False" sourcevalue="1" unitname="cm">1.0cm</chmetcnv>，同前大致相仿。5、胸椎、肋骨破坏大致同前。6、左胸腔积液较前减少，左侧胸膜增厚；右侧胸腔积心包未见积液中医的意见与西医大夫一致：暂时不用做任何其它治疗，继续观察并服用易瑞莎，辅助以草药以及益肺清化膏但妈妈的感觉没有以前好，痛感以及频度都比过去强，而且现在气短、无力、咳嗽加重、小便有些费劲谢谢东方的建议，重新考虑吃英国版易瑞莎。请教各位：对于以上报告，大家有什么建议吗？我自己认为必须采取一定措施，不能坐等；但医生却说，问题不大，观察观察。弄不明白，好郁闷啊

小路 · 发表于 2007-7-21 07:27:36

谢谢jimmy,你的译文太重要了, 我想问jimmy: 易瑞沙耐药后直接上它沙瓦会有效吗？“易瑞沙稳定期用它沙瓦会有效……”什么叫稳定期？是指“易”耐药后重上化疗后的稳定期吗？具体多长时间？这句话含义是什么？

[此贴子已经被作者于2007-7-23 16:55:18编辑过]

东方 · 发表于 2007-7-23 23:34:34

感谢jimmy,对于上述报告我有同感，我妈妈就是在易瑞沙耐药后，用了两期力比泰单疗无效后立即转用特罗凯，争取了3个月有效期，虽然现在再度出现耐药，但我上周开始进行DCA的服用后目前感到有效。也就是说，在易瑞沙耐药后，再次化疗争后转用特罗凯仍有效。

小路 · 发表于 2007-7-24 06:23:32

东方，目前服用DCA成功的案例有吗？有机会给大家讲讲。谢了！

jimmy112199 · 发表于 2007-7-24 07:49:25

<div class="msgheader">QUOTE:</div><div class="msgborder">以下是引用小路在2007-7-21 7:27:36的发言： 谢谢jimmy,你的译文太重要了, 我想问jimmy: 易瑞沙耐药后直接上它沙瓦会有效吗？“易瑞沙稳定期用它沙瓦会有效……”什么叫稳定期？是指“易”耐药后重上化疗后的稳定期吗？具体多长时间？这句话含义是什么？ 
</div>我也不太清楚，原文是 within four months of discontinued treatment with Iressa, 四个月不连续的IRESSA治疗。 但查看了他们的另一论文，好像是直接上 TARVECA。因为文中报道的中位癌症无进展只有60天。 <h1>A
phase II study of erlotinib treatment in advanced non-small cell lung
cancer after failure of gefitinib: Is a clinical benefit still
achievable?</h1>


<table width="98%" cellspacing="0" cellpadding="0" border="0">
<tbody><tr>
 <td width="99%" valign="top">
 <table width="100%" cellspacing="3" cellpadding="0" border="0">

 <tbody><tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>
 Sub-category:
 </h3></td>
 <td width="99%" valign="top"><h4>
 <a href="http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_category_abstracts_view&confID=47&subCatID=47">
 Non-Small Cell Lung Cancer
 </a>
 </h4></td>
 </tr>


 <tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>
 Category:
 </h3></td>
 <td width="99%" valign="top"><h4>
 Lung Cancer
 </h4></td>
 </tr>

 <tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>
 Meeting:
 </h3></td>
 <td width="99%" valign="top"><h4>
 <a href="http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_meeting_categories_view&confID=47">
 2007 ASCO Annual Meeting
 </a>
 </h4></td>
 </tr>
 </tbody></table>
 </td>
 <td width="1%" valign="top" nowrap="nowrap">

 <h4>
 <a target="_new" href="http://www.asco.org/portal/site/ASCO/template.RAW/menuitem.34d60f5624ba07fd506fe310ee37a01d/?javax.portlet.tpst=0e116779df458209ada2be0aee37a01d_ws_RW&javax.portlet.prp_0e116779df458209ada2be0aee37a01d_viewID=abst_detail_rawview&javax.portlet.begCacheTok=com.vignette.cachetoken&javax.portlet.endCacheTok=com.vignette.cachetoken&index=n&confID=47&abstractID=30381">
 <img border="0" alt="" src="http://www.asco.org/portal/beans/virtualmeeting/images/print.gif"/>
 Printer Friendly
 </a>
 </h4>
 <h4>
 <a href="http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_detail_view&confID=47&index=y&abstractID=30381#">
 <img border="0" alt="" src="http://www.asco.org/portal/beans/reutersnews/images/email.gif"/>
 E-Mail Article
 </a>
 </h4>

 </td>
</tr>
</tbody></table>

<table width="98%" cellspacing="3" cellpadding="0" border="0"><tbody><tr><td colspan="2"><img width="1" height="10" border="0" alt="" src="http://www.asco.org/portal/beans/virtualmeeting/images/clear.gif"/></td></tr>
<tr><td id="vmtablerowdark" colspan="2"><img width="1" height="1" border="0" alt="" src="http://www.asco.org/portal/beans/virtualmeeting/images/clear.gif"/></td></tr>
<tr><td colspan="2"><img width="1" height="10" border="0" alt="" src="http://www.asco.org/portal/beans/virtualmeeting/images/clear.gif"/></td></tr>

<tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>Abstract No:</h3></td>
 <td width="99%" valign="top">
 <h4>7609</h4>
 </td>
</tr>

<tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>Citation:</h3></td>
 <td width="99%" valign="top">
 <h4>Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007: 7609</h4>
 </td>
</tr>

<tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>Author(s):</h3></td>
 <td width="99%" valign="top">
 <h4>B. Cho, C. Im, H. Choi, S. Shin, J. Sohn, J. Kim, S. Kim, J. Moon, Y. Kim, J. Kang</h4>
 </td>
</tr>
<tr>
 <td width="1%" valign="top" nowrap="nowrap"><h3>Abstract:</h3></td>
 <td width="99%" valign="top">
 <h4>Background:
To evaluate the efficacy and toxicity of erlotinib in patients (pts)
with advanced NSCLC who had progression after treatment with gefitinib.
Methods: The study included stage IIIB/IV recurrent or
metastatic NSCLC pts who have received 2 or 3 prior chemotherapy
regimens and showed documented disease progression during or within 4
months after treatment with gefitinib. Pts received erlotinib 150 mg
daily until disease progression or unacceptable toxicity. We analyzed
EGFR mutations and other genetic abnormality from available tumor
samples. Results: Pts and disease characteristics (n = 21)
included median age 56 years; number of prior chemotherapy regimens
(two, n=10; three, n=11); male (n=10); adenocarcinoma (n=15); and
smoking status (never, n=11; former, n=3; current, n=7). Among the 17
pts with tumor samples available, EGFR mutation were detected in 5
(29.4 %). The DCR and RR for all pts were 28.6% (95% CI, 16.7 to 59.6%)
and 9.5% (95% CI, 5.6 to 19.8%). All responders were EGFR nonmutants,
with long duration of disease control on prior gefitinib therapy
(>180 days). The median duration of disease control was 125 days
(95% CI, 73-261 days). The median progression-free survival and overall
survival were 60 days (95% CI, 43-77 days) and 158 days (95% CI,
141-175 days), respectively. Pts who had SD on gefitinib showed
significantly higher DCR (75% vs. 17.6% in non-SD pts,

= 0.050) and RR (50.0% vs. 0% in non-SD pts,

= 0.029). These pts also showed longer median PFS (140 vs. 37 days in non-SD pts,

= 0.005) and OS (not reached vs. 120 days in non-SD pts,

=
0.043). Among 17 pts with biomarker results available, EGFR nonmutants
who had SD on gefitinib showed significantly higher DCR (100% vs. 21.4%
in non-SD and/or EGFR mutants,

= 0.029) and RR (RR, 66.7 % vs. 0 % in non-SD and/or EGFR mutants,

= 0.022). Conclusions: Erlotinib seems to be a potential therapeutic option for the treatment of selected pts with gefitinib-nonresponsive,
EGFR nonmutant, advanced NSCLC. Response to erlotinib
<table cellpadding="1" border="1" id="&lcub;42C44746-BCFD-4697–8CC6-D678AF8CE792&rcub;" class="DisplayTable" col="3" tgroupstyle="zlj-abs"><tbody><tr><td colspan="1" rowspan="1">Response (RECIST criteria)</td>
<td align="center">No. of pts (n = 21)</td>
<td align="center">%</td></tr><tr><td colspan="1" rowspan="1">Complete response</td><td colspan="1" rowspan="1">0</td><td colspan="1" rowspan="1">0</td></tr><tr><td colspan="1" rowspan="1">

artial response</td><td colspan="1" rowspan="1">2</td><td colspan="1" rowspan="1">9.5</td></tr><tr><td colspan="1" rowspan="1">Stable disease</td><td colspan="1" rowspan="1">4</td><td colspan="1" rowspan="1">19</td></tr><tr><td colspan="1" rowspan="1">

rogressive disease</td><td colspan="1" rowspan="1">15</td><td colspan="1" rowspan="1">71.4</td></tr><tr><td colspan="1" rowspan="1">Disease control rate</td><td colspan="1" rowspan="1">6</td><td colspan="1" rowspan="1">28.6</td></tr><tr><td colspan="1" rowspan="1">95% CI,%</td><td colspan="1" rowspan="1"> </td><td colspan="1" rowspan="1">16.7-59.4</td></tr><tr><td colspan="1" rowspan="1">Overall response rate</td><td colspan="1" rowspan="1">2</td><td colspan="1" rowspan="1">9.5</td></tr><tr><td colspan="1" rowspan="1">95% CI,%</td><td colspan="1" rowspan="1"> </td><td colspan="1" rowspan="1">5.6-19.8</td></tr></tbody></table></h4></td></tr></tbody></table>

jimmy112199 · 发表于 2007-7-24 09:03:45

这里是意大利的一篇TARCEVA抗药后直接上IRESSA的文摘。 

Gefitinib (G) treatment outcome after progression on
erlotinib (E) in patients with advanced non-small cell lung cancer
(NSCLC).  Sub-category:     Non-Small Cell Lung Cancer  Category:    
Lung Cancer  Meeting:     2007 ASCO Annual Meeting

rinter Friendly  E-Mail Article  Abstract No:     18138 
Citation:     Journal of Clinical
Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20
Supplement), 2007: 18138  Author(s):     F. Grossi, A. Brianti, C. Defferrari, M.
Loprevite, G. Catania, P. Pronzato 
Abstract:     Background: Two case
reports describe a response to E after failure of G (Garfield DH, J Clin Oncol
2005) or to G after failure of E (Choong NW et al, Nat Clin Pract Oncol 2006)
in patients (pts) with advanced NSCLC. Otherwise, a limited experience in 5 pts
suggests that E is not effective in pts progressing on G (Viswanathan A et al,
Lung Cancer 2005). Aim of this study was the evaluation of response and time to
progression (TTP) in advanced NSCLC pts treated with G after failure of E.
Methods: Pts received G 250 mg/day after disease progression (PD) with E 150
mg/day. Pts accrual was stopped on August 2006 after the approval of E for use
in <st1country-region><st1place>Italy</st1place></st1country-region> and
the consequent closure of the G compassionate-use program. Results: From May
2005 to August 2006, 15 pts were enrolled. Median age 65 years (50-85); males=
14 pts (93%); never/former smokers= 4/10 pts (26/67%); adenocarcinoma= 10 pts
(67%); PS 0/1= 5/10 pts (33/67%); in 2 pts (13%) E was administered as
first-line therapy, 8 pts (53%) received 2 prior lines of chemotherapy (CT) and
3 pts (20%) received CT between E and G. One patient (7%) had a partial
response (PR) and 5 pts (33%) had disease stabilization (SD) with E; with G no
PR and 6 SD (40%) were obtained. Five out of 6 RP/SD pts with E, had SD with G;
8 out of 9 PD pts with E, had PD with G; 1 SD patient with E, progressed with G
and 1 vice versa. TTP in RP/SD pts was 7.2 and 3.4 months for E and G
respectively; in PD pts TTP was 1.7 and 1.6 for E and G respectively. Conclusions:
Our data suggest that there is a benefit with G in pts who had RP/SD with E and
that is associated with a good TTP. Conversely G is not recommended in pts that
immediately progressed after E. Moreover these results support the rationale of
treating PD pts with an EGFR TKI with another one; it may be worthwhile to
collect more data on E.

<op> </op>

<op> </op>

在治疗晚期非小细胞肺癌( NSCLC ) ,Tarceva治疗进展后用IRESSA治疗结果


子类:非小细胞肺癌类<op></op>

:肺癌会议: 2007 asco届年会打印机友好电子邮件<op></op>

文章摘要:
18 138

引文<op></op>

:临床肿瘤学杂志, 

2007 asco届年会诉讼第一部分25卷,第 18S系列( 6月20补编) , 2007年: 18 138

作者: F. Grossi, A. Brianti, C. Defferrari, M. Loprevite, G.
Catania, P. Pronzato

摘要<op></op>

:背景:两个病例报告描述了针对IRESSA失败后TARCEVA的效果(Garfield DH, J Clin Oncol 2005 ) ,或 TARCEVA失败后IRESSA的效果。(Choong
NW et al, 临床实用肿瘤2006年) 对
晚期非小细胞肺癌的患者. 另外, 有限的经验,在5病例表明TARCEVA不能有效正进行IRESSA治疗的患者，
((Viswanathan A et al, ,肺癌2005 ) . 

此项研究的目的是评价，对晚期非小细胞肺癌TARCEVA治疗
失败后，用IRESSA的效果和疾病进展时间( TTP )，<op></op>

方法:

病人得到150毫克/天TARCEVA治疗，之后病情进展( PD ).

病人收到250毫克/天的IRESSA治疗，试验被停止了，由于2006年8月TARCEVA被批准在意大利使用和随之而来的禁止IRESSA的慈善使用. 结果<op></op>

从2005年5月至2006年8月，15个病人注册试验. 年龄中位数65岁( 1950年至1985年) ; =男性14例( 93% ) ; 从不/从前吸烟者=4 / 10例(67分之26% ) ;腺癌10例( 67%
) ;

S 0 / 1 = 5 / 10例(67分之33% )
; 在2例中(占13% )TARCEVA被作为第一线治疗,
8例病人(
53% ) 以前得到2个化疗( CT ) ，3例( 20%
) , 在TARCEVA和IRESSA之间接受CT，接受TARCEVA治疗后，
其中一名病人(
7% ) 部分缓解( PR ) , 5例( 33%
)疾病稳定，接受IRESSA治疗后，没人部分缓解(

R)
，和6个稳定(SD)(
40% ) ，6个接受TARCEVA治疗后获得部分缓解或稳定的，接受IRESSA治疗后，5个是稳定， 9个接受TARCEVA治疗后进展的病人中，8人接受IRESSA治疗后仍进展，1个TARCEVA稳定，IRESSA进展，一个TARCEVA进展，但IRESSA是稳定，部分有效(RP)
和稳定(SD病人的TTP，TARCEVA和IRESSA分别是7.2和3.4个月; 进展病人(PD)的TTP，TARCEVA和IRESSA分别是1.7和1.6个月。<op></op>

 结论: 我们的资料显示, 对那些对TARCEVA是部分缓解(PR)或稳定的(SD)
的病人，，同时有与良好的TTP，IRESSA是有好益的。. 反之，TARCEVA后立即进展的病人，不推荐IRESSA。此外，这些研究结果支持基本理由--治疗进展的病人使用这种或那种EGFR
TKI; 也许值得收集更多的关于TARCEVA的数据<op></op>

水中老蛇 · 发表于 2007-7-24 20:37:06

我爱人易瑞沙耐药后，由于经济因素，没有象你们一样进行系统的治疗。但肺部病灶的进展并不显著，倒是转移到卵巢部位的癌细胞威胁极大。现在主要的危险来自于腹水，近几天咳嗽也有加剧，估计肺部病灶有进展。但令我不解的是，绝大多数患者，耐药后病情急剧恶化，很快就离开了人世。我爱人可能是耐药比较早的，但至今却还健在。算起来，从发现耐药到今天，已经8个多月了，已经超过了肺癌晚期病人的平均生存期。

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易瑞沙 耐药后的解决方案，请大家都来找出路

易瑞沙耐药后的解决方案，请大家都来找出路