肺癌脑转准备尝试拉帕替尼特别请jimmy进来看看

jimmy112199

加拿大阿尔伯塔大学教授的DCA公开信

Letter from Dr. Evangelos Michelakis
August 02, 2008

Dear Friends,

This is a short update on our DCA project at the University of Alberta.

We would like to express our gratitude and appreciation for your support in our fund raising efforts. Through donations on this web page and philanthropic foundations we have been able to expand our basic science efforts as well as initiated and run two clinical trials in Edmonton. In collaboration with the Cross Cancer Institute and the Alberta Cancer Board, we are running clinical trials in patients with solid tumours that have failed standard therapies as well as in patients with malignant brain tumours. The objectives of these trials is to determine the safety of DCA as a novel therapy for cancer. We are trying to determine the optimal dose and to monitor potential adverse effects, such as drug interactions and toxicities. This is necessary to do before embarking on more definitive trials to test the effectiveness of this drug in the treatment of cancer. We have enrolled more than half of our target numbers of patients in these trials and we are gaining invaluable experience. Both the progress and the preliminary results are promising, although the detailed outcomes of these trials will be published in medical journals, after their completion.

We are very encouraged by these early results, and are now preparing to initiate additional clinical trials, in Edmonton and in collaboration with other Universities in around the world.

We are gratified to see that other researchers have begun to share our excitement with DCA. Several recent studies have reported findings similar to ours. These include some work suggesting that DCA has anti-cancer effects in endometrial and prostate cancer (see the references at the end of this letter). However a word of caution, these experiments were not done in patients, but rather in animals and test tubes, and so the applicability of these results to human disease has not been determined. They make however, the need for clinical trials even more pressing. We also reiterate that in the absence of knowledge about the safety and effectiveness of this drug in people it is unwise to be taking this agent unsupervised and outside of a clinical trial.

On behalf of the many people here at the University of Alberta that continue to work on DCA,

Thank you very much!

amei

jimmy:
    谢谢你，非常有用的信息，但是avastin不是有出血的负作用么？记得avastin的禁忌症中特别强调不能有脑转移，同时副作用中也说明了最严重的一种副作用就是脑出血，不知用于脑转移瘤是否可能会导致此现象发生？另外，用avastin的时候可以加入低分子肝素预防血栓形成么？因为avastin是抑制血管生成的药物，假如低分子肝素是否会导致avastin失效？

[ 本帖最后由 amei 于 2008-11-13 12:56 编辑 ]

jimmy112199

原帖由 amei 于 2008-11-13 12:41 发表
jimmy:
    谢谢你，非常有用的信息，但是avastin不是有出血的负作用么？记得avastin的禁忌症中特别强调不能有脑转移，同时副作用中也说明了最严重的一种副作用就是脑出血，不知用于脑转移瘤是否可能会导致此现象发 ...

下文介绍了2008最新结果，AVASTIN用于NSCLC(鳞癌除外)脑转的安全性是可接受的
Acceptable safety of bevacizumab therapy in patients with brain metastases due to non-small cell lung cancer.
Sub-category:
  
Metastatic Lung Cancer
Category:  Lung Cancer--Metastatic Lung Cancer
Meeting:  2008 ASCO Annual Meeting
   
Abstract No:8043
Citation:        
J Clin Oncol 26: 2008 (May 20 suppl; abstr 8043)
Author(s):
W. L. Akerley, C. J. Langer, Y. Oh, D. K. Strickland, S. Joo Royer, Q. Xia, Y. Mu, J. Huang, M. A. Socinski

Abstract:

Background: Bevacizumab (Bv) + carboplatin/paclitaxel received FDA approval in 10/06 for improving survival in first-line treatment of advanced NSCLC patients (pts) without brain metastases (mets). We report on the safety of Bv therapy in combination with standard therapy in 91 pts with NSCLC and treated (tx) brain mets. Methods: Subjects were treated on protocols ATLAS or PASSPORT. The ATLAS phase III study allows chemo+ Bv, followed by Bv ± erlotinib (E) to disease progression, for pts with advanced non-squamous or peripherally located squamous NSCLC. Tx for brain mets was whole brain radiotherapy (WBRT). The PASSPORT phase II study tests Bv in combination with first or second line systemic therapy in subjects with non- squamous NSCLC and tx brain mets. Treatment for brain mets includes radiosurgery (RS), neurosurgery (NS) or WBRT. The overall rate of central nervous system (CNS) hemorrhage and exact 95% CI using Blyth-Still-Casella methodology are reported. Results: Data collected: March 2006 through October 2007. The median number of Bv doses (15 mg/kg/q3w) in 85 Bv tx pts was 4 (range 1-17); 6 pts were non-Bv treated. No CNS hemorrhages were reported on either study during the main study tx (95 % CI: 0, 4.2). One Grade 2 CNS bleed was observed in a pt on post-progression therapy in ATLAS after 14 cycles of Bv; pt's site of disease progression was CNS mets. In Bv tx pts, seven had Grade (Gr) 3-5 CNS events: one had Gr 5 cerebral arterioscelerosis and Gr 3 leukoencephalopathy, one had Gr 3 ataxia, one had Gr 3 convulsion, three had Gr 3 mental status change, and one had Gr 3 syncope. Conclusions: 85 subjects with treated brain metastases have received bevacizumab without symptomatic Gr>2 hemorrhages observed during the main treatment (pre-progression) phase; no additional safety signals were identified. These data strongly suggest the safety of bevacizumab in advanced NSCLC pts with treated brain mets.
        ATLAS        PASSPORT
N        Total: 26
Men: 17
Women: 9        Total: 65
Men: 37
Women: 28
Median Age        61        60
Prior Therapy for CNS Mets        WBRT: 242 patients were
enrolled with untreated
brain mets        WBRT alone: 35
WBRT + RS/NS: 12
NS alone: 1
RS alone: 15
TBD: 2
Treatment Line        1st Line: 26        1st Line: 38
2nd Line: 26 TBD: 1

[ 本帖最后由 jimmy112199 于 2008-11-14 08:07 编辑 ]

amei

谢谢jimmy，我妈妈有深静脉血栓，不知道如果同时注射低分子肝素钙预防血栓可以么？是不是会降低avastin的有效率呢？或者会不会增加出血风险呢？我记得论坛里曾经有病友提过avastin不能同时用低分子肝素，是这样么？我妈妈心脏也不太好，不知道avastin是否有心脏毒性？谢谢jimmy，太谢谢你了

[ 本帖最后由 amei 于 2008-11-14 21:21 编辑 ]

jimmy112199

这是AVASTIN 与抗血栓药物联用(低分子肝素或华法令阻凝剂)的结果

http://neurooncology.ucla.edu/pub/18436627.pdf

21人AVASTIN 与抗血栓药物联用72天，3人在MRI下有小出血，一人最终导致出血得症状，无人有长久的神经逻辑问题。
无人有大出血，无人显示使用AVASTIN得禁忌症。

AVASTIN确实有增加心脏病得危险。

[ 本帖最后由 jimmy112199 于 2008-11-15 03:42 编辑 ]

amei

谢谢，jimmy，针对avastin的副作用，现在医学有什么手段可以控制其副作用么？尤其是心脏和出血的副作用

jimmy112199

心脏好像还没有

我们在一起

amei,你好 ！
看了你家人的情况，很想知道后面进一步的治疗情况！
我是奇迹网中的我们在一起，我老婆得了非小细胞肺癌，经过多方的治疗，现在也是脑转，并且全放无效！现在是头痛、呕吐、癫痫等，现在医院接受对症治疗（治标），效果不明显，想上化疗又不行！想马上上靶向药，来减轻症状；希望得到你的帮助！谢谢！

我的邮箱：linjl2008@sina.com.cn
     QQ:526942529，我QQ空间里有比较详细的治疗过程
     phone:13616085599
    林建铃