肺癌脑转准备尝试拉帕替尼特别请jimmy进来看看

jimmy112199

这是Erbitux和Lapatanib联药治疗IRESSA耐药的报道。

A recent study showed promise for a combination of Cetuximab (Erbitux) and Lapatanib (Tykerp),

 

"In this study, we show that a combination of lapatinib and cetuximab overcomes gefitinib resistance in NSCLC with the T790M mutation. We observed that T790M lung cancer cells were resistant to gefitinib, and Stat3 was persistently activated in the resistant cells. A reversible EGFR and HER2 TKI, lapatinib, decreased Stat3 activation by blocking heterodimerization of EGFR and HER2, which led to a modest increase in the inhibitory effect on gefitinib-resistant T790M cells. In addition to lapatinib, the anti-EGFR antibody, cetuximab, induced down-regulation of EGFR and apoptotic cell death in T790M cells. Finally, combined lapatinib and cetuximab treatment resulted in significantly enhanced cytotoxicity against gefitinib-resistant T790M cells in vitro and in vivo. Taken together, these data suggest that treatment with a combination of lapatinib and cetuximab, which induces dimeric dissociation and EGFR down-regulation, appears to be an effective strategy for treatment of patients with EGFR TKI-resistant NSCLC."

Both Erbitux and Lapatanib are FDA approved drugs, though not specifically approved for this purpose.  They can be prescribed off label if a physician chooses.  

amei

Jimmy，谢谢您提供的资料，我仔细看过了，有几点不是很明白：

（1）Xcytrin 这个药上市了么？在中国是否可以买到？他有商品名称么？此药是否可以通过血脑？属于化疗药么?

(2) 因为我现在别无选择，我打算先尝试一下拉帕提尼，看了你的二期非小细胞肺癌的临床数据，尚有20%的人可以获得6个月以上的稳定。

  另文章中：“There were no complete responses.
 Of 56 pts in the target population, 1 (2%) achieved partial
 response (PR), 11 (20%) had stable disease (SD) of 24 wks; in
 the non-target population, 1 pt had a PR (1.3%) and 12 (16%)
 had SD of 24 wks. 3 pts had ERBB1 mutations (G719S, S768I, KRAS
 G12S; L858R and T790M; L858R) but none of them responded. There
 were no ERBB2 mutations. Three of 77 pts evaluated had ERBB1
 gene copy increase (none of whom responded) and 2 had ERBB2
 gene copy increase (one had a 51% decrease in tumor size). ” 是否说明lapatinib的疗效和erbb1（egfr）基因突变没有统计学的差异？

 如果我服用拉帕提尼的话，如何服用呢？曾经看到一些报道说是与饭同服可以增加生物利用率，增强效果，不知如果我每日早晚各服用500mg与饭同服，是否可行？报道中好像说每日一次1500mg和每日两次500mg，效果和副作用没有差异，是么?

（3）如果拉帕提尼和c225连用的话，是否要一直用下去呢？价格确实是个问题

  (4) 您知道利比泰是否可以控制脑转移么，国外有没有相关的资料呢？

再次非常感谢jimmy的热心帮忙，得到这些资料对于我非常有价值，期待听到您的进一步解答。

[此贴子已经被作者于2008-5-15 9:09:40编辑过]

amei

顶一下

jimmy112199

1) Xcytrin 去年年底上市，不知国内的情况，用于   NSCLC 脑转(和放疗一起)，疗效明显高于其他癌症的脑转，
2) Lapatanib： 对ERBB2(同乳腺挨)，20%稳定， 对不区分ERBB1和ERBB2，16%的6个月稳定，有统计学的差异。
3) Lapatanib 和C225联药应一直用下去，C225单药也有报道TARCEVA耐药后有效。
4) 利比泰不能控制脑转移，但有文献介绍NSCLC化疗的比不化疗的脑转的低10%左右(根据记忆，不一定正确)。

国内有Enzastaurin试药吗。另外，AVASTIN 可用于脑转。

iamsharuru

JIMMY 可以给我你的MAIL嘛

amei

jimmy:

   Enzastaurin我查了一下，是用来治疗脑瘤的，现在有报道对肺癌脑转移有效么？此药可以买到么？是否已经上市？

小小草

您好！能请教您点肺癌脑转的问题吗？请问有QQ号码吗？谢谢！

小小草

amei  在吗？？我父亲也是小细胞肺癌！能请教您点问题吗？