服用IRESSA无肿瘤减小仅为稳定的患者最晚耐药的报道

jimmy112199

   One of my earliest posts when I started OncTalk
was on the use of oral inhibitors of the epidermal growth factor
receptor (EGFR), one of the growth signals that is often over-active in
cancer cells, against advanced bronchioloalveolar carcinoma (BAC), a
unique subtype of lung cancer that tends to grow within the lungs,
sometimes slowly, and not progress elsewhere. These EGFR inhbitors like
iressa (gefitinib) and tarceva (erlotinib) have certainly been well
studied in NSCLC in general, but both of these drugs have been a focus
of particular attention as a treatment for BAC. In fact, the largest
trial that has yet been conducted in advanced BAC is one that I led,
called SWOG 0126, that gave iressa at 500 mg by mouth daily (actually
twice the dose that was eventually settled on, but possibly a more
effective dose) to 135 eligible patients with advanced BAC. My
colleagues and I published the results of this trial a couple of years
ago (abstract here), but this year at ASCO I presented the results with longer-term follow up (abstract here), which yielded some interesting findings.

Obviously, the response rates and side effects didn’t change with a
couple of years of longer-term follow up. Nor did the median
progression-free and overall survival numbers, since those reflect the
point at which half of the patients will have demonstrated progression
or have died:

It’s worth noting that while this study enrolled both patients who
had never been previously treated and some other patients who had
received prior chemotherapy, both the chemo-naive and previously
treated patients had the same progression-free and overall survival
results, as shown in the superimposed curves shown above.

As we saw in the initial reports, there
were major differences by clinical variables, including far better
results in never-smokers compared with current/former smokers, those
who developed a rash compared with those who didn’t, in women vs. men,
and in patients with a good performance status compared with those with
a marginal performance status. Here are the differences in survival
that emerged:

But the most interesting issue isn’t what happened for the majority
of people, but how remarkably well a few patients did.  We identified
six patients who went more than four years without progression,
including three who continue on the study without progressing at this
time.   To my knowledge, this is the first time that we’ve seen
published documentation that patients who continue to do well on an
EGFR inhibitor for this far out (as if they were some mythical creature
that we heard exists but never actually encounter).  And you can see
various clinical and molecular features of these patients:

So here are some important points to glean from the table above.  
These patients aren’t only female never-smokers, although three of the
six never smoked.  These aren’t only patients who have EGFR mutations
or have EGFR gene amplification as measured by “fluorescence in situ
hybridization” (FISH) — tissue was available from just a few of these
patients,  and this work suggested that the major benefits aren’t only
seen in patients who have molecular predictors of a good response to
EGFR inhibitors.  Finally, none of these patients met the strict
criteria for a response.  Instead, they all had stable disease only,
although some had good minor responses, and then went years and years
and years without progressing on iressa.

I think these results are very important to serve as an illustration
of how well people can do on an EGFR inhibitor, and also that you don’t
need to have the clinical or molecular predictors of major benefit to be not only a beneficiary, but even a huge
beneficiary who shows no progression over 4 years or more.   To me,
these patients also highlight why I don’t think we’re ready to
routinely use molecular testing to shape our clinical decisions in
whether and when to use EGFR inhibitors.  Some people might see someone
like patient D in the table, a former smoker without an EGFR mutation
and negative by EGFR FISH, and decide that they don’t have a real
chance of getting a benefit from an EGFR inhibitor.  And they’d pass up a treatment on which she’s shown no progression over more than five and a half years, and still counting.

More on the great debate about the pros and cons of molecular testing for EGFR soon.

[此贴子已经被作者于2008-7-24 6:47:54编辑过]

jimmy112199

本文介绍的6位患者，都是服用IRESSA后，4年多才开始耐药，(有的5年多了还没耐药)，患者有男有女，有抽烟的，不烟抽的，
检测EGFR有阴性的，也有阳性，但  6人都有一个特点，都是仅仅是稳定，没有部分响应，或完全响应(没有病灶减小/部分减小)。
而当初疗效比他们好的病友，耐药后反而都过世了。


请其他知道类似情况的网友跟帖，是不是减量服药，只维持稳定的耐药最晚？？？

译文：
长期生存者
6个患者(全部具有不可测量但是可评估的)展现了4年以上的无进展生存。临床和分子特性如下：
患者   性别 以前化疗   吸烟  EGFR变异 EGFR检测   最好响应  用IRESSA时间  目前状态
A         女       NO         从未     未知            未知           稳定          5。4年            仍生存，去SAE就医
B         男       NO         从未     未知            阳性            稳定         5。9年            仍生存，继续IRESSA
C         男       NO        目前       无              阴性            稳定          4。5年           仍生存，已进展
D         女       NO        过去       无              阴性             稳定         5。6年           仍生存，继续IRESSA
E         女       YES      从未      未知            未知            稳定          4。3年           仍生存，已进展
F         男       NO        过去      EX21           阳性            稳定         5。0年           仍生存，  继续IRESSA

[此贴子已经被作者于2008-7-24 6:35:35编辑过]

小路

谢谢jimmy！

miss_mjl

5年，真羡慕……

爸爸别放弃

我爸吃的是印的易，现在已经两个半月了，第一次检查说肿瘤扩散的速度降下来了，然后也没再检查，现在但从精神和外观看起来不好也不坏，不象有的用易有效的，看上去各方面都有好转，也不象用易无效的身体越来越垮，现在继续服用，真希望我爸能够一直维持稳定下去．

嘎子

这个是好消息，有这样的例子

wtl831127

我爸爸就是这样的，2年现在也耐药了，不过比和他一起吃药的病友，病情进展要慢的多。

hzlgp

请教（wtl831127):你爸爸吃了二年的易开始耐药,他是怎么吃的?每天呢还是间断吃?其间有没同时服用其他药物?谢谢!