易瑞沙耐药后的解决方案，请大家都来找出路

ljxsq · 发表于 2007-7-2 15:34:20

我母亲肺腺癌晚期，没做过放化疗，也没手术（不能手术），已经扩散到胸腔，打阿奇霉素都有药物反应，准备给她吃易瑞莎，听说同时吃灵芝袍子油能保肝，不知有人试过吗？

jimmy112199 · 发表于 2007-7-4 06:54:56

<h2>A case of lung adenocarcinoma of the lung with disappearance of brain
metastasis by re-treatment with gefitinib</h2>

[Article in Japanese]

<a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Kato%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Kato
T</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Nakashima%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Nakashima
M</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Yoshimura%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Yoshimura
K</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Imao%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Imao
M</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Goto%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Goto
H</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Yasuda%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Yasuda
S</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sano%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus">Sano
K</a>.

Respirtory Medicine, <st1place><st1placename>National</st1placename>
<st1placetype>Hospital</st1placetype>
<st1placename>Nagara</st1placename>
<st1placename>Medical</st1placename>
<st1placetype>Center</st1placetype></st1place>.

BACKGROUND: Tumor response rate to gefitinib by previously
treated patients with advanced non-small-cell lung cancer was approximately
20%. However, there are few reports about effect of re-treatment with gefitinib.
CASE: A 40-year-old man was given a diagnosis of adenocarcinoma of lung
(c-T2N3M1). Response was not obtained with chemotherapy (paclitaxel +
carboplatin, vinorelbine + gencitabin). He developed brain metastasis and
received whole brain radiation therapy. He was then given gefitinib. Reduction
of the primary tumor, brain metastasis, pulmonary metastasis and liver
metastasis was seen. Recurrence of pulmonary metastasis and liver metastasis
was discovered 8 months after treatment with gefitinib. Therefore, treatment by
gefitinib was stopped. Response was not achieved with chemotherapy (docetaxel
and amrubicin). At the request of the patient, retreatment with gefitinib was
resumed. Disappearance of brain metastasis was achieved. However, primary tumor,
pulmonary metastasis and liver metastasis progressed. CONCLUSION: We reported a
case whose brain metastases disappeared with re-treatment with gefitinib. This
report is thought to be useful in terms of information about the acquired
resistance of gefitinib. Further investigations are needed to determine the
indication of re-treatment with gefitinib.

一
例肺腺癌并发脑转移, 重用IRESSA后脑转移完全消失的例子<op></op>

[原文为日文] 

加藤 T,  Nakashima M, 等<op></op>

国家医院长良医疗中心,
呼吸医学<op></op>

.背景:

对以往已治疗过晚期非小细胞肺癌肿瘤，IRESSA反应率为约占20%
. 但是,
只有少数重用IRESSA的报道. 

案例:

一个40岁男子被诊断为肺腺癌(C- t2n3m1 ) 化疗没有取得效果 (紫杉醇+卡铂,诺维gencitabin
+ ) . 他发展了脑转移，接受全脑放射治疗.
于是,他被给IRESSA治疗.原发性肿瘤,脑转移,肺转移和肝转移.减少。8个月治疗后，发现肺转移和肝转移复发.
因此,
停止IRESSA治疗. 后来的化疗(紫杉醇amrubicin
)
未取得效果 . 在病人提出要求下,IRESSA被恢复.脑转移达到完全消失. 然而,原发性肿瘤,肺转移和肝转移进展.

 结论:

本病例中，重用IRESSA后的脑转移瘤消失,. 这份报告被认为是有用的信息，当IRESSA获得抗药性. 进一步调查后才能确定重用IRESSA的作用范围。.

相信奇迹 · 发表于 2007-7-4 09:32:18

化疗很少有突破屏障作用到脑的，针对这个案例，我的感觉，意瑞沙对脑转的效果一直存在，但是已经无法控制肝转和肺内转，即使是化疗后复用还是无法控制。根据医生的评价标准，只要是进展了，无论是哪个部位，都视为意瑞沙耐药。

我爱妈妈 · 发表于 2007-7-12 10:05:37

我妈妈肺腺癌IV期，从07年3月7日开始服用易瑞莎，5月中旬检查病灶明显缩小；改服印度版；7月11日CT检查显示，原病灶（左肺）有扩展；右肺有新病变发生；但胸腔积液减少，最初的骨转移没有变化。难道4个月的时间就开始耐药了？我很痛苦：停止易瑞莎，改化疗方案，如果能坚持半年，再重新服用易瑞莎？请问各位有什么建议吗？拜谢了！

jimmy112199 · 发表于 2007-7-13 05:30:19

你是不是碰上假药了

小路 · 发表于 2007-7-13 07:32:20

印度NATCO公司在印度排在钢铁米塔尔公司之后，居第二。又属世界500强。

东方 · 发表于 2007-7-13 10:36:48

TO 我爱妈妈:你妈妈的医生看过CT怎么说?试试用回英国版易瑞沙,一个月后再拍片子检查,如果无进展说明英国版易瑞沙对你妈妈比较适用.

jimmy112199 · 发表于 2007-7-20 08:20:24

这是韩国的IRESSA后用TARCEVA的结果，有几点值得注意：1) IRESSA 和 TARCEVA 同时用药没有特别效果。There appears to be no benefit from combining Tarceva with Iressa for the
treatement of NSCLC2) 停药4个月没有提用化疗。 3) 给出的再次耐药的中位时间(125天)和中位生存期(158天)。 Tarceva® May Be
Effective in Patients with NSCLC Progressing after Responding to Iressa®

Researchers from <st1country-region><st1place>South Korea</st1place></st1country-region>
have reported that Tarceva®
(erlotinib) may be effective in patients with stable non–small cell lung cancer
(NSCLC) after
treatment Iressa® (gefitinib). The details of this study were reported in the <st1date month="6" day="20" year="2007">June 20, 2007</st1date> issue of the Journal
of Clinical Oncology.

Tarceva and
Iressa are tyrosine kinase inhibitors that are active in a subset of patients
with NSCLC. Responsive tumors were likely to be adenocarcinomas or
bronchio-alveorlar carcinomas and occurred more frequently in non-smokers and
women. Responses also occur more frequent in patients with specific mutations
of EGFR. There appears to be no benefit from combining Tarceva with Iressa for the
treatement of NSCLC but sequential use has not been reported before.

This trial included 21 patients who had received two or three prior
chemotherapy regimens and prior treatment with Iressa. Patients who experienced
cancer progression within four months of discontinued treatment with Iressa
were then treated with Tarceva.
Eleven patients were female, 16 had adenocarcinoma and 11 were never smokers.
Five of 17 evaluable patients had EGFR mutations.

The overall response rate was 10% with disease control in 29%. The median
disease control was 125 days. Median overall survival was 158 days.

<ul type="disc"><li class="MsoNormal">&#160

atients who
experienced disease stabilization while being treated with Iressa had a
75% rate of cancer control when treated with Tarceva.</li><li class="MsoNormal">&#160

atients who had not
experienced disease stabilization while being treated with Iressa had only
a 17.6% rate of cancer control when treated with Tarceva.</li><li class="MsoNormal">&#160

atients lacking EGFR
 mutations who experienced disease stabilization while being treated with
 Iressa had significantly higher rates of cancer control and cancer
 regression than the same group of patients with EGFR mutations.</li></ul>

The researchers concluded that patients with NSCLC who had prior disease
control with Iressa and do not have EGFR mutations appear to have benefit from
treatment with Tarceva
once their cancer progresses. Patient with recurrent NSCLC may wish to speak
with their physician regarding their individual risks and benefits of treatment
with Tarceva.

Comments: These data suggest that
sequential treatment of NSCLC with Iressa and Tarceva can be effective if patients had an
initial response.

Reference: Chul Cho B, Im C-K, Park M-S,
et al. Phase II study of erlotinib in advanced non–small cell lung cancer after failure of gefitinib. Journal
of Clinical Oncology. 2007;25:2528-2533. 

<op> </op>

<op> </op>

非小细胞肺癌患者伊丽沙®有效后又进展，它赛瓦®仍可有效<op></op>

<op> </op>

研究者来自南韩的报道，
它赛瓦®,可有效地治疗伊丽沙®治疗耐药后稳定期非小细胞肺癌( NSCLC ) . 

<op> </op>

详情本研究报告于2007年6月20日发行的临床肿瘤学杂志. 

它赛瓦和伊丽沙是酪氨酸激酶抑制剂, ，对肺腺癌，或支气管癌alveorlar ,

非吸烟者，，女性，患者有特定的突变受体.

,它赛瓦和伊丽沙联合治疗肺癌显然并没有特别效果，但使用时序还没有被报导过. 

<op> </op>

这项试验包括21个病人，病人事先已受到两个或三个前化疗，再接受伊丽沙治疗. 病人出现癌症的进展，中止伊丽沙治疗达四个月，再用它赛瓦.


<op> </op>

11例患者均为女性, 16例腺癌，和11名从未吸烟者. 17人中5人有EGFR突变. 整体有效率为10% ,疾病控制率在29% . 中期疾病控制是125天. 平均存活期为158天. 

<op> </op>

*病人经历IRRESA疾病稳定的, 用它赛瓦治疗75%治疗有效.

 *病人用IRESSA后，从未经历过疾病稳定, 的，, 用它赛瓦治疗，仅有17.6%
, 有效.

 *患者缺乏EGFR突变的人，经历了疾病稳定后,
比EGFR突变的人，<op></op>

有明显较高比率癌症控制。<op></op>

研究者的结论是：非小细胞肺癌患者用伊丽沙有效，并没有EGFR突变的，癌症进展后.似乎会得益于它赛瓦，
患者肺癌复发不妨跟自己的医生讨论，它赛瓦治疗对他们的风险和益处.

 评论: 这些数据表明,序贯使用治疗肺癌药物Iressa,它赛瓦是可以有效的,如果患者IRESSA治疗有效。.

 参考:吉町二,肌肉注射三钾,公园米S等. 

在晚期非小细胞肺癌IRESSA治疗失败后，用TARCEVA的第二阶段研究. 临床肿瘤学杂志. 2007年; 25:2528-2533 .

账号		自动登录	找回密码
密码			中文注册

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