我父亲肺鳞癌的治疗贴(2014年3月1日驾鹤西去）

英雄武松 发表于 2012-8-10 01:27

                               
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请问，比如我妈妈，吃易当时也挺好，有效8个月吧，属于EGFR突变型的，那么是不是拉帕替尼的有效可能性就不 ...

是的，老马说的对。
; {, ~4 B4 D$ f+ S不过，有研究表明，肿瘤发生，有上百种基因发生突变、扩增、抑制等改变。肿瘤发展过程中、治疗过程中基因也在不断发生变异，以适应新的环境变化。所以现在有大牛认为肿瘤是一种自成体系的新的生物种类。
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4 Y- X0 ?$ c& J/ w9 \所以，还是归结为一句说过无数次的老话：试了才知道有效没效。推测仅仅是推测。

我今天观察老爸，发现眉毛和胡子变黑了，新长的头发也是黑的。太奇怪了！@

老马 发表于 2012-8-10 20:16

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# M2 V0 L4 L/ d- a) E我今天观察老爸，发现眉毛和胡子变黑了，新长的头发也是黑的。太奇怪了！@

8 D7 ~# I, t2 e; L返老还童！

可以实现理想了：看到孙子高中毕业。

另外提示大家：BIBW 2992与食物同时服用会影响吸收，它溶解于pH1~6.8，因此不建议用肠溶胶囊。

另外上上周有病友推荐阿托伐他汀（Liptor，立普妥）代替辛伐他汀，我调查，立普妥的降血脂效果比辛伐他汀要强，但副作用大一倍。

越来越年轻，是不是你给吃什么激素类的吃多了？
年轻好啊。

老马 发表于 2012-8-10 20:16

                               
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& u5 Y: \) O- k7 @% V! J我今天观察老爸，发现眉毛和胡子变黑了，新长的头发也是黑的。太奇怪了！@

0 a; N3 f) |! }& V( P不奇怪，我家老歌也是这样的.

有个问题：对于her2扩增的，拉帕替尼和阿法替尼效果都不错，拉帕的NSCLC二期临床有一例肿瘤缩小了51%，但对于her2突变的，拉帕效果不成，而阿法替尼有效果。

Lapatinib minimally effective for non-small-cell lung cancer
MARCH 18, 2010
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* {8 C+ r; z# ?. GNEW YORK (Reuters Health) - Although well tolerated, lapatinib is minimally effective as monotherapy for advanced or metastatic non-small-cell lung cancer (NSCLC), according to a report in the March 15th Clinical Cancer Research.
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Lapatinib (GlaxoSmithKline) is a tyrosine kinase inhibitor of both epidermal growth factor receptor (EGFR) and HER2, the authors explain, and thus has theoretical advantages over inhibition of either EGFR or HER2 alone.

Dr. Helen J. Ross, from Mayo Clinic, Scottsdale, Arizona, and colleagues evaluated the overall response rate to lapatinib in 131 patients with advanced or metastatic NSCLC. Sixty-five patients were randomized to lapatinib 1500 mg once daily and 66 to lapatinib 500 mg twice daily.
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4 ?+ T0 N) i1 b* cWhen the study began, patients with any type of advanced or metastatic NSCLC were recruited ("non-targeted" population). However, when data from other studies began to show that EGFR inhibitors are particularly effective in patients with bronchioloalveolar carcinoma and in never-smokers with any histology of NSCLC, recruitment began to "target" such patients.
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! R6 C( T- U+ F- aThe targeted population included 24 patients in the 1500 mg/day group and 32 in the 500 mg twice daily group. The corresponding numbers in the non-targeted population were 41 and 34.

4 ^  v  _% ^; t* U" g+ rAt the interim analysis of the first 30 targeted patients to reach the initial response evaluation, the response rate was 0% in both treatment groups. In the non-targeted population, one patient in the 1500-mg group achieved a partial response.

Overall, 31 of 131 patients (24%) had stable disease or better.

Based on these findings, the study was stopped for reasons of futility, the investigators state.
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3 s! X1 Y# z, q, mOverall survival in the targeted population was 15.2 months for the 1500-mg once-daily group and 13.9 months for the 500-mg twice-daily group, and in the nontargeted population, overall survival was 11.4 months for the 1500-mg once-daily group and 8.1 months for the 500-mg twice-daily group.
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. I7 u" v- [, B5 I" S' i1 S! NMedian progression-free survival was 15.6 weeks (1500-mg once-daily) and 8.7 weeks (500-mg twice-daily) in the targeted population and 12.0 weeks (1500-mg once-daily) and 8.6 weeks (500-mg twice-daily) in the nontargeted population.
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6 G, |" a. _) ^3 WThe incidence of adverse events considered to be related to study medication was 89% for 1500 mg once daily and 83% for 500 mg twice daily, but only 8% of patients in each group experienced serious adverse events related to study medication.

Among 92 patients with tumor tissue available, 2 had mutations in EGFR and 1 had mutations in both EGFR and KRAS. None had mutations in HER2.
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Of 77 patients with sufficient DNA for gene copy evaluation, 5 (8.8%) had increased EGFR copy number and 2 (3.5%) had increased HER2 gene copy number.
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7 C3 I' e8 j9 q+ D  _8 o0 r2 ONone of the patients with EGFR mutations responded to lapatinib, and only 1 patient with HER2 amplification had an unconfirmed decrease of 51% in tumor measurement.
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"Lapatinib as a single agent at the doses studied seems to have minimal single-agent activity, at least as measured by response rates," the authors conclude, "although progression-free survival in the 1500-mg once-daily group was in the range that would be expected with first-line chemotherapy."

$ `. x- }8 W* t+ d# g( h' C9 s+ A"Patients in this small study had a suggestion of disease stabilization with lapatinib," Dr. Ross said. "It would be of interest to examine it in the adjuvant setting after resection perhaps, after chemoradiotherapy perhaps or after up-front chemotherapy. It is possible that combination with other targeted agents, such as anti-angiogenic agents, might be useful."

The study was sponsored by GlaxoSmithKline.