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肺癌靶向药物

ID #1041

易瑞沙耐药后该怎么办!

    靶向治疗肺癌晚期患者的一种可选治疗方法。

    目前常用的靶向治疗药物有阿斯利康公司生产的易瑞沙和罗氏生产的特罗凯。两种药物都能使部分晚期肺癌患者的病情得到控制。
    但是目前存在的问题是:靶向药物即使使用后有效果,但也会很快发生耐药。以常用的易瑞沙而言,大部分的患者在使用后6-7个月就会发生耐药。那么在易瑞沙耐药后,又该如何治疗?易瑞沙耐药后就不能再使用易瑞沙了吗?如何判断易瑞沙耐药了?
    如何判断易瑞沙耐药了?就现有的资料显示,一般易瑞沙的耐药是发生在服药后三个月以后。
    判断是否对易瑞沙耐药,可以从症状,客观检查结果上判断.如果症状加重,客观检查(包括胸片、胸CT、腹部彩超或CT、骨扫描等)提示病灶(包括原发灶和转移灶)出现进展,或者出现新病灶,应认为已对易瑞沙耐药,

    一旦判定已经对易瑞沙耐药,则易瑞沙就必须停用了。那么这个时候又该如何治疗呢?易瑞沙耐药之后没有标准的治疗方案可以遵循,一切都是在摸索,只能因人而异的试探性治疗,综合下来大致有以下几种治疗方向:

    1、耐药之后选择之前没有用过的化疗药物做化疗,这对于一些吃易瑞沙之前化疗方案不标准或者没有做化疗的病友可以考虑,但毕竟化疗对身体损伤太大,病人到了耐药阶段也承受不了太大的损伤,所以在化疗药物的选择上要尽量用副作用相对比较小的药物,但是一般重新服用易瑞沙有效持续的时间都不会很长。

    2、特罗凯(TARCEVA)联合阿瓦斯汀(AVASTIN),或联合其它化疗药物。这是论坛里病友讨论比较多的,但是特罗凯与易瑞沙一样是单一靶点作用于表皮生长因子(EGF)的药理,易瑞沙耐药了,特罗凯有效的可能性也比较小。包括我母亲在内的一些病友在易瑞沙耐药之后首先考虑的是特罗凯,但我只知道有一位病友的父亲是有效的,其他很少听到这种方案有效;

    3、力比泰(ALIMTA)联合泰索帝或者其它化疗药物,如果能有效控制病情了,可重新用回易瑞沙,可能易瑞沙仍然会有效,但一线或者二线直接用力比泰的效果是比较好的,耐药后用力比泰预后不是很好,但作为耐药后有限的选择之一,是一个需要关注的方案。网站也有病友反映耐药后用力比泰病情控制;

    4、就是目前还在做临床试验的易瑞沙二代Zactima(ZD6474),它不仅作用于表皮生长因子同时作用于血管表皮因子的双通道抑制剂,虽然至今没有上市,但已经处于Ⅱ期临床试验阶段,值得去期待。目前国内只有在个别医院进行试验组,国内买不到,但已有病友在美国购买到。目前有几位病友的亲人入组ZD6474的试验组了,但都是在尚未使用易瑞沙的情况下使用的;

    5、索拉非尼(多吉美)sorafenib——该药是治疗肾癌的药物,但用于非小细胞肺癌的Ⅲ期临床试验已经在2006年展开,我想之所以医生会推荐它在易瑞沙耐药之后使用,可能是因为该药是多靶点的靶向药物,和ZD6474一样是作用于表皮生长因子EGF和血管表皮生长因子VEGF的,这是优于易瑞沙的。目前网站已知的在易瑞沙耐药后使用索拉非尼的有3~4位;

    6、C-225,这段时间在与病友讨论易瑞沙耐药方案时几次听病友提及这个药,C-225也就是Erbitux(艾比特思;cetuximab),大致了解一下这个药适用于结肠癌和肺癌,资料里说该药是作用于表皮生长因子EGF,而达到减少血管表皮生长因子VEGF的生长,这一点与易瑞沙二代ZD6474(Zactima)的药理有相似之处,不知道是不是因为这个原因,而使它被医生作为易瑞沙耐药后的推荐。价格太过于昂贵,目前我知道的仅有北京的病友dura给她母亲用过,但因为是在易瑞沙之前用的,而且使用时间不长,不好评估。

 最后一点,如果耐药后使用了上述手断得到治疗后上述药又耐药后可以重新用回易瑞沙!

 ==== 汉译英 ====

Targeted therapy in patients with advanced lung cancer, an alternative method of treatment.

     Now commonly used in targeted therapy drugs manufactured by AstraZeneca Iressa and Tarceva Roche production. The two drugs can make some patients with advanced lung cancer under control.
     But the current problem is: Even after the targeted drug effects, but it can also occur as quickly resistance. Iressa in common, the majority of patients 6-7 months after use drug resistance will occur. Well, after the Iressa drug resistance, how it treated? Iressa drug Iressa after no longer use it? How to determine Iressa resistance it?
     How to determine Iressa resistance it? On the available information shows that the general Iressa resistance occurred after taking the drug three months later.
     To determine whether Iressa-resistant, can be symptoms, objective findings on the judge. If the symptoms get worse, objective examination (including chest radiography, chest CT, abdominal color Doppler ultrasound, or CT, bone scan, etc.) prompted lesions (including the primary tumor and metastasis) to show progress, or the emergence of new lesions should be considered to have pairs of Iressa-resistant,

     Once the judge has Iressa resistance, then Iressa to be disabled. So how should this time be treated? Iressa drug resistance there is no standard treatment options after that can be followed, all groping and can only vary tentative treatment, integrated treatment down to the following several directions:

     1, drug resistance has not been used until after the choice of chemotherapy drugs chemotherapy, which Iressa for some food before the non-standard chemotherapy or no chemotherapy for sufferers can be considered, but, after all, too much damage on the body with chemotherapy, the patient to a drug-resistant phase also can not afford too much damage, so the choice of chemotherapy drugs, we should try to use side-effects of drugs is relatively small, but generally re-taking Iressa effective duration will not be very long.

     2, Tarceva (TARCEVA) combined Avastin (AVASTIN), or in combination with other chemotherapy drugs. This is a forum to discuss the more and more sufferers, but, like Tarceva and Iressa target is a single act on the epidermal growth factor (EGF) in pharmacology, drug Iressa, and Tarceva is also more effective the possibility of small. Including my mother, including some patients in the Iressa drug Tarceva after the first consideration is, but I only know of one patient's father, to be effective, the other seldom heard such programs effective;

     3, Alimta (ALIMTA) combined chemotherapy drug Taxotere, or other, if they can effectively control the disease, and can be re-used back to Iressa may IRESSA will continue to be valid, but harder than the first-line or second-line directly to the effect of Thailand is a better tolerated than in Thailand after the force is not a very good prognosis, but as one of the options limited after resistance is a need to focus on programs. Site also has other sufferers harder than in Thailand, after reflecting the resistance to disease control;

     4, that is, clinical trials are also being done Iressa II Zactima (ZD6474), which not only act on the epidermal growth factor at the same time acting on the vascular epidermal factor dual-channel inhibitors, although there has been no market, but it is already in phase Ⅱ clinical the pilot phase, it is worth to expect. Currently only the test group in individual hospitals, the domestic buy anything, but there are other sufferers in the United States to purchase. There are a number of patient's family members into the group of ZD6474 in the test group, but they are not yet the case of the use of Iressa use;

     5, Sorafenib (Nexavar) sorafenib - drug to treat kidney cancer drug, but for non-small cell lung cancer Phase Ⅲ clinical trials have been launched in 2006, I think the reason why a doctor would recommend it easy Rui Sha used after resistance, possibly because the drug is a multi-targeted drug targets, and as is the role of ZD6474 in the epidermal growth factor EGF and vascular epidermal growth factor VEGF, which is better than the prescribed IRESSA. Known in the current site after the use of Iressa-resistant Sorafenib there are 3 ~ 4;

     6, C-225, this time with the sufferers to discuss the program of Iressa-resistant patients have mentioned this several times to listen to drug, C-225 is Erbitux (Erbitux; cetuximab), an overview of what this drug for colon and lung cancer, information on where that drug is acting on the epidermal growth factor EGF, while the goal of reducing blood vessel growth epidermal growth factor VEGF, which is the second generation with Iressa ZD6474 (Zactima) pharmacological similarities do not know Is it because of this reason, while it was a doctor as recommended after the Iressa drug. The price too expensive, now I know that the only sufferers in Beijing dura to her mother used, but because it was used prior to Iressa, but the use of time is not long, bad evaluation.

  Finally, if, after using the above-resistant hand-off to be treated after the drug resistance also can re-use back to Iressa! 

Tags: 易瑞沙耐药后该怎么办!

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更新日期: 2009-11-03 07:10
作者: : mcyclub
修订: 1.1

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