我父亲肺鳞癌的治疗贴(2014年3月1日驾鹤西去）

老马 · 发表于 2012-1-10 00:06:17

本帖最后由老马于 2012-1-18 09:42 编辑

阿瓦斯丁治疗肺鳞癌的安全性
贝伐单抗最严重的不良反应是肿瘤相关性出血，与鳞状细胞癌、肿瘤坏死、空洞形成及肿瘤靠近大血管有关，并可引起高血压等心向管不息反应。

BRIDGE: An open-label phase II trial evaluating the safety of bevacizumab (BV) plus paclitaxel/carboplatin (PC) as first-line treatment (tx) for patients (pts) with advanced, previously untreated, squamous non-small cell lung cancer (NSCLC).
Background: In a phase II study of first-line tx with BV + PC for NSCLC, squamous histology was found to be a risk factor for severe (Gr ≥ 3) pulmonary hemorrhage (PH). Subsequently, pts with predominantly squamous histology were generally excluded from phase III studies. This final analysis from the BRIDGE study assesses safety of delayed BV administration in pts with locally advanced or metastatic squamous NSCLC. Methods: BRIDGE was an open-label, single-arm, multicenter pilot study of PC alone in cycles 1 and 2, and PC + BV in cycles 3 to 6, followed by BV until progressive disease (PD) or unacceptable toxicity. Eligible pts had stage IIIb (with pleural effusion), stage IV, or recurrent squamous NSCLC. Pts with recent arterial thromboembolic events, gastrointestinal perforation, hemoptysis, untreated brain metastases, intrathoracic lesion(s) with cavitation, or anticoagulation therapy were not eligible. The primary endpoint was incidence of Gr ≥ 3 PH. Results: Forty- seven pts received 2 initial cycles of PC, and 31 continued on study to receive ≥ 1 dose of BV. Median age was 65 (range: 48-80); 96.3% had Stage IV disease. Pts received a median of 6.0 (range, 1-18) doses of BV, and 2 pts (6.5%) completed 12 mos of tx. Among the 31 pts who received BV, there were 3 reports of PH of any grade in 2 pts. One pt had Gr 1 PH during cycle 3, withdrew due to PD on the same day, and recovered from PH. A second pt developed Gr 3 PH after post-progression treatment, 44 days after the last BV dose; PH resolved 2 d later, but after another 55 d the pt developed Gr 4 PH, and subsequently died due to PD. Incidence of Gr ≥ 3 PH (1 pt) was 3.2% (90% CI: 0.3-13.5%). Nine pts (29.0%) experienced Gr 3 events, including 5 (16.1%) with hypertension; 5 experienced Gr 4 events (dyspnea, PH, basal ganglia infarction, cerebral ischemia and pain). Median progression-free survival (PFS) was 6.2 mos (95% CI: 5.32-7.62 mos); 57% of pts had PFS of ≥ 6 mos. Conclusions: The incidence of Gr ≥ 3 PH in this study was 3.2% (1 pt). No new safety signals were identified. Until further trials are conducted, tx of squamous NSCLC with BV should be considered experimental.

Microsoft Word - 阿瓦斯丁™_AVASTIN_中文说明书.pdf (242.23 KB, 下载次数: 129)

英雄武松 · 发表于 2012-1-10 01:48:24

文章很好，可惜读不了。

老马 · 发表于 2012-1-10 08:04:36

EGFR抑制剂（EGFR TKIs）无论是小分子药物还是单克隆抗体，均具有良好的安全性和耐受性，常见不良反应有皮肤毒性和腹泻，罕见不良反应有间质性肺炎、肝功能异常、口腔炎、脱发、口腔干燥等，无威胁患者生命的血液学毒性。与化疗毒副反应的处理措施不同，应用此类药物出现不良反应并非停药的指征，反而是肿瘤对靶向药物敏感的临床信号。许多研究发现皮疹与EGFR TKIs治疗的疗效相关，中重度皮疹患者总体生存明显优于轻度或无皮疹的患者。

老马 · 发表于 2012-1-10 19:19:37

本帖最后由老马于 2012-1-11 13:26 编辑

EGFR基因突变和高表达与疗效的关系

老马 · 发表于 2012-1-11 13:32:16

本帖最后由老马于 2012-1-11 13:38 编辑

阿瓦斯丁联用特罗凯
http://cancergrace.org/lung/2010 ... s-overall-survival/

老马 · 发表于 2012-1-13 18:29:37

本帖最后由老马于 2012-1-15 14:52 编辑

最近老爸胃口不错，经常有练练书法，但还是懒得锻炼身体。
今天买了美国雅培安素Ensure成人复合蛋白质营养粉397g，和润肤霜。

肠内营养制剂主要成分一览表.rar (6.25 KB, 下载次数: 203)

老马 · 发表于 2012-1-13 18:46:44

本帖最后由老马于 2012-1-13 21:20 编辑

爱必妥和阿瓦斯丁的比较

http://cancergrace.org/lung/2008/08/30/bms099-os-neg/

http://cancergrace.org/lung/2007/12/27/platgem-erbitux-trial/
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Overall survival with cisplatin–gemcitabine and bevacizumab or placebo as first-line therapy for nonsquamous non-small-cell lung cancer: results from a randomised phase III trial (AVAiL)
Patients and methods: Patients (n = 1043) received cisplatin 80 mg/m2 and gemcitabine 1250 mg/m2 for up to six cycles plus bevacizumab 7.5 mg/kg (n = 345), bevacizumab 15 mg/kg (n = 351) or placebo (n = 347) every 3 weeks until progression. Primary end point was progression-free survival (PFS); OS was a secondary end point.
Results: Significant PFS prolongation with bevacizumab compared with placebo was maintained with longer follow-up {hazard ratio (HR) [95% confidence interval (CI)] 0.75 (0.64–0.87), P = 0.0003 and 0.85 (0.73–1.00), P = 0.0456} for the 7.5 and 15 mg/kg groups, respectively. Median OS was >13 months in all treatment groups; nevertheless, OS was not significantly increased with bevacizumab [HR (95% CI) 0.93 (0.78–1.11), P = 0.420 and 1.03 (0.86–1.23), P = 0.761] for the 7.5 and 15 mg/kg groups, respectively, versus placebo. Most patients (～62%) received multiple lines of poststudy treatment. Updated safety results are consistent with those previously reported.
avail-effect-of-avastin-7.5mg-on-pfs.jpg