i*****y
发帖数: 19 | 1 一年前在此发帖咨询得到一些很好的帮助。非常感谢！现想就一些新情况咨询懂医的网
友。
我父亲有长期烟史，壮年时得过肺结核。2003年底发现肺右下叶背段病灶，各种测试包
括同位素都无法确诊。2004年6月在胸腔镜辅助下手术，取样确定为癌症，改行右肺中
下页切除术，诊断是“原发性支气管肺癌，肺泡细胞癌T2N0M0ⅠB KPS90分”。随后做
了几
轮化疗。
这轮治疗后虽有很小肺部病灶，医生不建议其它治疗，病灶发展缓慢。2007开始一直服
用特罗凯似对存在的病灶有抑制作用。2011年5月左右起有骨转移症状，进行针对性放
疗似有效。2011年12月出现一些脑转移，全脑放疗几个月后检查似有较好抑制作用。
2012年1月用2004年（7年半前）手术取出的瘤块做基因测序显示有EGFR变异，无ALK变
异。（不知现在体内的癌细胞会否有进一步变异？）
在这些治疗过程中及至今仍继续服用特罗凯，因为医生认为虽有转移但特罗凯可能仍起
一定作用，所以放疗等都是用的姑息疗法（相对少些剂量），也不曾再用放疗。
2012年早些显示有其它部位骨转移，按医生推荐在继续服用特罗凯同时每月用择泰（唑
来膦酸）注射，昨天刚注射完最后一次（第6次）。此过程中似因药物作用病人胃口明
显下降，体重也有所减轻。另外在医生推荐下做了两次CIK免疫疗法。准备在约一个月
后做一次全面检查看病情进展。
我的主要问题是：
1。现在考虑进一步治疗的话是否化疗还是首选？（感觉我父亲现在的身体虽比以前虚
弱些，应该还是经得起化疗。）
2。是否需要考虑继续进行DC-CIK疗法？查了一下似乎此法在美国和其它国家并没有临
床应用？国内有几个医院做得挺多。不知是否足够安全和有效？不知是否知道国内哪个
医院此技术成熟些？
3。考虑病人可能已对特罗凯有抗药性，是否有新的靶向药物可以考虑？
希望懂行的网友能分享一些信息和建议，不胜感激！谢谢！ |
l*h
发帖数: 4124 | 2 the only word I want to say after reading this is "damn."
【在 i*****y 的大作中提到】
: 一年前在此发帖咨询得到一些很好的帮助。非常感谢！现想就一些新情况咨询懂医的网
: 友。
: 我父亲有长期烟史，壮年时得过肺结核。2003年底发现肺右下叶背段病灶，各种测试包
: 括同位素都无法确诊。2004年6月在胸腔镜辅助下手术，取样确定为癌症，改行右肺中
: 下页切除术，诊断是“原发性支气管肺癌，肺泡细胞癌T2N0M0ⅠB KPS90分”。随后做
: 了几
: 轮化疗。
: 这轮治疗后虽有很小肺部病灶，医生不建议其它治疗，病灶发展缓慢。2007开始一直服
: 用特罗凯似对存在的病灶有抑制作用。2011年5月左右起有骨转移症状，进行针对性放
: 疗似有效。2011年12月出现一些脑转移，全脑放疗几个月后检查似有较好抑制作用。
|
i*****y
发帖数: 19 | 3 I would appreciate useful comments/suggestions (and no meaningless comments)
. Thanks for your time, but I am not sure what point you are trying to make
here. I am very proud of and truly respect my father and other cancer
patients who have the courage to face and fight such diseases/ordeals.
【在 l*h 的大作中提到】
: the only word I want to say after reading this is "damn."
|
l*h
发帖数: 4124 | 4 you should know the so-called CIK was a hot concept in 80s and early 90s. it
was determined there was no merit to go into clinical trials. it is still
studied in labs but no major advance has been made in the last two decades.
it is simply robbery and fraud in using it in patients who really need to
use their money on effective treatments.
Most patients generate resistance in 6m - 1y to Tarceva. You should not have
assumed it was still effective. Testing old specimens doesn't provide any
guidance. Even testing current specimens doesn't necessarily do after
treatment.
Please don't take only flattering words as helpful.
comments)
make
【在 i*****y 的大作中提到】
: I would appreciate useful comments/suggestions (and no meaningless comments)
: . Thanks for your time, but I am not sure what point you are trying to make
: here. I am very proud of and truly respect my father and other cancer
: patients who have the courage to face and fight such diseases/ordeals.
|
l*h
发帖数: 4124 | 5 you should also understand growth factor inhibition has double effects in
reducing tumor size and but in certain cases promotes invasiveness and
metastasis. this is especially obvious in VEGF inhibition, but also present
in inhibiting other growth factors that have effects in angiogenesis. so
once you see metastasis, you should seriously think about whether you should
continue your current regimen.
comments)
make
【在 i*****y 的大作中提到】
: I would appreciate useful comments/suggestions (and no meaningless comments)
: . Thanks for your time, but I am not sure what point you are trying to make
: here. I am very proud of and truly respect my father and other cancer
: patients who have the courage to face and fight such diseases/ordeals.
|
I****a
发帖数: 407 | 6 I would suggest to continue Tarceva and Zometa and if your father has only
localized bone metastasis. If the new scan shows more progressive findings,
I would suggest to add Alimta in addition. Alimta is a fairly benign
chemotherapy and the side effects are minimal. If that fails I would then
consider Avastin combination. At any time, he could try Afatinib (an
more potent form of Tarceva) if it is available. This drug likely will be
approved in US by the end of this year.
I am against what so called DC-CIK therapy.
Good luck. |
i*****y
发帖数: 19 | 7 Thanks for the suggestions! I looked at Afatinib clinical trials. A few
ongoing trails do include Chinese sites, although the recruitment has not
started yet. Will need to read their eligibility criteria more carefully and
follow up. Thanks!
,
【在 I****a 的大作中提到】
: I would suggest to continue Tarceva and Zometa and if your father has only
: localized bone metastasis. If the new scan shows more progressive findings,
: I would suggest to add Alimta in addition. Alimta is a fairly benign
: chemotherapy and the side effects are minimal. If that fails I would then
: consider Avastin combination. At any time, he could try Afatinib (an
: more potent form of Tarceva) if it is available. This drug likely will be
: approved in US by the end of this year.
: I am against what so called DC-CIK therapy.
: Good luck.
|
l*h
发帖数: 4124 | 8 apparently your dad has metastasis to multiple organs/sites. there are two
options:
1. go aggressive with conventional chemo regimens
2. change to mainly palliative care
to be honest, waiting for a "new" drug is not a viable option. inclusion of
such patients usually occurs quite some time after the drug is approved in
the specific jurisdiction. the abuse of "new" drugs in China is just
astounding.
and
【在 i*****y 的大作中提到】
: Thanks for the suggestions! I looked at Afatinib clinical trials. A few
: ongoing trails do include Chinese sites, although the recruitment has not
: started yet. Will need to read their eligibility criteria more carefully and
: follow up. Thanks!
:
: ,
|
l*h
发帖数: 4124 | 9 to be more specific, at this time, if you don't want to go the palliative
path, you should urge your dad's oncologist to consider the following
regimens:
1. a microtubule inhibitor + a platinum derivative or
2. a microtubule inhibitor + a platinum derivative + a conventional
alkylating agent
folate antimetabolites can also be considered but I would not place them
ahead of the above two options.
you should be very cautious to consider bevacizumab. remember, your dad is ~
65 yo. bevacizumab just causes a lot of problems in this age group and doesn
't show actual clinical benefits. you should also remember your dad has
already intracranial metastasis.
it is easy for other people to give you some recommendations to use some
regimens on some high profile clinical trials. but your dad obviously doesn'
t fit into any of those groups that showed clinical benefits.
of
【在 l*h 的大作中提到】
: apparently your dad has metastasis to multiple organs/sites. there are two
: options:
: 1. go aggressive with conventional chemo regimens
: 2. change to mainly palliative care
: to be honest, waiting for a "new" drug is not a viable option. inclusion of
: such patients usually occurs quite some time after the drug is approved in
: the specific jurisdiction. the abuse of "new" drugs in China is just
: astounding.
:
: and
|
I****a
发帖数: 407 | 10 Some of the unique points of this particular lung cancer are:
1. It is EGFR mutation positive now likely has gained the resistance
mechanism.
2. The majority of the metastasis are in brain (not surprising) and bones.
So following cookie cutting algorithm may not be the optimal way to go.
There is nothing wrong to give him platinum doublet although I favor Alimta
in the doublet given the result from PARAMOUNT data and it is probably more
reasonable in my opinion to start with 1 agent given his progressive disease
is only in the bones. Afatinib in combination with Cetuximab in small phase
2 study produced almost 100% disease control rate and 50% response rate in
61 patients who accquired resistance after Tarceva or Irissa so I strongly
urge him to get enrolled in similar clinical trial if it is available.
I do
not recall ECOG4599 trial had the breakdown of response rate for EGFR
mutation status but I would not withhold Avastin base on his age or the
brain
metastasis. Those are not contraindications. I forgot to mention another
alternative which is to target c-met. The drug I am aware of is ARQ 197
however the phase 3 trial has been closed to recruiting.
~
doesn
【在 l*h 的大作中提到】
: to be more specific, at this time, if you don't want to go the palliative
: path, you should urge your dad's oncologist to consider the following
: regimens:
: 1. a microtubule inhibitor + a platinum derivative or
: 2. a microtubule inhibitor + a platinum derivative + a conventional
: alkylating agent
: folate antimetabolites can also be considered but I would not place them
: ahead of the above two options.
: you should be very cautious to consider bevacizumab. remember, your dad is ~
: 65 yo. bevacizumab just causes a lot of problems in this age group and doesn
|
i*****y
发帖数: 19 | 11 Hello icetea, lmh, & others who emailed me with useful information,
Thanks to you all for spending your time to offer valuable inputs. I will
take those into considerations and talk to my father's oncologist.
Another question: if there are appropriate medications that are available in
U.S. but not in China, is there any way for my father to purchase them from
U.S.? Meanwhile, If his new scan ( in a month) shows further metastasis (
hope not!), we will also consider the chemo option(s).
Thanks, |
l*h
发帖数: 4124 | 12 In principle, I agree with you on the use of pathway inhibitors. I think I
disagree with you on the practical issues.
1. her dad's oncologist doesn't seem to have a good knowledge of the
mutations of the tumor, the complexity of the pathways and the mechanisms of
these inhibitors.
2. his intracranial metastasis is a real big concern. if you think those
more conventional drugs are bad in getting into the brain (and the tumor),
currently available TKIs are worse. certain chemo drugs have been shown to
be somewhat effective for brain lesions including some of the -platins. so
far all the tested TKIs are disappointing for brain lesions even though they
may be highly effective for extracranial lesions.
3. avastin is not effective for brain lesions given by iv. we ask our
interventional neuroradiology people to give avastin to gbm and brain
metastasis patient using selective intraarterial injection preceded by
mannitol. this must be under a clinical trial protocol, or under a
regulatory approval based on compassionate grounds if the patient doesn't
qualify under the study protocol.
4. TKIs in principle can also be delivered by selective intraarterial
injection. the practical issue is they are only clinically available as
tablets or capsules. pharmaceutical companies have injections for
pharmacological studies. it wouldn't be easy to persuade them to give you
some. then you will also need some expertise from yourself or help from
clinical pharmacologists to scale the dose for IA injection.
5. if the number of metastatic sites are very small, convection-enhanced
delivery can be an effective way to deliver the drugs. then you will need a
neurosurgeon good at stereotactic targeting to do the procedure.
6. if the number of metastatic sites are very small, I would also suggest to
consider conformal radiation therapy to the metastatic sites to regular
dose, and involved field radiation to the whole brain at a lowered dose (~ 1
/3 – 1/2 of the metatstatic site dose). actually i would suggest this over
points 3, 4 and 5 because if the equipment is available, this is the easiest
to do.
7. other ways of blood-brain barrier opening/disruption have not shown any
improvement in brain cancer (primary or metastatic) therapy so far.
8. if all the therapeutic agents and technical expertise are available, the
lax regulation in China definitely can be played to his favor.
Alimta
more
disease
phase
in
【在 I****a 的大作中提到】
: Some of the unique points of this particular lung cancer are:
: 1. It is EGFR mutation positive now likely has gained the resistance
: mechanism.
: 2. The majority of the metastasis are in brain (not surprising) and bones.
: So following cookie cutting algorithm may not be the optimal way to go.
: There is nothing wrong to give him platinum doublet although I favor Alimta
: in the doublet given the result from PARAMOUNT data and it is probably more
: reasonable in my opinion to start with 1 agent given his progressive disease
: is only in the bones. Afatinib in combination with Cetuximab in small phase
: 2 study produced almost 100% disease control rate and 50% response rate in
|
l*h
发帖数: 4124 | 13 I think there is some laws allowing pharmaceutical companies to give out
some drugs to foreign patients if you can provide documents that the drug is
essential for treatment and will be handled by qualified foreign physicians
. You will need to plead with those companies directly. You can prepare a
medical summary and have it translated and notarized in advance.
Another question: if there are appropriate medications that are available in
U.S. but not in China, is there any way for my father to purchase them from
U.S.?
in
from
【在 i*****y 的大作中提到】
: Hello icetea, lmh, & others who emailed me with useful information,
: Thanks to you all for spending your time to offer valuable inputs. I will
: take those into considerations and talk to my father's oncologist.
: Another question: if there are appropriate medications that are available in
: U.S. but not in China, is there any way for my father to purchase them from
: U.S.? Meanwhile, If his new scan ( in a month) shows further metastasis (
: hope not!), we will also consider the chemo option(s).
: Thanks,
|
