肺鳞30月，父亲永远地走了

/ L& m/ D) ?; x3 P, Q1 U4.15 复查
+ U- h  U' D* Y医生认为CT才做一个月，结果稳定，这次查个血就够了，我认同，上次就CA125增长比较多，这次开单查了CEA、CA125、CA153、CA199，NSE。去年9月之前没记录，尚未找到规律，再来几次可能就知道哪个敏感了。
+ D0 H6 W3 x4 {  g! r如果2992还有效，是否改成吃8停5？目前状态很好，乳铁蛋白有奇效？

4.17 昨天抽了血，今天出报告：
CEA 1.76
+ ]5 t: N+ p+ eCA125 162.6 继续升高，估计2992耐药或部分耐药了
9 y) J  G" a- K4 }# b: @CA199 8.48
CA153 17.82
NSE 14.95

CT上个月做稳定，因此这次未做，CA125继续上升，纠结要不要化疗。医生提议目前生活质量很好，以CT为准，暂不管指标上升。
' P; N1 ^8 \, d9 [0 [! W纠结ing

现在考虑的方案：
1、试试易(平安老师认为肺癌不试试易可惜）
; m7 ^9 O5 m$ G6 d" }( l2、2992+半量xl184
' Y. `& k; s8 d9 E5 U9 `( m& q3、2992加量
. E# M1 n( h$ f) ?6 C凡德有试过，无效
! s( \2 h# n, ^* @
/ `2 }6 r7 c0 l
& |) N1 K. g; V! s6 P4 O爱老虎油！ 2013/4/17 星期三 18:56:31
3 d' X+ ]' I+ v  ?+ O3 z  `  h易用过吗？没用过试试易吧，肺，不用易太可惜了
7 C, m) }! y% V& R: a( H滴水(luxd)  20:20:13
# q& K" b2 _# X3 d/ C7 S4 e平安姐，我父亲是鳞、吸烟，是不是也试试
, V9 h( Y2 h' _( T1 T9 p滴水(luxd)  20:34:25
  K( v% C$ S) U2 t1 Z$ x之前就是考虑鳞+男性+吸烟，直接上的特。现在考虑：
1、试试易
8 Y' U4 t9 l% n; @5 e2、2992+半量xl184
3、2992加量
7 g! {+ G8 C& S0 l: B凡德有试过，无效
) y1 i# x) U& Q, k爱老虎油！  21:31:42
如果病情紧急就上2，不紧急就试试易

6 K4 q. Z' t7 N$ N. g) P
; ^# y9 `) M3 O( ^8 {0 _考虑方案4：替吉奥
6 S) [' Q0 x5 U
S-1, an oral fluoropyrimidine derivative, has been approved for the treatment of non-small cell lung cancer (NSCLC) in Japan. In the present study, the efficacy and safety of S-1 monotherapy for elderly patients with previously treated NSCLC were retrospectively evaluated, and the efficacy of S-1 monotherapy was compared by histopathological type. This retrospective study included 54 patients with advanced or recurrent NSCLC who had received S-1 monotherapy following the failure of previous chemotherapy regimens at our institutes. Patient outcomes were compared based on their age and histopathological type. S-1 was administered orally, twice daily, while the duration and interval were modified according to the medical condition of each patient. The default delivery schedule, the mean number of S-1 cycles, did not differ significantly between the two age groups (<70 and ≥70 years). The rate of therapy discontinuation, schedule modification or dose reduction due to intolerable toxicities or patient refusal was relatively frequent in the older group (40.7 and 55.6% for ages <70 and ≥70 years, respectively; p=0.414), and the incidence of grade 3 anemia was relatively high in the older group (3.7 and 18.5%, respectively; p=0.192). The response rates (13.0 and 4.8%, respectively; p=0.609) and disease control rates (39.1 and 33.3%, respectively; p=0.761) did not differ significantly between the two age groups. According to histopathological type, the disease control rate was significantly higher in adenocarcinoma (57.9%) compared to non-adenocarcinoma (20.0%, p=0.013). Thus, S-1 monotherapy may be equally effective and tolerated in patients <70 years and those ≥70 years. Additionally, adenocarcinoma may have a higher disease control rate than non-adenocarcinoma.
, M, Q( _  y' M, {& W8 ~, a
替的疾病控制率，腺比非腺高很多：57.9%vs20%

S-1联合铂类，效果与病理类型无关（即鳞和腺相当），这与培美不同，可能是作用TS的方式不同。
$ D: D9 w* E2 y' O3 R4 Zhttp://ar.iiarjournals.org/content/30/7/2985.full.pdf
% Q- r* R- P& y) R4 R单药却与病理类型有关？

综合平安老师、老马建议和自己判断，决定采用方案四，口服替吉奥。原因：
+ |  z: Y4 G+ L: @; T1、特、2992均已耐药，易有效的可能性很低；
2、2992趋于耐药，如果没有有效手段，反正都要化疗了，口服替是比较轻松的化疗方案；
3、如果不准备把2992用绝，联用方案也先不考虑：
--2992+184，平安老师认为在危急的时候用；
+ O) s5 y! x3 ]: f6 f" P--2992+替http://www.ncbi.nlm.nih.gov/pubmed/20530710，2992已经耐药，就先不考虑联用了；
- Y: P7 {* g* [$ }/ l& m6 n5、如果替有效，那怕只是稳定，也为切换回特创造条件，如果无效，就去多西他赛化疗。
还有什么要考虑的？每次情况变化，做决定都是犹豫不决。

4.22 开始替吉奥，60mg bid

关注！

论坛里有好几家在用替，关注中。