s********g 发帖数: 370 | 1 妈妈得了舌癌现在已经转移。之前放疗好像没有效果,放疗后转移,目前手术后在化疗
。医生推荐这个西妥昔单抗(Cetuximab)名爱必妥(Erbitux),请问大家有人知道这
个药效如何。在哪里买么?据说很贵,可能有折扣么? |
|
l*h 发帖数: 4124 | 2 what is the genetic testing of her tumor? cetuximab is expected to be
effective if the tumor is overexpressing EGFR and there is no constitutively
active downstream signal mutations (kras etc.). |
|
i*******n 发帖数: 48 | 3 这个东西不是那么容易做的。
提出hypothesis很容易,test起来很花钱。
和你的药物的作用机理有关系。
找biomarker方法很多,microarray, RNA seq, metabolomics,还是dependent on
mechanism of action.
先做回顾性数据:
如Cetuximab,BMS取了两组病人,response好的和不好的病人的tumor sample
->microarray->找到一堆相关的gene->QPCR quantitation
看和疗效的统计相关性
然后再做前瞻性实验:
有时一组clinical trial,用你的biomarker对病人分类,用Cetuximab+化疗(biomarker
postivie,他们根据QPCR结果打分>200),or 化疗only(biomarker negative<200).-》
果然有效。
so 这一组biomarker可以用于Cetuximab的病人选择及预测。
so 准备好money,再开展工作。 |
|
M*****e 发帖数: 279 | 4 不是一点副作用没有的。比如Erotinib 的skin rash。甚至skin rash被用来判断病人对这个药物反应良好。这是因为皮肤表达EGFR。我猜测,只是针对肿瘤细胞(因为突变,扩增等导致EGFR的活性超高的肿瘤细胞)的剂量比针对表达EGFR的正常的细胞的剂量要小。
这些当然针对正常细胞。只要正常细胞需要EGFR来维持,就会受到影响。正常皮肤需要EGFR维持。即使同类的Gefitinib,甚至EGFR单抗Cetuximab,都有这些副作用的。
我的数据让我猜测对这类药物耐药原因之一(注意:是之一)是:the alternative activation of EGFR.换句话说,虽然药还在用,EGFR可以通过别的途径被活化,所以肿瘤细胞继续增殖。太多的东西可以活化EGFR了。
本人认为Targeted therapy在医疗实践中早就有了。Target明确,药物的作用位点明确。只不过,那时的人没有给这叫Targeted therapy罢了。 |
|
I****a 发帖数: 407 | 5 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 pr... 阅读全帖 |
|
s********g 发帖数: 370 | 6 还没有做genetic testing,现在正在看在哪里做。文献看到说澳大利亚和比利时做的
最准。
请问是只要做KRAS就可以,还是要和EGFR或者其它的一起做才行?
谢谢您! |
|
l*h 发帖数: 4124 | 7 both. egfr testing is simple. kras testing is more difficult. also consider
akt/mTOR, another major pathway downstream egfr. |
|
|
l*h 发帖数: 4124 | 9 in northeastern US, MSKCC is doing comprehensive genetic cancer testing.
they spend ~$6,000 on each patient for such testing, even though they don't
know how to fully utilize the data yet.
i have no idea if and how much they charge for outside samples.
MD Anderson is also doing comprehensive genetic cancer testing.
you can call their Head and Neck services to discuss. |
|
l*h 发帖数: 4124 | 10 you should also ask whether the hospital is capable to do conformal or
intensity modulated radiation therapy. conventional RT may not be effective
because of the dose distribution limiting the dose the tumor received. |
|
f****o 发帖数: 2770 | 11 麻烦问问有没有什么比较好的药物可以治疗或者辅助治疗。--癌症,肯定是先用效果最
好的一线化疗方案,不行二线,三线,最后不行clinical trials。直肠癌还有用
bevacizumab, cetuximab一起和化疗治疗。你可以问问医生。不过两个药都很贵就是了
。(你在美国是买不到的)
辅助治疗怎么辅助法?symptom management?
病情暂时稳定-病人还如何痛苦法?有什么症状需要治疗? |
|
b****y 发帖数: 1867 | 12 请问这几种药物在美国可以买到么?需要处方么?谢谢了. |
|
f****o 发帖数: 2770 | 13 问】我没有处方,如何买到静脉注射的化疗药物呢?
【答】静脉注射(IV)的化疗药物(Chemo)不是靠处方买的。药店是没有权利购入IV
Chemo的。病人都是直接去oncology infusion clinic,医院,门诊去接受infusion。 |
|
|
|
I****a 发帖数: 407 | 16 what you do now: start taxol plus avastin.
与此同时取活检查T790M mutation,为将来用Afatinib alone or Afatinib plus
cetuximab 做准备. Afatinib is not even readily available for us patients so
it might take a great while for Chniese patients.
前面的回答都挺好但不实际. |
|
I****a 发帖数: 407 | 17 what you do now: start taxol plus avastin.
与此同时取活检查T790M mutation,为将来用Afatinib alone or Afatinib plus
cetuximab 做准备. Afatinib is not even readily available for us patients so
it might take a great while for Chniese patients.
前面的回答都挺好但不实际. |
|
m********t 发帖数: 13072 | 18 不要不服气,给你看一样东西,你去翻翻最近10年的会议,检验我说的每句话对不对。
ASCO:现有抗肿瘤药物最新研究进展
来源: 王国庆的日志
美国临床肿瘤学会(ASCO)2010年度会议于6月4-8日在芝加哥开幕。虽然新的抗肿瘤药
物依然是本次年会的关注重点,但现有药物最新研究进展同样也引起大家的高度关注。
以下是在本次年会上报道的某些现有抗肿瘤药物的最新研究进展要点。
Sprycel(扑瑞赛,Dasatinib达沙替尼):一项临床研究表明,百事美施贵宝(BMS)
的Sprycel对于新确诊的CML患者的疗效优于标准治疗药物格列卫(Gleevec)。目前
Sprycel为CML二线治疗药物,依据此项临床研究数据,BMS争取将Sprycel申报为CML一
线治疗用药。
Avastin(阿瓦斯汀,Bevacizumab贝伐单抗):一项三期临床研究结果表明,对于已经
出现转移的晚期卵巢癌患者,接受罗氏制药的Avastin联合其他化疗药物,再单独应用
Avastin,与只接受化疗相比,无进展存活率提高。
Erbitux(爱必妥,Cetuximab西妥昔单抗):Erbitux是礼来/BMS公司上市... 阅读全帖 |
|
w******y 发帖数: 8040 | 19 嗯,avastin多好的一个主题, 歪楼歪的太快了
FDA手下放了很多烂药, avastin是一个, cetuximab是另外一个
然后还慢慢腾腾的提出撤架要求, 就像唱双簧一般, hehe
这种烂药就该限定较低的价格
楚。
Ferrara本
的话
药厂
resear |
|
y****6 发帖数: 196 | 20 The in vivo application of fluorescence imaging is limited by its
penetration capability. Consequently, non-invasive diagonostics of human
tumor or other diseases is not that attactive. However, image-guided-surgery
is surface imaging. The advantage is that it can help the surgeon to
determine the tumor margin and/or identify small tumor tissues that are not
so obvious under naked eyes. This application does not limit to breast
cancer. The key here is to use cancer-specific targeting agents. It ... 阅读全帖 |
|
Z**********g 发帖数: 222 | 21 离治疗还远着吧。结直肠癌中APC, TP53, SMAD4,and KRAS mutations早八百年就知道
了吧,现在有靶向这些的药物吗??更别说新鉴定的mutation了。对病人有用的信息可
能就是KRAS mutation,可以指导是否用panitumumab或cetuximab靶向药物。 |
|
T****u 发帖数: 424 | 22 他俩说的并不矛盾。
主要是所有这些对鳞癌效果都不佳,培美曲塞尤其不佳。
指南上建议培美不用于鳞癌治疗。
鳞癌:
EGFR positive ->靶向治疗 TKI
鳞癌本身EGFR突变就不高。白人人群大约2%-3%,亚洲人群的数据是10% (
南方吴一龙的数据),在北方人群据说有20%。因此也routine检测EGFR,使用TKI也较多
。但TKI靶向效果也不好,机理待解决。->进展之后,二线 -〉多西/platin类-〉进展
三线
EGFR negative -〉一线化疗(vinorelbine,platin)or cetuximab->进展之后,二线
-〉多西/platin类 |
|
m***T 发帖数: 11058 | 23 现在很多人还没有意识到个性化医疗的重要性。我举个我前几天和几个肿瘤科和病理科
的大夫们讨论的例子。PTEN deletion和PTEN mutation对于药物Cetuximab的反应正好
相反。所以如果大家千篇一律吃同一个药、同一剂量,有的人可能会中毒,而另外的则
可能还没到治疗剂量。如何有效的根据病人的不同情况合理用药,是个很重要的课题。
medicine,
★ 发自iPhone App: ChineseWeb 8.7 |
|
y******m 发帖数: 14 | 24 NEW YORK, Jan. 10 /PRNewswire-FirstCall/ -- ImClone Systems Incorporated (
Nasdaq: IMCL - News) and Bristol-Myers Squibb Company (NYSE: BMY - News)
today announced that a Phase III study of ERBITUX® (cetuximab) plus
FOLFIRI (an irinotecan- based chemotherapy) met the primary endpoint of
increasing median duration of progression-free survival over FOLFIRI alone
in patients with previously untreated metastatic colorectal cancer (mCRC).
More than 1,000 patients were recruited from around the wo |
|
m*********3 发帖数: 1425 | 25 Sometimes, Fab N-glycan is important for activity. Indeed, Cetuximab has two
N-glycosylation sites. Furthermore, other glycoprotein such as EPO has
three N-glycosylation and one O-glycosylation, you can't just mutate the
sequence and remove all of them. |
|
d********h 发帖数: 2048 | 26 More information about the company:
ImClone Systems is dedicated to developing and commercializing novel
therapeutic products in the field of oncology. Our efforts have resulted in
a commercially available novel therapy, ERBITUX® (cetuximab), as well
as a broad spectrum of innovative product candidates with potential
application in multiple tumor types. As a member of the oncology community,
we are committed to providing treatments to meet the unmet needs of cancer
patients. To fulfill this |
|
yf 发帖数: 272 | 27 Afatinib 对T790M mutation 没有效果。不要浪费钱了。要用afatinib+Cetuximab. 或
者参加临床试验,astrazanaca 有一个专门对付T790M的新药,clinicaltrial ongoing
. Data 还没出来,但是估计很好。几天以后ASCO会有preilim data |
|
|