肺鳞30月，父亲永远地走了

4.15 复查
* F. b$ C' j) t" \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。
) x  w7 c/ P2 a# Z% [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：
9 m; l0 b( [, y, i4 s9 Y+ qCEA 1.76
CA125 162.6 继续升高，估计2992耐药或部分耐药了
CA199 8.48
& z3 ?  }4 E, l7 Q" V+ p( ]CA153 17.82
8 D) ^! z) V3 V; UNSE 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。
( A4 r% Y) W5 [/ O4 n. C4 u纠结ing

现在考虑的方案：
8 X: J/ j+ P+ j; L. E1、试试易(平安老师认为肺癌不试试易可惜）
% f- i, K# t! G$ j- r+ Z$ J2、2992+半量xl184
3、2992加量
凡德有试过，无效
2 ~+ x8 x' d  ~2 p: U

爱老虎油！ 2013/4/17 星期三 18:56:31
易用过吗？没用过试试易吧，肺，不用易太可惜了
滴水(luxd)  20:20:13
& B& j' P* H: l3 z5 V平安姐，我父亲是鳞、吸烟，是不是也试试
7 Y$ `8 \6 {7 y/ F滴水(luxd)  20:34:25
3 N9 {3 `2 ~& B' c( r. O之前就是考虑鳞+男性+吸烟，直接上的特。现在考虑：
9 R. f/ C0 l' }2 B+ ~# a1、试试易
2、2992+半量xl184
4 {" ^2 k  G4 A3、2992加量
凡德有试过，无效
爱老虎油！  21:31:42
' W2 y+ i5 M/ @$ @) z: o! x! c- J如果病情紧急就上2，不紧急就试试易
. \* x* H1 w9 p$ c5 @2 d

- A4 S# j/ U, B, E/ w' f6 M
: k4 x  r4 B0 T考虑方案4：替吉奥
" h2 I. z5 B! b* @. {
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.
2 P" P$ x; G8 f# r( V8 E& p
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。
/ ~, A0 A; @3 ]. [" whttp://ar.iiarjournals.org/content/30/7/2985.full.pdf
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：
# t  F0 l+ a* T! f1、特、2992均已耐药，易有效的可能性很低；
7 i6 i# m, h! D8 @& q: e5 q& Y2、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；
. W! I* c- }% Z- `3、如果不准备把2992用绝，联用方案也先不考虑：
7 {$ R3 f1 R9 E% [6 i--2992+184，平安老师认为在危急的时候用；
--2992+替http://www.ncbi.nlm.nih.gov/pubmed/20530710，2992已经耐药，就先不考虑联用了；
1 B. r' L* c! _. |' f5 s5、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

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