非小细胞肺癌脑转治疗方法荟萃（更新于2011年11月9日）

老马 · 发表于 2013-11-28 13:12:25

Continuous pemetrexed treatment for brain metastasis in non-small cell lung cancer-A report of two cases.
Nobuaki Ochi, Hiromichi Yamane, Tomoko Yamagishi, Nagio Takigawa
Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan.
Lung cancer (Amsterdam, Netherlands) (Impact Factor: 3.14). 12/2012; DOI:10.1016/j.lungcan.2012.12.010
Source: PubMed
ABSTRACT Brain metastasis is a major complication in patients with advanced non-small cell lung cancer (NSCLC), which is the malignancy that metastasizes most frequently to the central nervous system (CNS). Although the CNS is protected from cytotoxic agents by the blood-brain barrier under normal conditions, the blood-brain barrier is thought to become less functional in the presence of brain metastasis. Here, we describe two NSCLC patients who relapsed with brain metastases. Following brain stereotactic irradiation, salvage chemotherapy using pemetrexed was given. Continuous pemetrexed treatment resulted in no recurrence, including brain metastasis, over 2 years without whole-brain irradiation. Our experience suggests that pemetrexed suppresses brain metastasis after stereotactic irradiation.

http://www.researchgate.net/publ ... report_of_two_cases

老马 · 发表于 2013-11-28 13:17:35

ACR Appropriateness Criteria® multiple brain metastases.
http://www.guideline.gov/content.aspx?id=35161

ACR Appropriateness Criteria multiple brain metastases.pdf (967.81 KB, 下载次数: 57)

不平则鸣 · 发表于 2013-11-28 21:03:48

请教老马老师，本人2010年底发现肺腺癌早期，进行了根治手术，四次吉西他滨加顺铂的化疗，此后一直吃中药，今年9月复查发现小脑单转（其他部位均好），又进行了切除手术，然后又进行了2次化疗（紫杉醇加顺铂）。进行了基因检测，EGFR基因21外显子突变。现在想吃靶向药。想请教一下：1、现在体内无病灶，抗原指标也一直正常，吃正版靶向药可以获赠吗？2、吃易瑞沙还是特罗凯？3、吃鸦胆子油有用吗？

不平则鸣 · 发表于 2013-11-29 09:46:48

不平则鸣发表于 2013-11-28 21:03

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请教老马老师，本人2010年底发现肺腺癌早期，进行了根治手术，四次吉西他滨加顺铂的化疗，此后一直吃中药， ...

谢谢回复！我主要是担心如果今后复发治疗难度更大，所以想象憨叔那样吃靶向药把癌细胞控制住不让他复发。这样是否比出现病灶再上靶向要好。此外，我现在已做了两次化疗（紫杉醇加顺铂），是否有必要做完4次？如果有脑转，特罗凯的效果是否更好？再次谢谢马老师！

snowswan721 · 发表于 2013-12-7 23:07:23

yezi 发表于 2011-10-15 22:00

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我妈妈一直是脑转的问题控制不住，所以很感谢老马开了脑转治疗专贴。借这个帖子简单描述下我妈妈脑转用过的 ...

楼主你好，你妈妈当时脑转是什么症状啊，放疗后吃特效果很明显啊？我妈今天化疗第二天，用的是卡莫司汀，不知道此药效果如何，医生建议先化疗然后局部放疗，我想如果化疗效果好，是否可以试试特呢，我妈基因无突变不知道可否试特呢？因为肺转移头，我很害怕耽误治疗，您给看看如何是好呢？

snowswan721 · 发表于 2013-12-7 23:11:49

snow0371 发表于 2013-11-15 10:31

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帖子全部看完了，谢谢老马为我们大家的辛勤付出，可惜最近几天才注意到到妈妈全脑放疗后继发的语言障碍、肢 ...

全脑放的后遗症是什么时候体现出来的呢？为什么给我妈看病的医生说他从医这么久没发现全脑放就立马傻的，大概都是过十年二十年才会体现出来的，真是这样吗

snow0371 · 发表于 2013-12-9 14:48:41

snowswan721 发表于 2013-12-7 23:07

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楼主你好，你妈妈当时脑转是什么症状啊，放疗后吃特效果很明显啊？我妈今天化疗第二天，用的是卡莫司汀， ...

其实全脑放疗并没有用够全量，一般大夫会用总量的80%，还留20%这剩下的计量是给大病灶单个治疗准备的，我妈妈全脑放疗完以后有些后遗症，肢体没以灵活了（也许是脑水肿的原因），单个放疗（射波刀）做了三次，一次是脑、一次纵膈和肺、一次肝脏，历时一年多（每次放疗中间也需要休息），现在行动越来越不好了基本上卧床了，具体是因为病情还是因为放疗这个我不能完全定性，但是我们去做射波刀，上海复旦大学射波刀中心的大夫跟我们说，现在放疗的有一种趋势就是长一个做一个这样病人的生活质量高，当初我们做全脑放疗的时候也不知道有射波刀这样的手段，当时做全脑放疗的时候主要考虑的是把脑部能够看到的和看不到的小病灶都控制一下，现在妈妈脑部稳定，但是生活质量的确不高，我们要求也不高人在就行了，能看到她大家都很觉得很开心，即使是现在如果能够从新选择具体做不做全脑放疗我估计我仍然会纠结。

老马 · 发表于 2013-12-13 12:14:22

罗氏的Brain Shuttle技术
http://www.roche.com/research_an ... s/brain_shuttle.htm
Brain Shuttle is a technology that we have developed at Roche to increase penetration of large molecules such as antibodies into the brain. Access of large molecules to the brain is restricted by the blood brain barrier (BBB), a gatekeeper between the blood and the brain tissue that carefully filters which molecules can enter the brain. By using the Roche antibody engineering platform, we have created antibodies that are able to cross the blood brain barrier by binding to one of the protein receptors located on its surface. The so-called “brain shuttle” technology could potentially transport all types of therapeutic molecules into the brain, regardless of their intrinsic ability to cross the blood brain barrier.

beleon · 发表于 2013-12-21 10:44:05

老马老师您好,
爸爸四期低分化腺癌脑转靶向请教
http://www.yuaigongwu.com/forum. ... 8&fromuid=30155
(出处: 与癌共舞)
服易3个月后,一切指标正常,CEA:4.63;
空窗20天,CEA维持在4.60;
空窗43天CEA上升到5.94;检测医院参考值范围:0-6.5;
是等CEA指标超过6.5再重新服易好,还是现在就该服易?

老马 · 发表于 2014-1-3 11:47:26

Associations between Single Nucleotide Polymorphisms in the PI3K/PTEN/AKT/mTOR Pathway and Increased Risk of Brain Metastasis in Patients with Non-Small-Cell Lung Cancer
http://clincancerres.aacrjournal ... stract.html?papetoc
Purpose:Non-small cell lung cancer (NSCLC) metastasizes fairly often to the brain, but identifying which patients will develop brain metastases (BM) is problematic. The phosphatidylinositol-3 kinase (PI3K)-AKT-mammalian target of rapamycin (mTOR) signaling pathway is important in the control of cell growth, tumorigenesis, and cell invasion. We hypothesized that genotype variants in this pathway could predict BM in patients with NSCLC. Experimental Design:We genotyped 16 single nucleotide polymorphisms (SNPs) in 5 core genes (PIK3CA, PTEN, AKT1, AKT2, and FRAP1) by using DNA from blood samples of 317 patients with NSCLC and evaluated potential associations with the subsequent development of BM, the cumulative incidence of which was estimated with Kaplan-Meier analysis. Multivariate Cox regression analysis was used to analyze correlations between genotype variants and the occurrence of BM. Results:In analysis of individual SNPs, the GT/GG genotype of AKT1: rs2498804, CT/TT genotype of AKT1: rs2494732 and AG/AA genotype of PIK3CA: rs2699887 were associated with higher risk of BM at 24 months' follow-up (respective hazard ratios [HRs] 1.860, 95% confidence interval [CI] 1.199-2.885, P=0.006; HR 1.902, 95% CI 1.259-2.875, P = 0.002; and HR 1.933, 95% CI 1.168-3.200, P=0.010). We further found that these SNPs had a cumulative effect on BM risk, with that risk being highest for patients carrying both of these unfavorable genotypes (P=0.003). Conclusions:Confirmation of our findings, the first to indicate that genetic variations in PI3K-AKT-mTOR can predict BM, in prospective studies would facilitate stratification of patients for BM prevention trials.