肺鳞30月，父亲永远地走了

4.15 复查
, j3 i5 [+ ]8 [5 k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。
9 W3 N3 a4 m2 [* F- u$ ^1 p+ H7 c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：
* l- {9 |: _1 v9 D9 mCEA 1.76
3 y2 J6 S7 U- X: N# fCA125 162.6 继续升高，估计2992耐药或部分耐药了
CA199 8.48
CA153 17.82
! U% T* o& D( }5 e5 A4 y2 G3 x- NNSE 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。
# f0 }/ v: }# ~# t7 K纠结ing

2 Z% z7 O" \# w* J/ j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）
8 z4 c( P, |5 d1 d2 Q; d4 M" H2、2992+半量xl184
3、2992加量
凡德有试过，无效

5 L. R% z, I6 J) N1 K
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
- |4 W- l8 y7 D3 i- S滴水(luxd)  20:20:13
, t. t. z4 f3 f0 S" C  N平安姐，我父亲是鳞、吸烟，是不是也试试
滴水(luxd)  20:34:25
, p! ?$ x$ `' l8 d5 C! H/ _4 }; h% O1 L之前就是考虑鳞+男性+吸烟，直接上的特。现在考虑：
: M4 ?3 @1 P$ {" ]; I) g) \1、试试易
8 P$ L: y0 o! a: j6 F2、2992+半量xl184
' W4 C6 B" `0 a# U3 b/ Y3、2992加量
凡德有试过，无效
% i7 Z% o! V7 q) ?. \" g爱老虎油！  21:31:42
如果病情紧急就上2，不紧急就试试易
! ^/ s" o& m+ S5 n0 t. \

考虑方案4：替吉奥

; r3 M$ ^. k0 WS-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.

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。
http://ar.iiarjournals.org/content/30/7/2985.full.pdf
6 d7 t: t- ]7 @1 }- C4 Q+ y: r1 S4 F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：
1、特、2992均已耐药，易有效的可能性很低；
! r: b3 s6 g7 L, u! ?  r: c2、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；
--2992+替http://www.ncbi.nlm.nih.gov/pubmed/20530710，2992已经耐药，就先不考虑联用了；
5、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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