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      如今最近泰瑞沙哪里購買買得到?價格是多少錢一盒?bxyzxq

    1. 采購類型:現貨/標準
    2. 詢價日期:2019-06-08
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      奧希替尼9291購買威號:bxyzxq  艾女士  17161077085

      一、9291簡介


        對EGFR突變的非小細胞肺癌患者,第一代EGFR類藥易瑞沙和特羅凱的有效率相當高,但可惜的是都有耐藥問題。


        2005年William Pao教授及同事發現,在EGFR類藥耐藥后的癌細胞中發現癌細胞獲得了第2個突變——T790M突變。


      azd-9291泰瑞莎


        癌細胞具有“EGFR+T790M”雙突變后,所需要的藥物濃度以幾何倍數急劇上升,藥物濃度不夠后,就耐藥了。有些對易瑞沙敏感的患者,所需要的藥物濃度較低,耐藥后換血漿濃度是易瑞沙3倍以上的特羅凱,也就多得幾個月,有效時間明顯短于之前的易瑞沙,就是因為易瑞沙耐藥后所需要的藥物濃度上升較快。


        針對T790M耐藥機制,4002不少病友已經試過了。4002的缺陷主要有3個,一個是EGFR部分攻擊力不夠,需要聯用EGFR類藥;二個是用量大,導致使用成本高;第3是難入腦。由于專利糾紛,開發WZ4002的科學家重新開發了結構相似的CO-1686,但估計CO-1686延續了WZ4002的EGFR部分攻擊力不足的缺陷,不與EGFR類藥聯用的話,單藥CO-1686所需要的劑量大,因而副作用和費用也大。


        阿斯利康研發的AZD-9291則是CO-1686的競爭者,在EGFR攻擊力方面有明顯改進,費用上比4002低一些,易、特耐藥的病友可重點關注。


        二、劑量   奧希替尼9291購買威號:bxyzxq


        9291具有同時抑制T790M和EGFR的作用,我們可拆分為T790M和EGFR兩部分來分析。其中,T790M部分取4002來參照,EGFR部分取易、特來做參照。


        1、T790M部分:估計T790M部分9291(75mg)=4002(300mg)。


        2、EGFR部分:估計9291對EGFR的攻擊面要小于易瑞沙和特羅凱。


        (1)、如果癌細胞均處于9291、易瑞沙、特羅凱的攻擊范圍的話,EGFR部分的劑量維持*初的推測不變:9291(48mg)=2片易=0.5片特


        (2)、如果癌細胞以前處于易瑞沙、特羅凱的攻擊范圍之內,但有部分處于9291攻擊范圍之外的話,9291仍需要聯用易瑞沙或特羅凱。


        3、如果對有骨轉等需要藥物濃度高的患者,建議9291從75mg或略高一些試起,視效果再考慮加量、聯易或聯特。有骨轉的情況,可考慮聯2片易、或聯2天1片特。


        4、對沒有遠端轉移的易、特耐藥患者,建議9291可從48mg試起。如果患者原來要上到特,可考慮9291(48mg)聯“2天1片特”。


        5、9291對腦轉沒有太突出表現,如腦部出現T790M耐藥,建議考慮嘗試用9291(96mg)來進行4片脈沖吃法,乃至6片脈沖吃法。


        三、適用人群


        1、適用人群自然首先是EGFR類藥耐藥后具有“EGFR+T790M”雙突變的非小細胞肺癌患者。


        很少有患者有條件在EGFR類藥耐藥后再穿刺或其他手段取樣本做基因檢測,所以可根據某些特征來大致判斷哪些患者可能適用。


        (1)、耐藥至少出現在第4個月或更晚,耐藥出現得越晚越可能有效。


        模型實驗中,在一定濃度的EGFR類藥中,經過120天才開始顯現T790M突變。即使略早一些,恐怕前3個月內出現的耐藥患者,其耐藥原因并非由于出現T790M突變,若沒有T790M突變,自然也就不適合用9291。


        (2)、原先吃EGFR類藥,腫瘤體積至少要縮小一半以上,或CEA至少要下降一半以上。9291壓制T790M,目的就是恢復EGFR類藥的藥敏,也就意味著原先癌細胞大部分要對EGFR類藥敏感。


        2、4002耐藥患者。我家4002耐藥后使用9291仍有效,9291分子結構式和4002的明顯不同是沒有氯原子,可能4002和9291對T790M的抑制機理不同,4002耐藥后9291仍有機會有效。


        3、9291的EGFR部分攻擊力也不弱,EGFR突變患者一線使用9291應該也可以。但EGFR突變患者是否一線就使用9291,在抑制EGFR的同時,預防性抑制T790M是否會更有利?只是有這個可能,但沒人試過都不好判斷。而且9291對EGFR的攻擊面可能要小于易瑞沙和特羅凱。


        四、使用注意事項    奧希替尼9291購買威號:bxyzxq


        1、注意可能的CEA滯后問題。


        在有骨轉等多個位置病灶的情況,有可能有CEA滯后情況,這時候不要因為CEA滯后而把有效誤判為無效。


        通常CA125、CA153、CA199比CEA反應更快,可根據反應更快的指標來判斷。指標反應的快慢,通常能在歷史數據中有所體現,可留意。


        CEA滯后通常也就1個月左右,癥狀改善而又單看CEA的話可再吃1個月來判斷。


        2、注意劑量上升可能有乏力的副作用,估計對心臟有影響,我家觀察到的是心率有所升高。

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