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      請問azd9291購買渠道,用法用量 咨詢v好bxyzxq貨真價實

    1. 采購類型:現貨/標準
    2. 詢價日期:2019-06-08
    3. 聯系方式: 報價后可見
    4. 分享到:
      9291購買渠道途徑咨詢 17161077085薇號bxyzxq 艾女士


      一、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。


      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“EGFR+T790M”雙突變的癌細胞,需要同時抑制EGFR和T790M。4002不少病友已經試過。4002的缺陷主要有2個,一個是EGFR部分攻擊力不夠,需要聯用EGFR類藥;二個是不容易入腦。


      由于專利糾紛,4002連人體臨床都沒有開展。但9291對市場的爭奪步伐顯然不會因為對手的4002陷于專利糾紛而停止。4002研發過程中合成過的無 數個化學藥物,4002無疑是NO.1。4002的研發者顯然沒有那么多時間再弄出來一種比4002更完善的新藥,不出意料的話,他們重新開發的結構相似 的CO-1686,應該是其中的NO.2。主力因為專利糾紛不能上場,那就換替補上場。而CO-1686也延續了WZ4002的EGFR部分攻擊力不足的 缺陷,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。


      二、劑量


      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部分的劑量維持最初的推測不變: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或更高一些試起,視效果再考慮是否加量、是否聯易或聯特。如果需要聯易或特,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,視效果再考慮是否加量、是否聯易或2天1片特。不過EGFR耐藥時沒有遠端轉移的患者屬于少數,所以9291適合用低劑量的患者并不多。


      5、9291雖然入腦能力比4002強一些,但對腦轉的表現仍不算太突出,如腦部出現T790M耐藥,建議可從9291(96mg)試起,入腦效果不好再考慮加量或脈沖吃法。


      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4002九個月耐藥后使用9291仍得了七個月,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。


      四、使用注意事項


      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。


      奧希替尼購買渠道途徑咨詢 17161077085薇號bxyzxq 艾女士


      奧希替尼也被稱為泰瑞沙,別名為AZD9291,9291。它是由英國公司阿斯利康開發的第三代非小細胞肺癌EGFR抑制劑。  奧希替尼(泰瑞沙)用于第一代、第二代EGFR治療后耐藥的非小細胞肺癌T790M突變的患者。


      在有針對性的服藥過程中,有許多細節需要患者的注意。編輯了奧希替尼說明書,供患者參考,希望能幫助您了解這種強大的肺癌藥物。


      用法用量:奧希替尼每次服用80mg,每日一次,空腹服用,不能耐受不良反應可減至每日40mg,需要服用藥物直至疾病進展;


      給藥方法:用溫水吞服,如果患者吞咽困難,可以將甲磺酸奧希替尼片溶解在水中并通過鼻管或胃管給藥;


      常見的副作用:奧希替尼最常見的副作用(大于或等于30%)包括皮疹,口腔潰瘍,手足反應,甲溝炎等。部分患者也可能有視覺異常,惡心,腹瀉,嘔吐,便秘,不常見的副作用,如水腫,轉氨酶升高和疲勞;


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