肺鳞30月，父亲永远地走了

4.15 复查
/ |1 B# a) y0 R' B: {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。
  ^. E6 o0 ~3 G9 Z" ]. k6 X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：
CEA 1.76
$ v3 e; J. x6 s( w( DCA125 162.6 继续升高，估计2992耐药或部分耐药了
) Q3 W9 Q8 o1 p$ A. ^/ W( W- g; KCA199 8.48
. U3 z( }- Z- v7 f" `6 wCA153 17.82
/ L. f5 t) ?, k0 ~6 R7 i7 k$ yNSE 14.95
5 @4 G- H# w! U6 E: O* {! ^6 V

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。
纠结ing

; p- h4 e9 f- a  k8 }/ I. H3 O& C. W
  f1 Z1 F$ ]6 Y+ O) g现在考虑的方案：
$ G2 n7 \( d  h) T8 a: G4 z1、试试易(平安老师认为肺癌不试试易可惜）
5 I' K5 ^0 V/ B& }. e2、2992+半量xl184
/ \, O  x$ W  P  q) R/ S4 X8 P) F4 l3、2992加量
凡德有试过，无效

7 ]2 u  [, P4 z
爱老虎油！ 2013/4/17 星期三 18:56:31
$ O, i0 ]9 H' L7 c  T2 }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
平安姐，我父亲是鳞、吸烟，是不是也试试
% V  D+ `3 d) o' p+ z6 b( H滴水(luxd)  20:34:25
8 S9 c- l! c, V( i3 z  [之前就是考虑鳞+男性+吸烟，直接上的特。现在考虑：
2 H" T) e; v8 {1、试试易
8 U# W' d3 L8 e6 D2 W8 T2 L, U; B2、2992+半量xl184
3、2992加量
凡德有试过，无效
4 J3 N* s' s! e爱老虎油！  21:31:42
如果病情紧急就上2，不紧急就试试易

7 ~, e$ `+ \, K. ^7 q- h3 {
考虑方案4：替吉奥

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.

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。
) j  W, L, o9 Q; I& vhttp://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：
. S" z; y) K  y' p1、特、2992均已耐药，易有效的可能性很低；
2、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；
0 Z# U2 g1 p! K) f* k  x3、如果不准备把2992用绝，联用方案也先不考虑：
' `* [* r7 E2 S2 m4 W0 L3 q--2992+184，平安老师认为在危急的时候用；
2 i' _# S. s( T9 u0 V  W--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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