肺鳞30月，父亲永远地走了

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4.15 复查
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。
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：
, H! |  I0 }3 F: R1 @4 L0 nCEA 1.76
CA125 162.6 继续升高，估计2992耐药或部分耐药了
CA199 8.48
CA153 17.82
NSE 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。
2 `, [1 |0 f: h  p纠结ing

6 \" Y" i7 w) |  l' i  c
0 ]& C2 Y$ \- Z9 p& A现在考虑的方案：
' i* H- s. t$ U; p/ H7 k1、试试易(平安老师认为肺癌不试试易可惜）
2、2992+半量xl184
3、2992加量
# e# ~0 L9 _- H6 `9 x$ U/ z& _凡德有试过，无效
& _" s, w# ~& F* K1 X3 [( E0 V

爱老虎油！ 2013/4/17 星期三 18:56:31
$ B+ z! `" y3 q$ l9 h) [易用过吗？没用过试试易吧，肺，不用易太可惜了
9 i0 j, t' w$ n  l/ E1 E8 D5 ~- L. a滴水(luxd)  20:20:13
平安姐，我父亲是鳞、吸烟，是不是也试试
滴水(luxd)  20:34:25
( ^; }5 X1 J  t1 }之前就是考虑鳞+男性+吸烟，直接上的特。现在考虑：
7 j5 @$ Y+ j3 V" ^# b0 F# S1、试试易
' N- Q. [) a% n2 |& ~) l, L2、2992+半量xl184
3、2992加量
凡德有试过，无效
爱老虎油！  21:31:42
如果病情紧急就上2，不紧急就试试易
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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.
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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
4 `2 y8 h) E* i7 H5 k4 l5 @# e& @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；
  B2 F' I( H% y! g2、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：
6 }; Q5 K5 P6 n$ }- m& e# v6 N--2992+184，平安老师认为在危急的时候用；
& `) K4 o) K8 e9 ^3 R3 A! H--2992+替http://www.ncbi.nlm.nih.gov/pubmed/20530710，2992已经耐药，就先不考虑联用了；
8 V2 w; q/ G- g1 P4 D/ S+ c5、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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