分子靶向药物副反应诊断及处理_罗素霞

,,,--“,”,MoleculartargetedtherapyMoleculartargetedtherapyIRESSA)(TARCEVA)C-225AVASTIN)......Moleculartargetedtherapy20%ADRS18%CTC3-4ADRS1%1)75mg/m2250mg/day1:118812(1)PS0-2EGFR(FISH)—INTEREST*CTC291(40.7)62(8.5)400(55.9)272(37.3)CTC3-478(10.9)30(4.1)102(14.3)59(8.1)15(2.1)6(0.8)28(3.9)31(4.3)130(18.2)28(3.8)210(29.4)161(22.1)588(82.2)527(72.3)668(93.4)687(94.2)(N=715)®(N=729)(N=715)®(N=729)n(%)*—INTEREST≥10%(1)123(17.2%)109(15.0%)171(23.9%)49(6.7%)*102(14.3%)108(14.8%)117(16.4%)120(16.5%)151(21.1%)159(21.8%)*334(46.7%)182(25.0%)*73(10.2%)360(49.4%)/*254(35.5%)23(3.2%)187(26.2%)148(20.3%)177(24.8%)255(35.0%)(N=715)®(N=729):N(%)*—INTEREST≥10%)(2)113(15.8%)24(3.3%)126(17.6%)8(1.1%)()10(1.4%)111(15.2%)84(11.7%)34(4.7%)()72(10.1%)9(1.2%)74(10.3%)71(9.7%)*121(16.9%)79(10.8%)118(16.5%)69(9.5%)93(13.0%)67(9.2%)*112(15.7%)48(6.6%)*(N=715)®(N=729):N(%)*—INTERESTWHO,WorldHealthOrganization;PS,performancestatus1:11812WHOPS0-2250mg/day75mg/m23PFS(III)2008ASCOLeeDH—ISTANA1625ILD3.73.94.917.1—ISTANAA,AE,;SAE,;CTC,n(%)CTC3-4n=81(%)79(97.5)17(21.0)13(16.0)4(4.9)6(7.4)n=76(%)72(94.7)21(27.6)19(25.0)2(2.6)7(9.2)n=81(%)69(85.2)5(6.2)3(3.7)1(1.2)3(3.7)n=76(%)58(76.3)12(15.8)9(11.8)0(0.0)4(5.3)a—ISTANA**2(TARCEVA)EGFR:EGFRLacoutureM.NatRevCancer2006;6:803–127–10EGFRIsBR21TRUSTPA3EGFR-TKIEGFRIs---ororEGFRIs—EGFRIs—31.13.5374423275343--10--LVEF72417--71--515837/(%)(%)(%)Temsirolimus:25mgSunitinib:50mgQD:400mgBIDLVEFmTORNaeemBhojani.etal.Eururol(2007).doi:10.1016/j.eururo.2007.11.037456023146512457144213040772184145/--204719(%)(%)(%)Temsirolimus:25mgSunitinib:50mgQD:400mgBIDNaeemBhojani.etal.Eururol(2007).doi:10.1016/j.eururo.2007.11.037,---6~7---400mgbid(300mg-600mgbid)/TTPp0.05D.Strumberg,etal.EuroJCancer(2006);42:548-556.VEGF1~2[]5.6%---,------751681218%)(0.10ng/ml)651320%LVEF*(50%)753547(150/100mmHg)7575681175811N(%)TammyFChu,etal.Lancet2007;370:2011---LVEF---QTECGQT---(,,,)---®:74/25,000(0.3%)010203040VogelC,etal.JClinOncol2002;20:719–26Cook-BurnsN.Oncology2001;61(Suppl.2):58–60(%)164200.00.51.01.52.02.53.0HR=5.94.1%0.8%®()ACPHn=850,31CHFs,0ACPn=814,4CHFs,1Tan-Chiuetal2005NSABPB-31:3.3%(%)HRRelativeRisk5.9:a(NYHAIIIandIV)(II,IIIandIV)LVEF1(0.1)0(0.0)3(0.2)13(0.8)0(0.0)13(0.8)33(2.0)62(3.7)87(5.2)(%)an=17191-n=1682ACHF,;NYHA,;LVEF,St.gallen2009ACE,LVEFACE,®LVEF1009080706050403020100-10001002003004005006007008009001000LVEF(%)Studyday®(LVEF)————2)113——1--1B,(HACA1%)HAMA3(12—375mg/m21-4mg/ml,1150mg/h,3050mg/h400mg/h(5.2H):100mg/h30100mg/h,400mg/h(3.2H)50%12()(NSCLC)/KabbinavarF.JClinOncol2003;2160–5HurwitzH.NEJM2004;3502335–42GiantonioBJ.2005GastrointestinalCancersSymposium;2005127–29;HollywoodFLUSA.Abstract169a4--VEGFVEGF*VEGFVEGF