肺癌

    根据网上病友及家属最关心的易瑞沙相关问题，南方医院肿瘤中心罗荣城教授集中作出了一系列解答，期望能给患者及家属一些帮助。
 
1．问：哪些肺癌病人适宜用易瑞沙治疗？
答：易瑞沙主要用于治疗既往接受过化学治疗的局部晚期或转移性非小细胞肺癌。
 
2．问：在什么条件下易瑞沙对肺癌的治疗效果好？
答：目前临床研究结果表明，易瑞沙对东方人种（亚洲人为主）、女性、非吸烟者、肺泡细胞癌或腺癌患者的疗效较高。
 
3．问：易瑞沙对腺癌的疗效高，那么患肺鳞癌或其它非小细胞肺癌的病人服用易瑞沙有效吗？
答：易瑞沙对肺鳞癌的疗效较腺癌和肺泡癌的低。但根据病人实际情况选用易瑞沙治疗后，仍有部分肺鳞癌和其它非小细胞肺癌的病人在服用易瑞沙后可观察到明显疗效。
 
4. 问: 去年底在美国一项关于易瑞沙国际多中心临床试验（ISEL）的初步分析结果显示：易瑞沙不能延长肺癌患者生存期，但为什么易瑞沙在中国仍能正式上市？
答：根据阿斯利康方面提供的资料，这项临床试验结果表明的是不能延长总体病人的寿命，但这项试验同时也发现，易瑞沙对参加试验的东方人种的中位生存期延长了4个月，在东方人群中的整体生存和缓解率要明显优于西方人种。该结果再次证实了以往的临床研究结果提示易瑞沙治疗有效率在东方人种的病人中独具优势。在中国进行的临床试验中，易瑞沙治疗晚期非小细胞肺癌缓解率（CR+PR）达到26.4%，临床受益率（PR+CR+SD）达到50%以上。这些试验结果为易瑞沙在中国的上市批准提供了临床支持数据。
 
5．问：什么情况下选择易瑞沙治疗，什么情况下选择化疗？
答：这是经常令病人困惑的一个问题。目前研究结果表明两者同时使用与单药治疗的有效率无明显差别，故不主张同时联用。易瑞沙现被批准是二线治疗肺癌，主要用于化疗失败后的晚期肺癌，在某些坚决不接受化疗或是对化疗有禁忌的病人也可作为一线用药。但总的主张先考虑化疗，再考虑易瑞沙治疗。易瑞沙治疗失败后，若病人既往未经化疗且身体状况允可，仍可考虑行全身化疗。我们治疗过坚决不行化疗的病人在服用易瑞沙后肿瘤缩小达到部分缓解或完全消退（完全缓解），但易瑞沙治疗1年后出现耐药，肿瘤进展，再次动员病人行全身化疗后仍明显的有效。
 
6.  问：易瑞沙何时起效，何时停用？
答：一般在口服1至2周左右就开始见效，因此服用1个月后可初步评价疗效，若有效，应长期继续服用，直至出现肿瘤进展的情况再考虑停用或调整。
 
7.  问：易瑞沙治疗有效后经济困难能减少用量吗？
答：治疗有效后减量或停用应非常慎重。我们治疗1例在易瑞沙治疗后达到肿瘤完全消退的病人，因经济原因停药后，肿瘤再次复发，重新启用易瑞沙治疗肿瘤再次完全消退。但也有停用后再重新服用无效的病例。
 
8.  问：易瑞沙的副作用是什么，能够在家服药吗？
答：易瑞沙最常见的副作用是腹泻和皮疹，其它有肝功能受损、恶心、呕吐等，但大多数程度轻微，经对症处理后能缓解。另外，在极少数病人中出现间质性肺炎，需要立即住院治疗。建议患者在服药初期在肿瘤专科住院观察，待病情稳定后可返家服药，但仍应定期到医院随诊。
 
9.  问：易瑞沙引起的间质性肺炎可怕吗？
答：全球因易瑞沙所致的间质性肺炎平均发病率约1%，在中国发病率更低些，只有0.5%。致死病例在日本偶有发生，在我国迄今尚未见报道。我们主张在个别已有肺纤维化、接受过大面积放疗和肺功能严重受损的病人中应慎用易瑞沙，以防止发生致命性间质性肺炎。但在相当一部分晚期肺癌病人本身合并有肺部其它疾病（肺结核病、肺气肿、支气管哮喘等），肺部易诱发感染，因此不能完全确定所有的间质性肺炎均为易瑞沙所致。
 
10. 问：肺癌分子靶向治疗的前景？
答：近年来分子靶向治疗新药的陆续上市改变了传统治疗思路和模式，为晚期肺癌患者及家人带来了新希望。分子靶向药物与传统治疗手段的联合，或是不同的分子靶向药物的联用治疗是未来的发展方向。

==== 汉译英 ====

According to online sufferers and their families are most concerned about Iressa related issues, Nanfang Hospital Cancer Center, Professor Luo Rongcheng made a series of answers to focus on, hoping to give patients and their families some help.
 
1. Q: Which of lung cancer patients suitable for treatment with Iressa?
A: Iressa for the treatment of past received chemotherapy for locally advanced or metastatic non-small cell lung cancer.
 
2. Q: Under what conditions Iressa lung cancer treatment for good?
A: Currently, clinical studies showed that Iressa race for the East (mainly Asians), female, non-smokers, alveolar cell carcinoma or adenocarcinoma in patients with a higher efficacy.
 
3. Q: adenocarcinoma of the efficacy of Iressa high, then the risk of squamous cell carcinoma or other non-small cell lung cancer patients treated with Iressa effective?
A: Iressa compared the efficacy of lung adenocarcinoma and squamous cell lung cancer, low. However, according to the actual situation in the patient selection of Iressa treatment, there are still some lung squamous cell carcinoma and other non-small cell lung cancer patients taking Iressa noticeable effect was observed after.
 
4. Q: In the United States late last year a study on Iressa international multi-center clinical trial (ISEL) of the preliminary analysis shows that: Iressa lung cancer patients can not be extended survival, but why Iressa still officially listed in China?
A: According to information provided by AstraZeneca, the clinical trial results showed that it was not possible to extend the overall life of the patient, but this trial also found that Iressa right to participate in testing the East race to extend the median survival time 4 months, the overall population in the east of survival and remission rate was significantly superior to Westerners kinds. The results once again confirm the previous clinical study results suggest that Iressa treatment effectiveness in patients in the East race unique. In China to conduct clinical trials, Iressa treatment of advanced non-small cell lung cancer remission rate (CR + PR) reached 26.4%, clinical benefit rate (PR + CR + SD) to reach over 50%. The results of these trials for Iressa in China, provides a listing of approved clinical supporting data.
 
5. Q: Under what circumstances choose Iressa treatment, under what circumstances choose chemotherapy?
A: This is often a problem in confusing the patient. The present study results show that the simultaneous use of both single-drug therapy had no significant difference in efficiency, it does not advocate the same time, MS. Iressa is currently approved second-line treatment of lung cancer is mainly used for advanced lung cancer after failure of chemotherapy, and in some firmly refused to undergo chemotherapy or have a contraindication to chemotherapy patients who also serve as first-line drugs. But the general idea first consider chemotherapy, and then consider Iressa treatment. Iressa treatment failed, patients without a past and physical condition Yunke chemotherapy, systemic chemotherapy could be considered OK. We are resolute not do chemotherapy treatment for patients taking Iressa shrink the tumor to achieve partial remission or completely dissipated (complete remission), but Iressa treatment a year after the emergence of drug, tumor progression, re-mobilization of patients undergoing systemic chemotherapy after clear and effective.
 
6. Q: When Iressa onset, when disabled?
A: Generally 1 to 2 weeks in the oral or so beginning to bear fruit, so taking a month after a preliminary assessment of efficacy, if valid, should continue to take a long time, until the emergence of tumor progression of re-consider disabling or adjustment.
 
7. Q: Iressa after effective treatment can reduce the amount of the economic difficulties do?
A: The effective treatment after the reduction or disabled, should be very careful. We treat one cases in the Iressa treatment of patients achieved complete tumor regression due to economic reasons, after stopping, tumor relapse, re-enable the Iressa treatment of cancer once again dissipated. But there are also disabled and then re-taking the invalid cases.
 
8. Q: What are the side effects of Iressa, medication can do at home?
A: The most common side effects of Iressa are diarrhea and rash, the other had liver function impairment, nausea, vomiting, etc., but most of them minor, after symptomatic treatment can alleviate. In addition, in a very small number of patients with interstitial pneumonia occurred and requires immediate hospitalization. Recommended medication in patients with early stage tumor specialist at the hospital for observation until a stable condition after returning home medication, but should still be followed up regularly to the hospital.
 
9. Q: Iressa caused interstitial pneumonia frightening?
A: The global result of Iressa-induced interstitial pneumonia incidence rate is about 1% on average in China, a lower incidence of these, only 0.5%. Occasionally fatal cases occurred in Japan in our country has so far not been reported. We advocate the individual had pulmonary fibrosis, received extensive radiation therapy and lung function in patients with severely damaged Iressa should be used with caution in order to prevent fatal interstitial pneumonia. However, a considerable number of patients with advanced lung cancer with lung itself, other diseases (tuberculosis, emphysema, bronchial asthma, etc.), easy to induce lung infection, and can not be completely sure that all of the interstitial pneumonia caused by both Iressa .
 
10. Q: prospects for molecular targeted therapy for lung cancer?
A: In recent years, molecular targeted therapy of new drugs onto the market has changed the traditional treatment of ideas and models for advanced lung cancer patients and their families have brought new hope. Molecular targeted drug combined with traditional treatment, or a different molecular targeted drugs, combined with therapy is the future direction of development.