在nsclc脑转移中的应用课件.ppt

1，日本京都大学医学院 2，美国田纳西州儿童医院 5，日本仙台东北大学，美国波士顿的哈佛医学院 6，北京协和医院 * * 特罗凯治疗8个月后，给患者进行了用C11 标记的厄洛替尼做为同位素示踪剂的PET/CT检查。静脉注射[C11]-厄洛替尼后60分钟内动态收集示踪剂在脑部的聚集情况 为了避免原先服用的厄洛替尼和[C11]-厄洛替尼示踪剂之间对于受体的竞争性结合，在PET/CT检查前停用厄洛替尼7天 * synchronous * Eur Respir J SCI：5.9分 PS 0：5.8%，1：58.8%；2：29.4% 厄洛替尼 1L：58.8%；2L：29.4%；3L：11.8% * * * September 2004，A 27-yr-old nonsmoking male for cough and dyspnoea.CT showed an alveolar infiltration of the right middle lobe and micronodular pattern in both lungs. Bronchoalveolar lavage revealed a non-mucinous adenocarcinoma. Brain CT and positron emission tomography found a single metastasis at the right cotyloid notch, which was histologically proven. Thus, a stage IV (T4N2M1) adenocarcinoma of pneumonic type previously known as diffuse bronchioloalveolar carcinoma was diagnosed. The bone biopsy revealed an exon 19 deletion of EGFR. The patient was included in a phase II trial (IFCT 04-01) of EGFR-TKI (250 mg/day-gefitinib). A clinical and radiological partial response was noted within 2 weeks. January 2006,the patient had a thoracic and cerebral relapse treated with chemotherapy (six courses of carboplatine) associated with brain irradiation (30 Gy). At 1 month after stopping chemotherapy, a pulmonary relapse occurred and treatment with (150 mg /day-erlotinib) was carried out. until January 2007, when multiple liver metastases were detected. A secondary T790M resistance mutation in exon 20 of EGFR was found on the liver biopsy. Erlotinib was stopped and chemotherapy (cisplatine(80 mg/m2; day 15 day 22)–vinorelbine (25 mg/m2; day 15 day8) one course, followed by pemetrexed (500 mg/m2; day 15 day 22) six courses) commenced. March 2007, the patient complained of headaches and hypoacousia, revealing cerebral metastases (fig. 2a) with cytological proven carcinomatous meningitis. A total of 13 bi-weekly intrathecal methotrexate (15 mg) injections were administrated without effect. Mutational analyses in the cerebrospinal fluid (CSF) showed the exon 19 deletion