凯美纳治疗肺癌脑转移病例分享课件.ppt

精品 精品 精品 精品 精品 精品 血脑屏障是机体参与固有免疫的内部屏障之一，能阻挡病原生物和其他大分子物质由血循环进入脑组织和脑室。 在血管内皮和基板之间的散在分布的一种扁平而有突起的细胞叫周细胞（pericyte） 血脑屏障是指脑毛细血管阻止某些物质（多半是有害的）由血液进入脑组织的结构。血液中多种溶质从脑毛细血管进入脑组织，有难有易；有些很快通过，有些较慢，有些则完全不能通过，这种有选择性的通透现象使人们设想可能有限制溶质透过的某种结构存在，这种结构可使脑组织少受甚至不受循环血液中有害物质的损害，从而保持脑组织内环境的基本稳定，对维持中枢神经系统正常生理状态具有重要的生物学意义。 血脑屏障的这种结构可使脑组织少受甚至不受循环血液中有害物质的损害，从而保持脑组织内环境的基本稳定，对维持中枢神经系统正常生理状态具有重要的生物学意义。 厄洛替尼作为小分子的靶向治疗药物，能一定比例透过血脑屏障，有着得天独厚的优势；对于NSCLC的原发灶、脑转移灶、其他转移灶都有治疗优作用 * 给健康小鼠口服吉非替尼后血浆浓度达峰值时，在中枢神经系统可测得14C放射标记的吉非替尼，但浓度仅为肺中的2%. * A 52-year-old woman without a history of smoking. CT scan revealed bilateral pleural effusion, bilateral innumerable intrapulmonary nodules, and pericardial effusion. Multiple brain lesions compatible with metastatic tumors were found with MRI of the brain. Cytologic examination of the pleural fluid revealed adenocarcinoma, and the patient was diagnosed with metastatic nonsmall cell lung cancer (NSCLC). Simultaneously, a sensitive EGFR mutation (exon 18 G719A) was identified based on analysis of the malignant effusion. After chest-tube drainage, gefitinib was administered, and a partial response was achieved for approximately 1 year. After disease progression on gefitinib, the patient was consecutively treated with several chemotherapy regimens. During the course of therapy, the brain metastases became symptomatic, and she underwent WBRT (total of 30 Gy). In the spring of 2009, erlotinib was administered, and disease stability was obtained for 4 months, followed by a progression of brain metastases with complaints of gait disturbance and dysarthria. Elrotinib was changed to pemetrexed as the sixth-line treatment. 2 weeks after initiation of the agent, her symptoms further deteriorated. The brain MRI and body computed tomography scan showed a further progression of brain metastases (Figure 1A), despite stable extracranial lesions. Erlotinib was given on alternating days at a dose of 300 mg/d. Two weeks after the initiation of high-dose erlotinib, both her clinical