非小细胞肺癌（NSCLC）的化疗宝典

非常系统，就是看完后在GP和GC方案之间不知如何抉择了！卡铂的死亡率比顺铂的死亡率高？

边学习，变等待化疗方案出炉！加油，用不止步！

谢谢分享，妈妈正在进行第三轮化疗，学习了很多

谢谢，老马，雪中送炭

依托泊苷 Etoposide VP-16
Oral VP-16 (Etoposide): How I Use It
http://theoncologist.alphamedpress.org/content/2/3/186.full
F. Anthony Greco, M.D.
+ Author Affiliations

The Sarah Cannon-Minnie Pearl Cancer Center, 250 25th Avenue North, Suite 412, Nashville, TN 37203

Background

Variable absorption, but bioavailability is better; (70%-80%) with low daily doses.

Data highly suggest that low plasma levels are as effective as higher levels, and with less myelotoxicity.

Duration of therapy is key element not studied enough. Twenty-one days of oral etoposide appear too long; increases myelosuppression and no increase in activity. Optimal duration appears to be 7-15 days.

Efficacy seems similar when using low doses daily for many days, i.e., 10 p.o. Very low doses can be given i.v. infusion for weeks without major toxicity in most patients.

We use Etoposide incorrectly in nearly all settings; doses too high, duration not quite long enough. Solution: use low doses, 50-100 p.o. qd for 10 days only.

Use of Oral Etoposide in Combination

I think low dose oral etoposide, 50/100 mg daily for 10 days can be substituted in any standard regimen using higher doses of etoposide except germ cell tumors. (I do not have the nerve to do this, but intellectually think it would be as effective and less toxic than 100 mg/m2 daily i.v. × 5 days). We have used oral etoposide as part of a combination for elderly patients with aggressive lymphomas and results are good. Published in JNCI. Until and if further study refutes this, I think the best dose is 50 mg alternating with 100 mg orally for 10 days (the “optimal” dose and schedule).

Use as Single Agent for Palliation—a Long List

Recurrent small cell lung cancer

Recurrent lymphomas

Recurrent germ cell tumors

Recurrent advanced ovarian cancer

Recurrent advanced breast cancer

Recurrent medulloblastoma

Untreated mesothelioma

Untreated advanced gastric cancer

Untreated advanced NSCLC

Kaposi’s sarcoma with AIDS

J Clin Oncol. 1993 Feb;11(2):374-7.
Bioavailability of low-dose oral etoposide.
Hande KR, Krozely MG, Greco FA, Hainsworth JD, Johnson DH.
SourceDepartment of Medicine, Vanderbilt University School of Medicine, Nashville, TN.

Abstract
PURPOSE: To determine the bioavailability of oral etoposide capsules administered at doses of 100 mg and 400 mg.

PATIENTS AND METHODS: The bioavailability of oral etoposide was determined by measuring the area under the etoposide plasma concentration versus time curve (AUC) following intravenous (IV) etoposide administration and comparing that value to the AUC achieved following an oral dose administered 1 day later to the same patient. The bioavailability of a 100-mg oral dose of etoposide was measured on 16 occasions in 11 patients. The bioavailability of a 400-mg dose was determined on 12 occasions in six patients.

RESULTS: The mean (+/- SD) bioavailability following a 100-mg dose of oral etoposide was 76% +/- 22%, which was significantly greater (P < .01) than the mean bioavailability of 48% +/- 18% following a 400-mg oral dose. The coefficient of variation in oral etoposide bioavailability was significant: 29% with a 100-mg oral dose and 37% with a 400-mg dose.

CONCLUSION: Bioavailability of a 100-mg oral etoposide dose is greater than suggested in the package insert from Bristol Laboratories (Evansville, IN). Comparable oral etoposide doses are not uniformly twice that of an IV dose, as suggested by the package insert, but will depend on the final oral dose administered. Bioavailability is better at lower oral etoposide doses. This study confirms the wide interpatient and intrapatient variability in oral etoposide bioavailability.
http://www.ncbi.nlm.nih.gov/pubmed/8426216

Cancer Chemother Pharmacol. 1996;37(4):327-31.
Bioavailability of 50- and 75-mg oral etoposide in lung cancer patients.
Fujiwara Y, Ohune T, Okusaki K, Niitani K, Sumiyoshi H, Takemoto Y, Yamaoka N, Yamakido M.
SourceSecond Department of Internal Medicine, Hiroshima University School of Medicine, Japan.

Abstract
This study was designed to determine the bioavailability of etoposide capsules administered orally at doses of 50 and 75 mg. Patients with inoperable or relapsed lung cancer, who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 and adequate organ function, were eligible. A group of 17 patients were evaluable, all of whom were 75 years old or less, with an ECOG performance status of 0 or 1. The bioavailability of oral etoposide was determined by measuring the area under the etoposide plasma concentration versus time curve (AUC) on days 1, 10 and 21 during a once-daily regimen of oral administration for 21 consecutive days and comparing the value with the AUC achieved following intravenous administration 1 or 2 weeks after the last oral dose. The bioavailability of 50, 75 and 100 mg oral etoposide was determined in six, nine and two patients, respectively. The mean etoposide bioavailabilities (+/- SD) of the 50-mg and 75-mg doses were 47 +/- 11% and 59 +/- 18%, respectively, and of the 100-mg dose in two patients were 51% and 33%, respectively. There was no statistically significant difference in bioavailability between the 50-mg and 75-mg doses. The bioavailability of low-dose oral etoposide was the same as that reported in previous higher dose oral etoposide bioavailability studies and that shown on the package insert supplied by the manufacturer. Improved bioavailability of low-dose oral etoposide was therefore not observed in a population of Japanese patients.
http://www.ncbi.nlm.nih.gov/pubmed/8548877

依托泊苷 Etoposide VP-16
方案：一天一次，一次50mg，空腹，连续服用二周，休息二周，每四周一个疗程。
注：如果是25mg的剂型，可以每天二次，一次25mg服用。
对于50mg每天方案，如果头二个疗程无缓解，副作用微弱，可以加量到75mg每天（1天50mg，另一天100mg或者每天25mg*3）
，或者吃三周停一周。
依托泊苷软胶囊（泊瑞）50mg*10粒 青岛海尔药业有限公司 232元一盒
依托泊苷软胶囊(拉司太特)25mg*40粒 日本化药株式会社 862元一盒。
医保乙类药。

老马 发表于 2013-7-28 19:05

                               
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依托泊苷 Etoposide VP-16
方案一：一天一次，一次50mg，连续服用二周，休息二周，每四周一个疗程。
方案 ...

老马，咨询下这个和化疗的关系是什么？看了3个链接，感觉都没有描述，而且时间好像都蛮早的。

谢谢分享。