Thursday, March 28, 2013

More on lung cancer
*10-15% of Squamous and Adenocarcinoma will be misdiagnosed by Transbrochial biopsy (Soler et al.).
* On tissue, test TTF1 to confirm presence of Adenocarcinoma
and P63 for Squamous histology
*Definitely check for EGFR status prior to giving the first treatment because gefitinib gives consistently higher response rate and progression free survival  in various trial (NEJ002, WJTOG, OPTIMAL and EURTAC)
*Give Crizotinib if ALK positive tumor! (AT 250MG PO BID)(SAME DOSAGE WITH GEFITINIB!)
*Remember KRAS tranduce or is downstream the EGFR stimulation.
However Amplification of KRAS "may indicate lack of responsiveness to EGFR-TKI (Tyrosine Kinases Inhibitors).

ROS-1
is in close proximity to ALK
Use Crizotinib in ROS -1 positive patients

MetMAb
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MET amplification does give worse prognosis to cancers
MET amplification does give resistance to Gefitinib/Erlotinib

IN SECOND LINE SETTING (AFTER FAILURE OF ONE REGIMEN IN METASTATIC LUNG CANCER) TAXOTERE WAS EQUALLY EFFECTIVE TO PREMETREXED.  BUT FOR AN UNCLEAR REASON, PREMETREXED DID BETTER IN LARGE CELL CANCER TYPE.  THIS IS AN INTERESTING ISSUE.  (HANNA N ET AL. FOR ORIGINAL JCO ARTICLE).

  
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