璩�(g貌u)鐗╂寚鍗�
璩�(g貌u)鐗╀繚闅�
鏀粯鏂瑰紡
閰嶉€佹湇鍕�(w霉)
鍞悗鏈嶅嫏(w霉)
闂�(gu膩n)浜庢垜鍊�
鎮ｈ€呭彲浠ラ伕鎿囧湪閱�(y墨)闄㈡垨鑰呰棩搴楄臣(g貌u)璨风壒鐖剧珛锛屽湪閮ㄥ垎鍦板崁(q奴)宸茬稉(j墨ng)閫�(j矛n)鍏ヤ簡閱�(y墨)淇濈洰閷勭暥(d膩ng)涓�銆傜壒鐖剧珛闋�(y霉)闃插拰娌荤檪鑵槫鏀剧檪鎴栧寲鐧傚悗寮曡捣鐨勭櫧绱�(x矛)鑳炴笡灏戠櫏锛涙不鐧傞楂撻€犺姗�(j墨)鑳介殰绀欏強楠ㄩ珦澧炵敓鐣板父缍滃悎寰�锛涢爯(y霉)闃茬櫧绱�(x矛)鑳炴笡灏戝彲鑳芥經鍦ㄧ殑鎰熸煋骞剁櫦(f膩)鐧�锛涗娇鎰熸煋寮曡捣鐨勪腑鎬х矑绱�(x矛)鑳炴笡灏戠殑鎭㈠京(f霉)鍔犲揩銆� 瑭虫儏
鐧借鐥呮槸涓€绋棦鍙互鍑虹従(xi脿n)鍦ㄥ厭绔ヨ韩涓婁篃鍙互鍑虹従(xi脿n)鍦ㄦ垚骞寸兢楂旇韩涓婄殑鐤剧梾锛岄渶瑕佸灏�(du矛)鐥呮儏閫�(j矛n)琛屼簡瑙�锛屾湁闇€瑕佺殑鏅�(sh铆)鍊欓倓闇€瑕佺敤钘ユ不鐧�銆傝€岀儚鑻編鍙哥墖鐢ㄦ硶鐢ㄩ噺锛氭垚浜�锛屼竴鏃�30mg锛�3鐗囷級锛屼竴娆★紙鏃╂櫒绌鸿吂鍙ｆ湇锛夋垨鍒�3娆″彛鏈�锛涘厭绔ラ厡娓�锛屾垨閬甸啱(y墨)鍥�锛涘鐧ョ媭绶╄В锛屽彲姣忓懆鏈嶇敤2锝�3娆�銆� 瑭虫儏
鐣欏彲鐒讹紙鑻竵閰告爱鑺ョ墖锛変富瑕佹垚鍒嗙偤鑻竵閰告爱鑺�锛屽寲瀛�(xu茅)鍚嶇ū锛�4-[闆�(2-姘箼鍩�)姘ㄥ熀]鑻竵閰搞€傚湪钘ョ墿娌荤檪閬�(gu貌)绋嬩腑锛屾偅鑰呮噳(y墨ng)鍤�(y谩n)鏍奸伒瀹堥啱(y墨)鍥�锛屾寜鏅�(sh铆)鎸夐噺鏈嶈棩锛岄伩鍏嶈嚜琛屽娓涘姂閲忔垨鏇存彌钘ョ墿锛屼互鍏嶅紩鐧�(f膩)涓嶈壇鍙嶆噳(y墨ng)鎴栧奖闊挎不鐧傜檪鏁�銆� 瑭虫儏
钘ユ埧鍜岄啱(y墨)闄㈤兘鍙互璩�(g貌u)璨峰埌娉扮憺娌�锛屾湰钘ョ墿灞簬涓€鍖呰棩锛屽彲鐢ㄤ簬IB-IIIA鏈熷瓨鍦ㄨ〃鐨敓闀�(zh菐ng)鍥犲瓙鍙楅珨(EGFR)澶栭’瀛�19缂哄け鎴栧椤瓙21(L858R)缃彌绐佽畩鐨勯潪灏忕窗(x矛)鑳炶偤鐧�(NSCLC)鎮ｈ€呯殑娌荤檪锛屾偅鑰呴爤鏃㈠線鎺ュ彈閬�(gu貌)鎵嬭(sh霉)鍒囬櫎娌荤檪锛屽苟鐢遍啱(y墨)鐢熸焙瀹氭帴鍙楁垨涓嶆帴鍙楄紨鍔╁寲鐧�銆� 瑭虫儏
浜嗚В钘ョ墿鏈唱(zh矛)灏�(du矛)浜庢偅鑰呬締(l谩i)瑾�(shu艒)鏄緢閲嶈鐨勶紝瑗块粌涓告垚浠芥槸楂斿鍩硅偛鐗涢粌銆佷汉宸ラ簼棣欍€侀唻涔抽銆侀唻娌�(m茅i)钘�銆傛湰钘ョ墿鐐烘瑜愯壊鑷抽粦瑜愯壊鐨勭硦涓�锛涙埃鑺抽锛屽懗寰嫤銆傚灞噳(y墨ng)鎺屾彙钘ョ墿鍩烘湰鐭ヨ瓨(sh铆)鑸囨噳(y墨ng)鎬ヨ檿鐞嗘帾鏂�锛岀偤鎮ｈ€呮(g貌u)寤哄叏鏂逛綅鍋ュ悍灞忛殰銆� 瑭虫儏
鐟炲紬铇紙鑹炬洸娉婂笗涔欓唶鑳虹墖锛夐仼鎳�(y墨ng)鐧ワ細閬╃敤浜庢棦寰€灏�(du矛)绯栫毊璩�(zh矛)婵€绱狅紟鍏嶇柅鐞冭泲鐧界瓑娌荤檪鍙嶆噳(y墨ng)涓嶄匠鐨勬垚浜猴紙鈮�18鍛ㄦ锛夋參鎬у厤鐤€э紙鐗圭櫦(f膩)鎬э級琛€灏忔澘娓涘皯鐧ワ紙ITP锛夋偅鑰�?锛涢鍛风矘锛差€垛拋鐛楋紦蹇楀辜鈥(hu谩n)澧冩竻娼�锛屽畾鏈熷皪(du矛)瀹ゅ収(n猫i)閫�(j矛n)琛屾秷姣�锛屽悓鏅�(sh铆)瑕佸仛鍒板嫟娲楁墜锛岄伩鍏嶆帴瑙告劅鏌撴簮銆� 瑭虫儏
鐧借鐥呭湪鎮ｄ笂涔嬪悗鏈�(hu矛)灏�(du矛)鎮ｈ€呯殑韬珨鐢�(ch菐n)鐢熻純澶х殑褰遍熆锛岄渶瑕佺⿳妤电殑閰嶅悎閱�(y墨)鐢熺敤钘�銆傝€岀～鍞戝槍鍛ょ墖娉ㄦ剰浜嬮爡(xi脿ng)锛氳嚧鑲濆姛鑳芥悕瀹�锛屾晠鑲濆姛鑳藉樊鑰呭繉鐢�锛屼害鍙櫦(f膩)鐢熺毊鐤�锛屽伓鑷磋倢鑲夎悗绺紝鐢ㄨ棩鏈熼枔鐢�(ch菐n)鍝佹鏌ヨ璞�銆� 瑭虫儏
鏂扮憺鐧斤紙鑱氫箼浜岄唶鍖栭噸绲勪汉绮掔窗(x矛)鑳炲埡婵€鍥犲瓙娉ㄥ皠娑诧級鐢ㄦ硶鐢ㄩ噺锛氭湰鍝佸湪姣忓€�(g猫)鍖栫檪鍛ㄦ湡鎶楄叓鐦よ棩鐗╃郸钘ョ祼(ji茅)鏉熷悗鐨笅娉ㄥ皠銆傛帹钖︿娇鐢ㄥ姂閲忕偤涓€娆℃敞灏勫浐瀹氬姂閲�6mg?锛涢鍛风矘锛差€垛拋閳р偓(g猫)浜虹殑娓呮綌鍜岃(w猫i)鐢�锛屽灞鐓ч¨濂芥偅鑰�锛屼繚鎸佺梾鎴跨殑骞插噲銆� 瑭虫儏
鍜栧暋閰哥墖鐢ㄦ硶鐢ㄩ噺锛氬彛鏈�锛屼竴娆�0.1g-0.3g锛�1-3鐗囷級锛屼竴鏃�3娆�锛�14鏃ョ偤涓€鐧傜▼锛屽彲閫ｇ簩(x霉)鎳�(y墨ng)鐢ㄦ暩(sh霉)鐧傜▼?锛熜ヤ汉宕烆兒m鎳�(y墨ng)鐧ワ細鐢ㄤ簬澶栫鎵嬭(sh霉)鏅�(sh铆)闋�(y霉)闃插嚭琛€鎴栨琛€锛屼互鍙婂収(n猫i)绉�銆佸│鐢�(ch菐n)绉戠瓑鍑鸿鎬х柧鐥呯殑姝㈣?锛涢鍜傜秿r(sh铆)瑕佹敞鎰忎繚鎸佺毊鑶氱殑娓呮綌锛岄伩鍏嶄娇鐢ㄥ埡婵€鎬х殑娲楄(h霉)鐢�(ch菐n)鍝�銆� 瑭虫儏
涓嶈壇鍙嶆噳(y墨ng)灏�(du矛)鎮ｈ€呯殑鐢ㄨ棩鏈�(hu矛)鐢�(ch菐n)鐢熷奖闊�锛岃€岀櫨澹涓嶈壇鍙嶆噳(y墨ng)锛氬姂閲忚秴閬�(gu貌)200mg/鏃ワ紝鍙娇T绱�(x矛)鑳炴笡灏戝伓鏈夌毊鐤�銆佺槞鐧�銆侀牠鐥�銆侀潰閮ㄦ诞鑵拰涓€浜涙秷鍖栭亾鍙嶆噳(y墨ng)锛屽鎯″績銆佸様鍚愩€佽吂鐎�銆佽粺渚匡紱鍊�(g猫)鍒ュ彲鍑虹従(xi脿n)涓€閬�(gu貌)鎬ц紩搴ST鍗囬珮锛涗竴鑸湪鍙ｆ湇閬�(gu貌)绋嬩腑鎴栧仠钘ュ悗娑堝け銆� 瑭虫儏
钘ョ墿閬�(gu貌)閲忓彲鑳芥渻(hu矛)寮曡捣涓嶈壇鍙嶆噳(y墨ng)锛岀暀鍙劧閬╂噳(y墨ng)鐧ョ偤闇嶅閲戠梾锛屾暩(sh霉)绋潪闇嶅閲戠梾娣嬪反鐦�锛屾參鎬ф穻宸寸窗(x矛)鑳炴€х櫧琛€鐥�锛岀摝鐖剧櫥鏂壒鍊法鐞冭泲鐧借鐧�锛屾櫄鏈熷嵉宸㈣吅鐧岋紱鐣欏彲鐒跺皪(du矛)浜庨儴鍒嗕钩鑵虹檶鐥呬汉涔熸湁鏄庨’鐨勭檪鏁�銆傞亷(gu貌)閲忕殑鎯呮硜涔嬩笅鍙兘鏈�(hu矛)寮曡捣鍏ㄨ绱�(x矛)鑳炴笡灏戙€佺櫜鐧囩櫦(f膩)浣滅瓑鍟�(w猫n)椤�锛岃鍙婃檪(sh铆)鐨勮檿鐞�銆� 瑭虫儏
鍜栧暋閰哥墖瀛曞│浣跨敤鐨勬檪(sh铆)鍊欒鎱庨噸锛屽洜?y脿n)妯佃D鐨勯珨璩�(zh矛)姣旇純鐗规畩锛屽鏋滅敤钘ヤ笉鐣�(d膩ng)鏈�(hu矛)褰遍熆鍋ュ悍鐨�锛屾墍浠ョ敤钘ュ墠瑕佸挩瑭㈤啱(y墨)甯�銆傝€屼笖韬珨涓嶈垝鏈嶇殑鏅�(sh铆)鍊欓倓瑕佸厛鍒伴啱(y墨)闄㈡鏌�锛屽彲浠ユ牴鎿�(j霉)妾㈡煡鐨勭祼(ji茅)鏋滆檿鐞�锛屽钩鏅�(sh铆)瑕侀(y菐ng)鎴愬ソ鐨勭敓娲荤繏(x铆)鎱ｄ締(l谩i)鍋氬ソ鐤剧梾鐨勯爯(y霉)闃层€� 瑭虫儏
鏍规摎(j霉)鐣�(d膩ng)鍓嶇殑閱�(y墨)淇濇斂绛栵紝鏂介仈(d谩)璩芥槸鍙互鍫�(b脿o)閵风殑锛屽叾閬╃敤浜庡皪(du矛)鍖呮嫭鐢茬：閰镐紛棣浛灏煎湪鍏�(n猫i)鐨勬不鐧傛柟妗堣€愯棩鎴栦笉鑳借€愬彈鐨勬參鎬ч珦绱�(x矛)鑳炴ǎ鐧借鐥�(CML)鎵€鏈夌梾鏈�(鎱㈡€ф湡銆佸姞閫熸湡銆佹穻宸寸窗(x矛)鑳炴€ヨ畩鏈熷拰楂撶窗(x矛)鑳炴€ヨ畩鏈�)鐨勬垚浜烘偅鑰�锛涘彟澶�锛岄仈(d谩)娌欐浛灏肩墖鍙敤浜庡皪(du矛)浠ュ線娌荤檪钘ョ墿鑰愯棩鎴栦笉鑳借€愬彈鐨勮不(f猫i)鍩庢煋鑹查珨闄�(y谩ng)鎬ф€ユ€ф穻宸寸窗(x矛)鑳炴€х櫧琛€鐥�(Ph All)鎴愬勾鎮ｈ€�銆� 瑭虫儏
閬厜銆佸瘑闁�銆侀櫚娑煎共鐕ヨ檿淇濆瓨鏄壘鍔涘彲鐨勮帛钘忚姹�锛岃€屽叾鐢ㄦ硶鐢ㄩ噺锛�1.鐢ㄤ簬鐨啔鐤剧梾鐨勬不鐧�锛屽彛鏈嶏紝姣忔棩2锝�3娆�锛屾瘡娆�10mg锛� 2.鐢ㄤ簬鎬ユ€ф棭骞肩矑绱�(x矛)鑳炵櫧琛€鐥呯殑娌荤檪锛屽彛鏈�锛屾寜楂旇〃闈㈢⿳姣忓ぉ45mg/m[sup]2[/sup]锛屾瘡鏃ユ渶楂樼附閲忎笉瓒呴亷(gu貌)0.12g锛屽垎2~4娆℃湇鐢�锛岀檪绋�4~8鍛�锛涙牴鎿�(j霉)娌荤檪鍙嶆噳(y墨ng)瑾�(di脿o)鏁寸敤閲忥紝閬�(d谩)瀹屽叏绶╄В鍚庯紝閭勬噳(y墨ng)绲︿簣妯�(bi膩o)婧�(zh菙n)鍖栨不鐧�銆� 瑭虫儏
璨炶姫鎵舵椤嗙矑鏈夋彁楂樹汉楂斿厤鐤姛鑳�锛屼繚璀�(h霉)楠ㄩ珦鍜岃厧涓婅吅鐨唱(zh矛)鍔熻兘锛涚敤浜庡悇绋柧鐥呭紩璧风殑铏涙悕锛涢厤鍚堟墜琛�(sh霉)銆佹斁灏勭窔銆佸寲瀛�(xu茅)娌荤檪锛屼績閫�(j矛n)姝ｅ父鍔熻兘鐨勬仮寰�(f霉)銆傚瓨鍦ㄦ湁缂烘悕鍟�(w猫n)椤岀殑鐤剧梾鎮ｈ€呭彲浠ュ強鏅�(sh铆)灏囧€�(g猫)浜虹殑韬珨鎯呮硜鍛婄煡閱�(y墨)鐢熶締(l谩i)閬告搰钘ョ墿閫�(j矛n)琛岃檿鐞�銆傚彟澶栵紝涔熻鍘婚棞(gu膩n)娉ㄧ敤钘ユ湡闁撶殑椋查瑾�(di脿o)鐞嗗拰璀�(h霉)鐞嗘柟娉�锛屼繚鎸侀２椋熷妯ｅ寲锛岀偤韬珨鎻愪緵鐕�(y铆ng)椁�(y菐ng)鏀寔銆� 瑭虫儏
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鐢ㄨ棩鍏ㄧ▼鎸囧皫(d菐o)
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瀹夊叏鏀惧績 闅辩閰嶉€�
