小细胞肺癌靶向治疗回顾

小细胞肺癌（small cell lung cancer,SCLC）占肺癌的13％。SCLC虽然对放化疗敏感,但易复发,5年生存率低于5％。随着靶向治疗药物吉非替尼、厄罗替尼等成功用于治疗非小细胞肺癌,靶向治疗亦有可能为提高小细胞肺癌的疗效提供更广阔的可能空间。     

吉非替尼敏感性不同的非小细胞肺癌中miRNA-7表达的差异及临床意义

目的检测吉非替尼敏感性不同的非小细胞肺癌中miR-7的表达差异,并探讨其临床意义。方法采用吉非替尼(Gefitinib)药物大剂量冲击法诱导H827,建立耐吉非替尼肺癌细胞亚系H827-7/GR,有限稀释法将H827-7/GR细胞单克隆化,CCK-8法检测耐药前后细胞株及各单克隆细胞对吉非替尼的敏感性;RT-PCR方法检测H827、H827-7/GR和耐药单克隆细胞株以及其他对吉非替尼敏感性不同的肺癌细胞株A549、H358、H1299、H1650和H1975中miR-7的表达差异。结果 H827/GR耐药指数大于100;获得的6株耐药单克隆细胞株对吉非替尼的半生长抑制浓度(the half growth inhibition concentration,IC50)值不同;和吉非替尼敏感株H827相比,诱导的耐药细胞株H827/GR、耐药单克隆细胞株和吉非替尼耐药株A549、H358、H1299、H1650和H1975中miR-7的相对表达水平均降低(P<0.05)。结论在非小细胞肺癌中,耐药细胞中miR-7的相对表达水平均较敏感细胞系降低,提示miR-7的低表达可能与非小细胞肺癌耐药性相关,其可能是潜在的肺癌药物敏感性预测分子标志物。     

表皮生长因子受体酪氨酸激酶抑制剂ZD1839与奥沙利铂联合对人肺癌A549细胞的作用

背景与目的:ZD1839是一种表皮生长因子受体酪氨酸激酶的小分子抑制剂,是目前肺癌分子靶向治疗中较为成熟的药物,因其单药临床有效率低,如何与化疗联合提高抗癌效应受到关注.本实验通过研究ZD1839联合奥沙利铂的不同给药方案对人肺腺癌细胞A549的杀伤作用,探讨两药联合的最佳模式.方法:以药物联合效应测定方法,评价ZD1839和奥沙利铂不同给药顺序对A549细胞的抑制作用,以流式细胞仪测定不同联合方案对A549细胞周期分布及凋亡率的影响.观察ZD1839、奥沙利铂不同给药方案作用时,裸鼠A549细胞移植瘤生长情况,测定肿瘤生长抑制率.结果:先奥沙利铂后ZD1839的序贯给药方案表现出明显的协同作用,药物联合指数为0.51±0.01;而先ZD1839后给予奥沙利铂时,药物联合指数为1.56±0.03,两药间为拮抗作用.先奥沙利铂后ZD1839组G2/M期细胞比例与其他组相比明显增加,达到37.9%(P＜0.05),细胞凋亡率达到22.3%.体内实验表明,先奥沙利铂后ZD1839组抑瘤率最高,达到58.9%;而先奥沙利铂 ZD1839 24 h后ZD1839 48 h组的抑瘤率为52.4%,ZD1839后奥沙利铂组的抑瘤率为30.6%.结论:先奥沙利铂后ZD1839序贯给药对A549细胞增殖的抑制作用更强.     

吉非替尼在非小细胞肺癌放疗中增敏作用的研究进展

表皮生长因子受体（epidermal growth factor receptor,EGFR）抑制剂吉非替尼（gefitinib,Iressa,ZD1839）在非小细胞肺癌（non-small cell lung cancer,NSCLC）治疗领域的应用已经取得了令人鼓舞的临床疗效,但有关其与放射治疗联合应用的基础与临床研究尚未取得较为明确的结论,本文回顾性总结了吉非替尼在非小细胞肺癌放疗治疗中增敏作用的相关研究进展,以作进一步开展此方面研究的基础.     

肺腺癌吉非替尼获得性耐药相关microRNAs的筛选鉴定

背景与目的肺腺癌吉非替尼获得性耐药严重影响了肺癌的治疗效果,microRNA在肺腺癌吉非替尼获得性耐药中的作用及其机制尚不清楚。本研究筛选与肺腺癌获得性吉非替尼耐药相关的microRNAs。方法以吉非替尼敏感肺癌细胞PC9与吉非替尼耐药肺癌细胞PC9/AB11为细胞模型,观察二者的形态学差异,流式细胞仪检测二者的细胞周期,计算它们的倍增时间,MTT法检测吉非替尼对两种细胞的IC50,应用microRNA芯片检测和筛选与吉非替尼耐药相关的microRNAs,并进行real-timePCR验证。结果 PC9细胞与PC9/AB11细胞形态差异明显,在细胞周期、倍增时间和吉非替尼对其的IC50上均具有统计学差异。microRNA芯片结果显示,与PC9相比,耐药肺癌细胞株PC9/AB11中有4个microRNAs表达水平明显上调,有9个microRNAs表达水平明显下调。经real-timePCR验证,microRNA-138在PC9/AB11中表达明显下调,与芯片结果一致。结论 PC9和PC9/AB11细胞株microRNA表达谱存在明显差异,初步筛选到了13个与肺腺癌吉非替尼耐药密切相关的microRNAs,为进一步深入研究microRNA在肺腺癌吉非替尼获得性耐药中的作用及其分子机制提供了实验依据和理论基础。     

埃罗替尼治疗吉非替尼耐药的晚期非小细胞肺癌有效1例

晚期非小细胞肺癌（NSCLC）预后差,以化疗为主的联合治疗只能降低死亡风险26％-32％。近年来,非小细胞肺癌的靶向治疗成为研究热点,其中尤以表皮生长因子受体酪氨酸激酶抑制剂（EGFR—TKI）进展最快,其代表药物吉非替尼（gefitinib、iressa）和埃罗替尼（erlotinib、tarceva）。我科用埃罗替尼治疗吉非替尼耐药的晚期非小细胞肺癌（NSCLC）一例取得了较好疗效,现报告如下。     

埃罗替尼治疗吉非替尼耐药的晚期非小细胞肺癌有效1例

晚期非小细胞肺癌(NSCLC)预后差,以化疗为主的联合治疗只能降低死亡风险26%-32%[1].近年来,非小细胞肺癌的靶向治疗成为研究热点,其中尤以表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)进展最快,其代表药物吉非替尼(gefitinib、iressa)和埃罗替尼(erlotinib、tarceva).我科用埃罗替尼治疗吉非替尼耐药的晚期非小细胞肺癌(NSCLC)一例取得了较好疗效,现报告如下.     

非小细胞肺癌术前新辅助靶向治疗2例

自2005年2月靶向药物吉非替尼（易瑞沙）上市以来,靶向治疗广泛应用于晚期非小细胞肺癌二线或三线治疗,但术前新辅助靶向治疗尚是一种新的尝试,鲜见报道。2007年4月至2008年5月,浙江医院收治2例新辅助靶向治疗肺癌病人,报告如下。     

MicroRNA-145增强非小细胞肺癌细胞对吉非替尼敏感性及其机制探讨

目的:探讨微小RNA-145（microRNA-145,miR-145）对非小细胞肺癌细胞系吉非替尼耐药的作用及其可能的潜在机制。方法:实时荧光定量PCR（Q-PCR）方法检测正常细胞及非小细胞肺癌细胞中miR-145的表达差异;不同时间5 μmol/L吉非替尼干预肺癌细胞SPC-A-1和A549后,Q-PCR检测miR-145表达变化;miR-145 mimics和miR-145 inhibitors分别转染SPC-A-1和A549肺癌细胞后,CCK8检测细胞活力变化;双荧光素酶报告系统检测miR-145与ADAM19的靶向结合;miR-145 mimics转染SPC-A-1和A549肺癌细胞,Western blot检测ADAM19蛋白表达;Western blot检测5 μmol/L吉非替尼干预后,SPC-A-1和A549肺癌细胞中ADAM19蛋白的表达;miR-145 mimics转染SPC-A-1和A549肺癌细胞,再用5 μmol/L吉非替尼干预,Western blot检测ADAM19蛋白的表达;采用siRNA抑制ADAM19表达,再用5 μmol/L吉非替尼干预,CCK8检测细胞活力;采用BALB/C雌性裸鼠皮下接种肿瘤细胞的方法,观察上述效应。结果:Q-PCR结果显示,与正常肺上皮细胞系BEAS-2B相比较,肺癌细胞SPC-A-1和A549中miR-145表达明显降低;5 μmol/L吉非替尼干预SPC-A-1和A549细胞后,miR-145表达显著上调;转染miR-145 mimics后,CCK8结果显示两种细胞细胞活力下降;双荧光素酶报告系统结果显示,miR-145靶向结合ADAM19基因的3'-UTR区;Western blot结果显示,5 μmol/L吉非替尼诱导SPC-A-1和 A549细胞后,两种细胞中ADAM19蛋白表达均降低;miR-145 mimics转染SPC-A-1和A549细胞,之后给予5 μmol/L吉非替尼治疗,ADAM19蛋白表达下调;siRNA抑制SPC-A-1和A549细胞中ADAM19表达,再给予5 μmol/L吉非替尼治疗,CCK8结果显示,两种细胞的细胞活力显著降低;过表达BALB/C雌性裸鼠的miR-145后,显著抑制皮下肿瘤生长,并且增强吉非替尼的抗肿瘤效果。结论:miR-145显著增强肺癌细胞SPC-A-1和A549对吉非替尼的敏感性,其机制可能是通过靶向结合AMDM19基因的3'-UTR区域,从而抑制其表达。miR-145有可能成为治疗非小细胞肺癌吉非替尼耐药的有效靶点。     

奥希替尼联合抗血管生成靶向药对人肺腺癌细胞抑制作用的实验研究

目的:通过体外细胞学实验初步探究奥希替尼联合两种不同机制的抗血管靶向治疗药物（贝伐珠单抗或阿帕替尼）治疗表皮生长因子受体（EGFR）敏感突变和T790M耐药突变肺腺癌细胞的抗肿瘤活性及其作用机制。方法:培养人肺腺癌细胞PC-9（E19 del）和H1975（E21 L858R/E20 T790M）,CCK-8法检测奥希替尼及抗血管靶向治疗药物（贝伐珠单抗或阿帕替尼）单药或联合处理肺腺癌细胞48 h后的抑瘤率;蛋白质印迹法检测EGFR及其下游AKT和ERK信号通路蛋白表达情况。结果:PC-9和H1975肺腺癌细胞对奥希替尼敏感且呈剂量依赖性。奥希替尼联合抗血管生成靶向药物（贝伐珠单抗,阿帕替尼）较同等浓度的单药奥希替尼可增加对PC-9和H1975细胞株的抑瘤率（P<0.05）。低浓度奥希替尼联合高浓度阿帕替尼（1 000 nmol/L）的抑制作用与高浓度奥希替尼相当（P>0.05）。随着联合的阿帕替尼浓度的升高,对PC-9和H1975细胞抑瘤率也有一定程度的提高（P<0.05）。不同处理因素对PC-9细胞的抑制率均高于对H1975细胞（P<0.01）。随着奥希替尼浓度的上升,p-EGFR、p-AKT、p-ERK磷酸化蛋白表达逐渐降低。结论:奥希替尼联合贝伐珠单抗或阿帕替尼会进一步增强对EGFR敏感突变或T790M突变肺腺癌细胞的杀伤作用。奥希替尼与阿帕替尼联合使用具有很强的抑瘤活性,具有很好的应用前景。奥希替尼单药或与抗血管形成药联合作用可能是进一步下调EGFR及其下游AKT和ERK信号通路的活化。     

Preclinical evaluation of ZD1839 alone or in combination with oxaliplatin in a panel of human tumor cell lines -- implications for clinical use

BACKGROUND: Preclinical studies have suggested antitumor activity of an epidermal growth factor (EGF)-receptor targeted therapy with selective tyrosine kinase inhibitors alone or in combination with conventional cytostatic drugs. However, in non-small cell lung cancer (NSCLC), addition of ZD1839 (Iressa) to combination chemotherapy did not improve the therapeutic outcome. Thus, further work is necessary to define factors predicting outcome of combination therapy. MATERIALS AND METHODS: In the present study, the activity of ZD1839 alone or in combination with oxaliplatin (Eloxatin) was evaluated in 12 human cancer cell lines including colon, testicular, anaplastic thyroid and epidermoid carcinoma cells. RESULTS: The EGF-receptor protein was overexpressed in line A431 (epidermoid carcinoma) and near the minimum detection limit in all other cell lines. The single agent activity of ZD1839 was highest in cell line A431. In the other cell lines, it was lower and appeared to be independent of EGF-receptor expression levels. The relative antitumor activity (RAA) was low (RAA = 1). Combined exposure to oxaliplatin and ZD1839 (IC30) resulted in significant synergy in 4 out of 6 colorectal cancer (CRC) cell lines and significant antagonism in 4 out of 6 non-colorectal cancer cell lines. Continuous exposure to ZD1839 (IC30) induced a marked G1-phase arrest and dephosphorylation of EGF-receptor in A431, whereas no significant cell cycle perturbation could be detected in the low-expression cell lines. Other factors than cell cycle perturbation seem to determine the mode of drug interaction between oxaliplatin and ZD1839. CONCLUSION: Based on RAA, the single agent activity of ZD1839 in the investigated cell line panel appeared to be low. Combined exposure to ZD1839 and oxaliplatin exerted synergy in colorectal cancer cell lines, warranting further evaluation in this type of cancer. However, based on the observed antagonism in non-colorectal cancer cell lines, combined treatment with ZD1839 and oxaliplatin is not recommended for other types of cancer. Further research is necessary to identify factors which determine the nature of drug interaction in different tumor types including CRC and lung cancer.     

Cooperative cell-growth inhibition by combination treatment with ZD1839 (Iressa) and trastuzumab (Herceptin) in non-small-cell lung cancer

An important recent advance in anticancer therapy was the development of molecular-targeting drugs, such as the epidermal growth-factor receptor (EGFR)-targeting drug ZD1839 (Iressa) and the HER2-trageting anti-HER2 monoclonal antibody trastuzumab (Herceptin). ZD1839 and trastuzumab are reported to improve the therapeutic efficacy of treatment for non-small-cell lung cancer (NSCLC) and breast cancer, respectively, although the effectiveness of either drug alone is not satisfactory. NSCLC cells often express both EGFR and HER2. We therefore investigated whether a combination of ZD1839 and trastuzumab had an additive or synergistic antitumor effect. In culture ZD1839 inhibited the growth of four NSCLC cell lines (A549, NCI-H23, NCI-H727, and NCI-H661) that expressed various levels of EGFR, HER2, HER3, and HER4. A significant cytotoxic effect was observed when ZD1839 was combined with trastuzumab in A549 cells. However, this combination had no apparent effect in NCI-H23 cells. Significant G(1)-phase arrest, increased p27 expression and decreased cyclin E or D1 levels were detected in A549 cells treated with ZD1839 and trastuzumab. No significant effects were detected in NCI-H23 cells examined. The combination treatment significantly inhibited the phosphorylation of EGFR, HER2, retinoblastoma, extracellular signal-regulated kinase-1/2, and protein kinase B/Akt in A549 cells, but not in NCI-H23 cells. Our results indicated that increased levels of constitutive EGFR/HER2 heterodimers were formed in A549 cells in the presence of ZD1839, whereas no heterodimer formation was detected in NCI-H23 cells. We therefore suggest that combination treatment with ZD1839 and trastuzumab might have improved therapeutic efficacy against NSCLC cells expressing both EGFR and HER2.     

The sensitivity of lung cancer cell lines to the EGFR-selective tyrosine kinase inhibitor ZD1839 ('Iressa') is not related to the expression of EGFR or HER-2 or to K-ras gene status

ZD1839 ('Iressa') is an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that inhibits EGFR signaling. Emerging evidence indicates that ZD1839 has clinical potential in lung cancer, but very little is known about the molecular characteristics of lung cancers that may determine sensitivity to ZD1839. We examined a panel of 19 lung cancer cell lines to investigate possible association between ZD1839 sensitivity and histological type, expression level and constitutive phosphorylation of EGFR and K-ras gene status. Our results indicate that neither expression level nor constitutive activation status of EGFR seems to predict sensitivity to ZD1839. In addition, ZD1839 sensitivity was not associated with expression of human epidermal growth factor receptor-2 (HER-2), another member of this tyrosine kinase receptor family nor with co-expression of EGFR and HER-2. Finally, no correlation was found between the presence of activating mutations of the K-ras gene, an important downstream mediator of the EGFR-transduced signals and the relative resistance to ZD1839. These findings warrant future study to clarify how ZD1839 inhibits lung cancer cell growth and to find a useful marker for prediction of sensitivity to this novel and promising agent for the treatment of lung cancers.     

Molecular mechanisms underlying the interaction between ZD1839 ('Iressa') and cisplatin/5-fluorouracil

ZD1839 ('Iressa'), an orally active, selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is currently being investigated in clinical trials as a treatment for cancer. 'Iressa' is a trademark of the AstraZeneca group of companies. We have previously demonstrated a synergistic interaction between ZD1839 and cisplatin/5-fluorouracil (5FU) in CAL33, a human head and neck cancer cell line that markedly expresses EGFR. This study examined the effects of this drug combination on the cell cycle, cell cycle regulators, apoptosis-related factors, EGFR-related signalling and DNA repair in CAL33 cells. The cells were incubated with ZD1839 alone for 48 h, then cisplatin and 5FU were added. Exposure to the drug combination continued for a further 48 h. ZD1839 alone induced accumulation of cells in the G0/G1 phase of the cell cycle at 24 h accompanied by a concomitant increase in p21, p27 and Bax, a significant decrease in Bcl2 and a decrease in Akt phosphorylation. A decrease in DNA-PK was observed at 48 h. ZD1839 alone had no effect on caspase-3 activity, but addition of ZD1839 to cisplatin-5FU led to a significant increase in caspase-3 activity at 96 h. Thus, ZD1839 affects key cellular pathways controlling cell proliferation, apoptosis and DNA repair. These data provide a rationale to support clinical trials combining ZD1839 and cisplatin-5FU and other protocols that combine EGFR-targeting agents with chemotherapy or radiotherapy.     

Gene-expression profiles of human tumor xenografts in nude mice treated orally with the EGFR tyrosine kinase inhibitor ZD1839

To date, no single or multiple molecular markers have been successful in predicting sensitivity of individual patients to anti-cancer drugs. As the nature of a specific cancer is considered to be defined by the proteins being expressed in the tumor cells, systematic analysis of gene-expression profiles may provide information reflecting sensitivity of a given tumor to certain drugs. Recent progress in genome technology has enabled us to examine expression profiles of thousands of genes in a single experiment. We used this approach to examine 13 xenografts of human tumors implanted into nude mice for sensitivity to an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), ZD1839 (Iressa). To identify genes that might be associated with sensitivity to this drug we used a cDNA microarray representing 23,040 genes to analyze expression profiles of the 13 xenografts and identified 114 genes whose expression levels correlated significantly with sensitivity of the tumors to ZD1839. We then investigated alteration of expression profiles in response to the ZD1839 treatment in four non-small cell lung cancer (NSCLC) xenografts, of which two (LC6 and LC11) were sensitive and the other two (Lu116 and L27) were resistant to this EGFR-TKI. Systematic analysis of expression at various time points during oral treatment for 14 days, compared with corresponding untreated samples, identified a set of genes whose expression levels changed in the two sensitive tumors but not in the two resistant tumors. The data obtained here should provide useful information on the molecular mechanism underlying clinical responses to EGFR-TKIs, aid the development of novel therapies for lung cancer, and potentially identify predictive molecular markers for sensitivity to ZD1839.     

Enhancement of antitumor activity of ionizing radiation by combined treatment with the selective epidermal growth factor receptor-tyrosine kinase inhibitor ZD1839 (Iressa).

PURPOSE: The epidermal growth factor receptor (EGFR) is expressed in the majority of human epithelial cancers and has been implicated in the development of cancer cell resistance to cyotoxic drugs and to ionizing radiation. Experimental Design: We used ZD1839, a selective small molecule EGFR tyrosine kinase inhibitor currently in clinical development. We tested the antiproliferative and the proapoptotic activity of ZD1839 in combination with ionizing radiation in human colon (GEO), ovarian (OVCAR-3), non-small cell lung (A549 and Calu-6), and breast (MCF-7 ADR) cancer cell lines. The antitumor activity of this combination was also tested in nude mice bearing established GEO colon cancer xenografts. RESULTS: With ionizing radiation or ZD1839, a dose-dependent growth inhibition was observed in all of the cancer cell lines growing in soft agar. A cooperative antiproliferative and proapoptotic effect was obtained when cancer cells were treated with ionizing radiation followed by ZD1839. This effect was accompanied by inhibition in the expression of the antiapoptotic proteins bcl-xL and bcl-2, and by a suppression of the activated (phosphorylated) form of akt protein. Treatment of mice bearing established human GEO colon cancer xenografts with radiotherapy (RT) resulted in a dose-dependent tumor growth inhibition that was reversible upon treatment cessation. Long term GEO tumor growth regressions were obtained after RT in combination with ZD1839. This resulted in a significant improvement in survival of these mice as compared with the control group (P < 0.001), the RT-treated group (P < 0.001), or the ZD1839-treated group (P < 0.001). The only mice alive 10 weeks after tumor cell injection were in the RT-plus-ZD1839 group. Furthermore, 10% of mice in this group were alive and tumor-free after 26 weeks. Similar results were obtained in mice bearing established human A549 lung adenocarcinoma xenografts. Finally, the combined treatment with RT plus ZD1839 was accompanied by a significant potentiation in the inhibition of transforming growth factor alpha, vascular epidermal growth factor, and basic fibroblast growth factor expression in cancer cells, which resulted in significant antiangiogenic effects as determined by immunohistochemical count of neovessels within the GEO tumors. CONCLUSION: This study provides a rationale for evaluating in cancer patients the combination of ionizing radiation and selective EGFR tyrosine kinase inhibitors such as ZD1839.     

表皮生长因子受体酪氨酸激酶抑制剂ZD1839与伊利替康联合效应的实验研究

目的 探讨ZD1839与伊利替康的活性代谢产物7-乙基-10羟基-喜树碱（SN38）联合的最佳方案及其机制。方法 以药物联合效应测定方法,评价ZD1839和SN38不同给药顺序对人结肠癌细胞HT-29和LoVo的抑制作用;以Western blot和免疫共沉淀方法,分析ZD1839与化疗不同联合方案对各自靶蛋白及其下游分子表达的影响;以流式细胞仪测定不同联合方案对细胞周期的影响;以组蛋白相关的DNA碎片分析,比较不同方案对细胞凋亡指数的影响。结果 先SN38后ZD1839的序贯给药方案表现出明显的协同作用;反之,则表现为拈抗作用。SN38明显抑制细胞拓扑异构酶-1（Topo-1）活性;ZDl839不影响表皮生长因子受体（EGFR）的表达,但能抑制EGFR的磷酸化。与SN38单药相比,SN38联合ZDl839对Topo-1的抑制无增强;与单药ZD1839相比,联合方案对EGFR、MAPK磷酸化的抑制作用无增强,但ZD1839、SN38同时给药,和先SN38后ZD1839序贯给药对AKT的抑制有所增强。同时,联合方案对细胞周期分布的改变影响明显。ZD1839可明显维持化疗诱导的DNA损伤和细胞凋亡。结论 先SN38后ZD1839序贯给药可能是治疗结肠癌的最佳联合模式。     

Sequence-dependent effects of ZD1839 ('Iressa') in combination with cytotoxic treatment in human head and neck cancer

Elevated levels of epidermal growth factor receptor in head and neck cancer have been extensively reported, and are correlated with poor prognosis. The combination of cisplatin and 5-fluorouracil is a standard treatment regimen for head and neck cancer, with radiation representing another therapeutic option. Six head and neck cancer cell lines were used to study the cytotoxic effects of combining ZD1839 ('Iressa'), a new selective epidermal growth factor receptor tyrosine kinase inhibitor, and radiation. Two of the cell lines were also used to study the combination of ZD1839 and cisplatin/5-fluorouracil. Cytotoxic effects were assessed by the MTT test. The results indicated that ZD1839 applied before radiation gave the best effects (P=0.002); an effect that was strongest in those p53-mutated cell lines that express the highest epidermal growth factor receptor levels. The effects of ZD1839 with cisplatin and/or 5-fluorouracil were sequence dependent (P<0.003), with the best results achieved when ZD1839 was applied first. For the triple combinations, ZD1839 applied before cisplatin and 5-fluorouracil resulted in a slight synergistic effect (P=0.03), although the effect was greater when ZD1839 was applied both before and during cytotoxic drug exposure. In conclusion, ZD1839 applied before radiation and before and/or during cisplatin/5-fluorouracil may improve the efficacy of treatment for head and neck cancer.     

肺癌分子靶向治疗新进展

近几年来 ,肺癌的分子靶向治疗取得了较大的进展 ,靶向治疗新药不断涌现 ,在临床试验或正式临床应用中取得非常鼓舞人心的结果 ,其中最引人注目的有Iressa (ZD183 9,Gefitinib)、OSI774(Tarceva ,erlotinib)、Herceptin(Trastuzumab ,贺赛汀 )、IMC C2 2 5 (cetuximab ,Erbitux)和Bevacizumab(Avastin)等。