有人能帮忙解释一下DA-EPOCH是怎么操作的么？

为了爱

查了一些文献，我妈正在用EPOCH-R治疗。在文献里看到DA是调整剂量的意思。不知道这个调整剂量是根据什么原则调整的。如何调整各种药的剂量？希望哪位高手指点一下。或者帮忙找个文献啥的。谢谢了。

per2008

希望对你有帮助。
这一篇来自Dose-adjusted EPOCH 方法的最早提出者，作者来自美国国家癌症研究所。
Blood. 2002 Apr 15;99(8):2685-93.
Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy.
Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlav N, Steinberg SM, Little RF, Janik J, Gutierrez M, Raffeld M, Staudt L, Cheson BD, Longo DL, Harris N, Jaffe ES, Chabner BA, Wittes R, Balis F.
SourceCenter for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.

Abstract
We hypothesized that incremental improvements in the cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP) chemotherapy regimen through optimization of drug selection, schedule, and pharmacokinetics would improve outcome in patients with large B-cell lymphomas. A prospective multi-institutional study of administration of etoposide, vincristine, and doxorubicin for 96 hours with bolus doses of cyclophosphamide and oral prednisone (EPOCH therapy) was done in 50 patients with previously untreated large B-cell lymphomas. The doses of etoposide, doxorubicin, and cyclophosphamide were adjusted 20% each cycle to achieve a nadir absolute neutrophil count below 0.5 x 10(9)/L. The median age of the patients was 46 years (range, 20-88 years); 24% were older than 60 years; and 44% were at high-intermediate or high risk according to International Prognostic Index (IPI) criteria. There was a complete response in 92% of patients, and at the median follow-up time of 62 months, the progression-free survival (PFS) and overall survival (OS) rates were 70% and 73%, respectively. Neither IPI risk factors nor the index itself was associated with response, PFS, or OS. Doses were escalated in 58% of cycles, and toxicity levels were tolerable. Significant inverse correlations were observed between dose intensity and age for all adjusted agents, and drug clearance of doxorubicin and free etoposide was also inversely correlated with age (r = -0.54 and P(2) =.08 and r = -0.45 and P(2) =.034, respectively). Free-etoposide clearance increased significantly during successive cycles (P(2) =.015). Lymphomas with proliferation of at least 80% had somewhat lower progression and those expressing bcl-2 had significantly higher progression (P(2) =.04). Expression of bcl-2 may discriminate the recently described activated B-like from germinal-center B-like large-cell lymphomas and provide important pathobiologic and prognostic information. Dose-adjusted EPOCH may produce more cell kill than CHOP-based regimens. Dynamic dose adjustment may overcome inadequate drug concentrations, particularly in younger patients, and compensate for increased drug clearance over time.

为了爱

per2008 发表于 2013-1-5 12:56
希望对你有帮助。
这一篇来自Dose-adjusted EPOCH 方法的最早提出者，作者来自美国国家癌症研究所。
Blood. ...

楼上的小哥。。。你难煞我也。。。我这半调子英格丽是不给力，看不懂。。。BLOOD里面的文献我望尘莫及啊。

per2008

免费的全文在以下链接中 http://www.docin.com/p-437672808.html
现在有网络电子字典，完全可以搞定它。想学习，就得付出不是？！
剂量方案在原文的第二页table1和table2中。

为了爱

per2008 发表于 2013-1-5 18:54
免费的全文在以下链接中 http://www.docin.com/p-437672808.html
现在有网络电子字典，完全可以搞定它。想 ...

谢谢楼上的小哥。关注你的帖子还有给其他病友的回复很久了。一看就是有文凭有素质有能力的难得的人才。呵呵。。。
用有道也很吃力的。

per2008

为了爱 发表于 2013-1-5 21:42
谢谢楼上的小哥。关注你的帖子还有给其他病友的回复很久了。一看就是有文凭有素质有能力的难得的人才。呵 ...

有捧杀之嫌。学起来，其实也跟你一样吃力，毕竟这隔行如隔山。
如果不是亲人遭遇086，我可能一辈子都不会去触碰它，实在是情非得已。
求最能接受的治疗方案，力求最佳的治疗效果和好的生存质量，大家一起努力吧。

乐山乐水

我踹弯了月亮 发表于 2014-2-28 10:33
你那个臭水平看不懂吧，呵呵，回家吃奶去吧

发小广告的别在这显眼了

乐山乐水

期待有高人回复，我最近也在考虑要不要上E-POCH呢，但医生说骨髓抑制更严重，我也在犹豫，因为普通RCHOP，每次都要打6只以上的升白针，真怕吃不消EPOCH，再感染个什么。。

娟娟

我踹弯了月亮 发表于 2014-2-28 11:22
看你这种人感觉不配和我聊，你就纯粹一个低等的人，怀疑不信任充斥了你的大脑，你的证据是什么，鄙视你哦 ...

大家都是病友，没必要在网站上相互攻击，保持好心情才是最重要的。

娟娟

乐山乐水 发表于 2014-2-28 11:17
你发个广告贴，告诉大家你没化疗，有个中药方子，一个2.5的退烧药，你很神啊，发完广告帖还不老老实实的 ...

没必要生气的，干嘛在这破坏心情的争吵呢？大家现在需要的事好心情

克斤

看图片上的，是英文，但应该能理解的。。。
我翻译第一段递增的：
就是中性粒细胞在0.5以上的话的，每个疗程VP16，阿霉素，环磷酰胺都递增20%

后面意思就差不多了，就是药量不增不减，和药量递增的前提

期待康复

da-这方案好像国人受不了。
来自安卓客户端

为了爱

乐山乐水 发表于 2014-2-28 11:19
期待有高人回复，我最近也在考虑要不要上E-POCH呢，但医生说骨髓抑制更严重，我也在犹豫，因为普通RCHOP， ...

为什么要考虑上VP-16呢？缓解的不好么？

阳光花坊

我爸爸是 外周 T，非特指，也用了 DA－EPOCH， 难道果然是参考 弥漫大B 的方案的？