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h*******r
发帖数: 182 | 1 一个风华正茂的小伙，二十多岁在DUKE就读，今年四月突然发病: mediastinum germ
cell tumor, AFP elevated, 常规化疗（cisplatin-based)后AFP 有所下降，就做了手
术切除，但术中和术后发现大量active tumor cells, mixed with teratoma and
sarcoma cells. 然后肿瘤开始不受控制地生长，并转移到肝脏，有10多个转移灶，大
的有4cm, 目前AFP高到几千，肝功能也不太好了，家长忧心如焚，迫切要找到有经验的
治疗晚期和复发的GCT的医生。看了一下现在的clinical trial, 包括大剂量化疗+自身
干细胞移植，他的肝功能可不允许，能一起作肝移植吗（A 大估计不赞同）？GCT 能用
pembrolizumab吗？
求大家给出出主意吧，但愿有奇迹出现，不要让年轻的生命过早凋零。 | J*********4
发帖数: 1274 | | h*******r
发帖数: 182 | 3 AFP results:
10/6/14 10/13/14 10/20/14 11/10/14 11/17/14 12/1/14 12/8/14
2843.0 1783.7 905.5 221.5 267.1 823.9 2730.0
chest/abd/pelvic CT with contrast 12/1/14:
Impression:
1.New and enlarging liver metastasis.
2.Improving disease within the mediastinum.
3.Residual left upper lobe opacity may represent improving atelectasis.
4.Splenomegaly.
CMP: 12/8/14
AST/ALT 47/27
BUN/Cr 7/0.5
其中一个药是dexamethasone 4 MG tablet
Instructions: Take 8mg (2x4mg tablets) by mouth with food twice daily (am
and pm) for 3 days following chemotherapy (days 4, 5, and 6)
请问肿瘤专家这是针对什么？
11月份AFP下降，12月又反弹，CT也显示新的转移灶，说明细胞resistant to chemo,
是否应该换regimen? | s*****e
发帖数: 404 | 4 1. His AST/ALT is OK. If his bilirubin is normal, his liver function should
be fine, even there are liver metastasis.
2. If there has been no change of chemo regimen, given the CT finding, his
disease is resistant to the current regimen. He should switch to a different
regimen.
3. High dose chemotherapy followed by autologus stem cell transplant is a
reasonable next step. Liver transplant is not indicated in this situation.
4. Cancer center at Duke is very good. If he were my family member, I would
trust them.
Bless! | A*******s
发帖数: 9638 | 5 This answer is priceless indeed.
should
different
★ 发自iPhone App: ChineseWeb 8.6
【在 s*****e 的大作中提到】
: 1. His AST/ALT is OK. If his bilirubin is normal, his liver function should
: be fine, even there are liver metastasis.
: 2. If there has been no change of chemo regimen, given the CT finding, his
: disease is resistant to the current regimen. He should switch to a different
: regimen.
: 3. High dose chemotherapy followed by autologus stem cell transplant is a
: reasonable next step. Liver transplant is not indicated in this situation.
: 4. Cancer center at Duke is very good. If he were my family member, I would
: trust them.
: Bless!
| h*******r
发帖数: 182 | 6 替小伙子和家人谢谢您的答复。
should
different
would
【在 s*****e 的大作中提到】
: 1. His AST/ALT is OK. If his bilirubin is normal, his liver function should
: be fine, even there are liver metastasis.
: 2. If there has been no change of chemo regimen, given the CT finding, his
: disease is resistant to the current regimen. He should switch to a different
: regimen.
: 3. High dose chemotherapy followed by autologus stem cell transplant is a
: reasonable next step. Liver transplant is not indicated in this situation.
: 4. Cancer center at Duke is very good. If he were my family member, I would
: trust them.
: Bless!
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