老公肝癌三期移植术后肺部结节---到美国梅奥诊所治疗记录

onchid 发表于 2015-1-3 13:15
PD-1值得一试啊！但不知道移植病人能否使用呢？得找个专家好好问问

明确告诉大家，香港著名肿瘤内科专家邵祖德院士告诉我们PD1移植病人可以用，我们今天又咨询了源正生物的首席科学家周向军博士，他也明确说移植病人是可以用PD1的，而且鼓励我们使用！

ngs 下一代基因检测可以一次性检测49个基因，费用约4000美元。而且是美国还领域该权威华盛顿大学的医生解读。这种新技术医生的水平也很重要。不只是仪器。他会推荐靶向药。但是得到靶向药的概率小于50%

多吉美一般会对肝癌管用一段时间，我觉得你可以先吃上。我父亲吃了几个月。最初效果很好。同时进行基因测续，寻找下个药。pd1应该作为下一个药。我的观点仅供参考。

多吉美一般会对肝癌管用一段时间，我觉得你可以先吃上。我父亲吃了几个月。最初效果很好。同时进行基因测续，寻找下个药。pd1应该作为下一个药。我的观点仅供参考。

Willdonggang 发表于 2015-1-10 21:52
多吉美一般会对肝癌管用一段时间，我觉得你可以先吃上。我父亲吃了几个月。最初效果很好。同时进行基因测续 ...

我们手术后一个月就开始吃多吉美，整整吃了十个月，就是在这期间肺部转移且一直有进展，梅奥医生说已经耐药让停药了！多吉美和PD1是两个概念，一个是控制，一个是治疗，甚至有机会治愈，所以我们决定大胆尝试！

Willdonggang 发表于 2015-1-10 21:44
ngs 下一代基因检测可以一次性检测49个基因，费用约4000美元。而且是美国还领域该权威华盛顿大学的医生解读 ...

我们目前已经在华大基因做了相关508个肿瘤跟肿瘤相关的基因检测，其中包括信号通路基因、原癌基因、抑癌基因等。非常感谢您的帮助，我们也已经预约了好几位国内和香港的专家帮忙解读，十分感谢！

谢谢楼主告知翻译机构！ 加油！ 祝您家先生取得良方，恢复健康！

一字不落得读完了。楼主很有心，并且坚持不懈。值得学习！
我是有点奇怪梅奥为什么在检测出肺部是恶性转移病灶之后突然没了治疗办法呢？要知道他们在穿刺之前也是清楚地知道一共有20多个结节并且体积都很小啊。穿刺结果除了证明是恶性转移病灶之外，没有什么新发现是穿刺之前不知道的。他们为什么之前不说明如果是恶性他们什么也做不了呢。感觉很突然。

fj168999 发表于 2015-1-11 08:24
我们目前已经在华大基因做了相关508个肿瘤跟肿瘤相关的基因检测，其中包括信号通路基因、原癌基因、抑癌 ...

华盛顿大学医学院Bevan Tendon 医生关于基因检测的观点，希望对大家有用。


With ngs, the issue is that the test produces lots of information but you need a good physician with clinical experience and understanding to figure out the significance in clinical terms what the sequence variants mean for the patient and their disease.   

Bevan
I don't know too much about Chinese lab.  certainly there are others here in us, but washU is world leader for cancer sequencing.  The first human cancer genome was fully sequenced at this institution for a patient with acute myeloid leukemia and GPS division here has experience processing approx 2000 cases for clinical ngs and cancer testing. It will test 49 genes with potential established therapeutic targets in the literature.   Some companies here like foundation clinical medicine offer up to 250 genes but many other genes do not have clear cut clinical significance

Rate of identification of cancer specific therapeutic target is less than 50%.  Probably lower.  In lung cancer most common targets are egfr  or alk  mutations which have specific drugs.  Stomach and liver cancer I will have to check.  Everyone here is very excited about this technology. However, it is important to have realistic expectations about the potential yield.  I will let you know liver and stomach cancer ngs let me research a little

Majority of patients I review are colon,  lung,  head and neck cancer

Also ngs testing can be done for all cancer types not just blood cancer leukemia

Other gene testing is prohibitively expensive to test multiple genes at same time.   Conventional single gene sequencing prior to ngs was Sanger Sequencing and can cost up to several thousand dollars for just 1 gene.  Clinical ngs is revolutionizing personalized medicine.  If there can be a pipeline of patients from China and I had a lab of my own this could be very good business.   Trust could be built up in first phase by sending to washU where I will have my name on the reports because I am generating the clinical report.  

Will

what is the difference of next generation sequencing and other gene test?



Bevan
Hello,  next generation sequencing is a major part of my job currently. I interpret the data and generate the report.   The laboratory takes the patient material  and extracts the DNA and runs it through the sequencer.  The patients in China should have access to their ffpe  blocks and slides.  After surgery for either excision or other biopsy the tissue is usually processed and made into the blocks which are then cut very thin and sections are mounted into a glass slide and reviewed under microscope by a pathologist.  Hope that answers your questions.

We would need his formalin fixed paraffin block biopsy from his cancer.  The patient should be able to obtain this material and have it shipped over.   

We get testing requests for therapeutic target identification using next generation sequencing from international patients.  Last month one of the doctors brother who lives in Germany had his brain biopsy material sent over and I interpreted his testing and we identified an antitumor target for his brain cancer

http://gps.wustl.edu/cancer

????,????????????,?????22?,they went to mayo clinic in US in December this year ,conclusion is it can not be treated,they want to try targeting antitumor drugs,and all other possible treatment, any suggestion?

Bevan
Precise data for frequency of mutations that are clinically relevant is  difficult to get from companies because they will always inflate the number for marketing purposes.  Even at washU  my experience had been only 10 percent of ngs cases yield useful clinical information


With ngs the issue is that the test produces lots of information but you need a good physician with clinical experience and understanding to figure out the significance in clinical terms what the sequence variants mean for the patient and their disease.   

Will
this is the brochure from BGI  , the major chinese player.i did a little research, there are many small agencies doing gene tests too,  mostly for parent children identification, prenatal screening, also child talent gene tests, etc.  serious testing are BGI and one lab from souel univ. korea. BGI says i will tests 508 genes.

Here in America company  called clinical foundation medicine does over 200 genes.  WashU does 151 but only 49 have been determined to be best for clinical report.   Many genes lack clinical associations in specific diseases and for  personalized medicine the number of genes for drug targets is still low overall.  There are multiple technologies for gene sequencing but hybrid capture for targeted panel analysis is probably what bgi  is doing for 500 genes

For marketing people might think more is better but when you generate data for genes that lack clear clinical association it becomes frustrating because then you don't know what conclusion to make

Also when you do more focused testing not only does that streamline interpretation to focus on genes that may have clinical association there is another major benefit

You can perform more sequencing  where you sequence the same gene hundreds or thousands of times (you increase the "coverage depth").  This enhances sensitivity significantly and improves rate of detection for potential disease related mutations in the targeted genes

I don't know what coverage depth is in the bgi  panel targeting 500 genes but that would be an important point of difference.   There is very precise data available to demonstrate mutation detection rate based on sequencing experiments on known  gold standard specimens.  WashU has approximately 99% sensitivity and specificity for the clinically reported genes which is a very important point to consider when comparing platforms and different tests

In general when you widen The target capture space and increase number of genes then the coverage depth is reduced for each individual gene

But that is rule of thumb

用病毒激活免疫的方法楼主有尝试或者咨询过吗，之前在天涯和这里都有看到这方面的一些消息。