特罗凯与PDL1联合用药，反应良好，摘自国外论坛

特罗凯与PDL1联合用药，反应良好，摘自国外论坛
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Tarceva + Atezolizumab - 15个月，仍然运作良好
## Atezolizumab（译注：PD-L1，商品名称tecentriq）
翻译：
大家好，这是关于我夫人成功的使用Tarceva + Atezolizumab（以前的MPDL-3280A）的后续文章。她于2014年10月被诊断为IV期非小细胞肺癌（译注：其本人的另一篇发言说到为“EGFR外显子19检测阳性"），并与脊髓转移，她的第一线治疗进入了上述药物组合的1B期临床试验。她有很多副作用，但一般情况下治疗效果良好：第一个月肿瘤萎缩约50％，大部分时间保持稳定一年以上，然后突然（甚至令人惊讶），四个肺肿瘤中有三个在几个月前再次一下子缩小了20-30％。她只是进行了另一次CT扫描，表明它们没有进一步缩小 - 在这个新常态下，一切似乎都是稳定的。

我的夫人大部分脊髓转移（需要辐射，几种Kyphoplasties，然后一堆PT）已有重大好转，她也有许多典型的Tarceva效应（腹泻，皮疹等），但总体来看这种治疗反应良好。我们的生活得很好，约束主要来自于这些副作用。我们的肿瘤学家非常高兴，药物公司将其参与临床试验延长一年，因为大多数患者的表现很好。

我长期以来没有看过clinicaltrials.gov，但​​我希望现在他们已经启动了这个试验的第二阶段，看到（并且希望证明）这种组合可以很好地作为一线治疗对于EGFR阳性的IV期肺癌患者。

原文链接：
https://www.inspire.com/groups/a ... still-working-well/
原文对照：
Hi everyone, here's another followup post about my wife's success taking the combination of Tarceva + Atezolizumab (formerly MPDL-3280A). She was diagnosed Stage IV NSCLC with mets to the spine in October 2014, and as her first line of treatment went into a Phase 1B clinical trial of the above drug combination at Sloan Kettering. She's had plenty of side effects but in general the therapy worked well: the tumors shrank about 50% in the first month, remained largely stable for more than a year, then suddenly (and much to everyone's surprise) three of the four lung tumors shrank again another 20-30% a couple of months ago. She's just had another CT scan which shows that they have not shrunk further - everything seems stable at this new normal.

Most of my wife's significant issues have related to the spinal metastases (requiring radiation, several Kyphoplasties, and then a bunch of PT), and she's also had many typical Tarceva effects (diarrhea, rash, etc.) but the big picture is that this therapy is working well. We have a lot of our life back, with the constraints mostly coming from those side effects. Our oncologist is extremely pleased, and the drug company extended her participation in the clinical trial past the one-year mark because most of the patients were doing similarly well.

I haven't looked at clinicaltrials.gov in a long time but I hope that by now they have launched a Phase 2 of this trial, to see (and, hopefully, prove) that this combination will work well as a first-line treatment for Stage IV lung cancer patients who are EGFR positive. We can only hope that it significantly extends the effective duration of Tarceva on its own.

阿特珠号称不需要PD-L1表达，我也觉得非常神奇，就是身边还没有人用过

这是找到的第二例关于PD-L1对于EGFR阳性的肺腺的良好反应者。
对于PD1(opdivo, keytruda)，国外医学者已多次提到PD1对于EGFR阳性的肺腺几乎无效，不建议使用。而目前无论是国内还是国外，暂时未找到EGFR阳性的肺腺对opdivo或keytruda有良好反应的实例，这样可能印证了上述的国外学者的判断。
而对于新的PD-L1（tecentriq）已异军突起，表现优异，值得关注。

刚刚又找到一例联合用药反应良好的实例：
https://www.inspire.com/dhrupatel2/
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关于dhrupatel2

www.inspire.com/dhrupatel2
29岁，男，已婚
波士顿，马萨诸塞州
2015年3月23日加入
我的母亲 - 56岁，诊断患有IV期EGFR L858R + NSCLC在02/2015与脑会议。去除了脑肿瘤，并开始对Tarceva + MPDL3280A进行临床研究，于2015年3月从肿瘤中恢复良好。

2015年8月：CT扫描显示，主要的减少60％，大脑中没有残留的转换
2016年1月：没有人脑转移的证据。

请问PD-L1是什么？

那是说pd-l1阴性也可以用吗？