据印度代购了解，同所有靶向药物一样，奥希替尼也会耐药，那么奥希替尼耐药后怎么办呢?首先就是要了解导致奥希替尼耐药的原因，然后对症下药。奥希替尼耐药的原因目前有C797S单发突变,C797S共发突变和MET扩增，那么针对以上情况，患者该如何处理呢?

According to daigou India, like all targeted drugs, oxitinib will also be resistant to drugs, so how to do after oxitinib resistance? The first thing is to understand what causes oxitinib resistance, and then to target it. At present, there are single mutations in C797S, co-mutations in C797S and MET amplification for the reasons of oxitinib resistance. Then, how should patients deal with the above situations?

据印度代购了解，1 C797S单发突变：一线奥希替尼耐药常见原因，一代TKI靶向药可有效抑制。转换思维，一线使用奥希替尼，部分患者是否可以进入“三代序贯一代序贯三代”的超长待机模式。继发的C797S单发突变是一线奥希替尼耐药后的常见耐药机制，临床处理思路也许不再是一代序贯三代，而是三代序贯一代。对于C797S单发突变，一代TKI靶向药是可以完美抑制的。如果再继续延伸，患者在长期使用一代TKI靶向药后，有可能会诱导产生T790M的继发突变，此时患者可以再次用回奥希替尼，最终将从“三代序贯一代序贯三代”的超长治疗模式中最大获益，生存期将最大程度叠加。

据印度代购了解，2 C797S共发突变：二线奥希替尼耐药常见原因，顺式、反式处理各不同。当T790M突变和C797S突变位于同一条染色体上，我们称之为顺式构型(cis);位于相对面的染色体上，称之为反式构型(trans)。两种方式的治疗策略完全不同。3 MET扩增：采用MET抑制剂可有效抑制。MET扩增常常与EGFR突变共存，因此处理上采用EGFR抑制剂+MET抑制剂，目前已有很多得到报道的临床研究支持。奥希替尼联合沃利替尼，有效率达33%。1b期TATTON研究分析，对于既往T790M阳性使用过奥希替尼治疗，耐药后采用奥希替尼+沃利替尼治疗，其客观有效率(ORR)可以达到33%。联用方案在后线治疗的疗效仍然可观。

According to Daigou in India, mutations in 2 C797S are common: the common cause of second-line oxitinib resistance, cis and trans treatment are different. When the T790M mutation and the C797S mutation are on the same chromosome, we call this cis configuration; It's on the opposite chromosome and it's called trans. The treatment strategies are completely different. 3 MET amplification: MET inhibitors can be effectively inhibited. MET amplification often coexists with EGFR mutations and is therefore treated with EGFR inhibitors plus MET inhibitors, which are supported by many reported clinical studies. Ociitinib combined with wallitinib, the response rate was 33%. In the phase 1B TATTON study analysis, the objective response rate (ORR) of oxitinib + wallitinib in patients with previous POSITIVE T790M treated with oxitinib after drug resistance can reach 33%. The therapeutic effect of combination therapy in the posterior line is still considerable.