EGFR突变型肺癌的处理课件.pptVIP

EGFR 突变型肺癌的处理晚期EGFR 突变型肺癌的处理您的观点: 1. 一线治疗 2. 维持治疗 3. 二线治疗一线治疗:目前的证据 Author Study N EGFR mut + RR Median PFS Median OS positive negative T : C Mok et al IPASS 132:129 71.2% vs 9.8 vs 6.4 21.6 vs 21.9 47.3 months months Lee et al First-SIGNAL 27:15 84.6% vs 8.4 vs 6.7 30.6 vs 26.5 37.5% months months Mitsudomi et WJTOG 3405 86:86 62.1% vs 9.2 vs 6.3 Pending al 32.2% months Maemondo et NEJGSG002 114:114 73.7% vs 10.8 vs 5.4 30.5 vs 23.6 al 30.7% months months Zhou et al OPTIMAL 82:72 83% vs 13.1 vs 4.6 NA months 36% Rosell et al EURTAC 135 NA positive NA将EGFR TKI 用于EGFR 突变型肺癌一线的理由PFS 的获益达3-8 个月QoL 有意义的改善更多的患者得到更多的治疗为什么PFS 不能转化为OS ?真正不能转化可能转化,但: ? 不是以OS 为主要终点指标的设计; ? 样本量不能达到检验出差异的把握度 ? 所有的突变可能不一致IPASS: 2010 overall survival: 增加样本量,有可能出现统计学的差异 EGFR mutation non-evaluable ITT Gefitinib n386 Probability 1.0 Carboplatin / paclitaxel n394 of survival HR 95% CI 0.8 0.82 0.70, 0.96; p0.015* No. events G298 77% 0.6 C / P 301 76% Median OS 0.4 G18.9 months C / P 17.2 months 0.2 0.0 0 4 8 12 16 20 24 28 32 36 40 44 48 52 6.9M Patients at risk: Time from randomisation months Gefitinib 386 319 295 257 214 174 150 130 99 65 28 6 0 0 C / P 394 326 274 225 188 139 109 87 68 36 12 1 0 0晚期EGFR 突变型肺癌的维持治疗已知道了EGFR 突变,还存 在维持治疗吗?晚期EGFR 突变型肺癌的处理您的观点: 1. 一线治疗 2. 维持治疗 3. 二线治疗治疗过程才知道突变的晚期NSCLC 患者您的观点 1. 立即转变为EGFR TKI 2. 和化疗联合使用 3. 将EGFR TKI 作为维持治疗 4. 将EGFR TKI 作为二线治疗立即转化为EGFR-TKI ? Second/third-line EGFR TKI Death Maintenance TKI chemotherapy OS similar Second/third-line EGFR Chemo x 4-6 Death Maintenance TKI TKI therapy Second/third-line Chemo x Death OS Maintenance TKI EGFR TKI therapy 1 or 2和化疗联用? CALGB 30406 Phase II RCTStudy: Trial Design Chemotherapy-naive patients with stage IIIB/IV adenocarcinoma or BAC who are never or “light” former smokers* ECOG PS 0-1 Daily oral erlotinib + Daily oral erlotinib 6 cycles carboplatin/paclitaxel Daily oral erlotinib Daily oral erlotinib Response evaluation every 2 cycles 6 weeks. Therapy could continue until disease progression or toxicit