鼻咽癌综合治疗应红梅__培训课件.pptVIP

TARGETED THERAPY IN NPC Anti-Epidermal Growth Faction Receptor (EGFR) Targeting re-expression of epigenetically-silenced EBV genes CONCURRENT IMRT-CETUXIMAB-CISPLATIN IN LOCALLY ADVANCED NPC Phase Ⅱ single arm study Previously untreated UICC stage Ⅲ/Ⅳ patients Sample size: 35 Primary endpoints: safety/tolerability, clinical response, overall and progression-free survival Cetuximab 400mg/m2 Day-7, 250mg/m2 weekly from D1 IMRT Cisplatin 30mg/m2 weekly from D1 PHASE Ⅱ STUDY OF ZD1839 (IRESSA) IN RECURRENT/METASTATIC NPC Single arm phase Ⅱ trial Second line treatment for recurrent/ metastatic disease ZD1839 500mg/day every 28 day 30 patients (two-stage design) Comparion study EPSTEIN BARR VIRUS IN NPC Restricted expression of EBV-associated malignancy Methylation of regulatory elements of transeription in C promoter→ lack of expression of the highly immunogenic viral proteins 5-azacypition regulatory elements and expression of full spectrum of latency antigen in EBV lymphoma cell lines and mice ASACYTIDINE INDUCES DEMETHYLATION OF THE EBV GENOME IN TUMOR IN PATIENTS 5-azacytidine Ⅳ infusion 75mg/m2/day *7 days as a single 3-hour infusion each day, repeated every 28 days for at least 2 cycles Post-treatment biopsy performed within 72 hours of day 7 of the first cycle of azacytidine Choice of Treatment Options Tumor control Cost Toxicity Tailor for Different Risk Groups 抗 - EGFR Gemcitabine Capecitabine Treatment of NPC Top skill Perfect balance 谢谢 晚期鼻咽癌放化疗荟萃分析（一） 10个随机研究，2450例病人 生存率：总的化疗有益 5年 4% 　P=0.01 同期放化疗 5年 20%　P=0.004 局部控制：诱导和同期放化疗有益 远处转移：诱导和同期放化疗有益 J Clin Oncol 22:4604-4612 晚期鼻咽癌放化疗荟萃分析（二） 　结论 同期放化疗能提高局部控制，降低远处转移，提高无瘤生存率和总的生存率 新辅助化疗能降低局部复发和远处转移，但未提高总的生存率 辅助化疗未显著提高无瘤生存率和总的生存率 J Clin Oncol 22:4604-4612 化疗与放射的综合治疗 需要大宗病例，随机对照研究得出结论新药、联合方法、用法、疗程等 NEWER AGENTS AND PLATINUM-BASED DOUBLETS IN METASTATIC NPC Metastatic NPC OR Paclitaxel (E Au) 22% Carboplatin (Chi Taiwan) 44% DDP/5FU (E Au) 66% Taxol/Carbo (Tan EH) 75% Gemzar (Foo KF) 49%