晚期NSCLC经典试验描述.ppt

* * * * * * * * * * 腺癌、大细胞癌和组织学类型不明确型NSCLC（NSCLC-NOS） 对复发或转移性疾病首先应确定其组织学分型。对于腺癌、大细胞癌和NSCLC-NOS，应确定其EGFR（1类）及ALK(2A类)的突变状态。若突变阴性或不明，采用一线化疗；若一线治疗开始前检出EGFR突变阳性，可采用厄洛替尼治疗，化疗过程中被发现突变阳性者，在化疗基础上加用厄洛替尼或换厄洛替尼维持治疗；若检测出ALK突变阳性，推荐Crizotinib治疗 2012版较2011版NCCN指南新增 ALK检测，2A类推荐 ALK阳性推荐Crizotinib治疗 鳞癌不常规推荐进行EGFR突变检测 * * * * This slide shows the study design for the E4599 phase III trial of carboplatin/paclitaxel with or without Avastin as first-line therapy for NSCLC. This was a multicentre randomised trial carried out by the Eastern Cooperative Oncology Group (ECOG) in 78 sites in the USA, Puerto Rico and South Africa. Randomisation was stratified by measurability of disease (yes or no), disease stage (IIIB/IV/recurrent), presence or absence of prior radiation therapy, and amount of prior weight loss (≧5% or 5%) Patients were treated until disease progression (as assessed by the investigator) or unacceptable toxicity. Patients in the CP-alone arm were not permitted to cross over to receive Avastin at disease progression. Reference Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Eng J Med 2006;355:2542-50. * Among the 878 patients randomised, 698 deaths had occurred at the time of the final analysis. The Kaplan-Meier curve shown here demonstrates the effect of adding Avastin to CP on overall survival.1 A significant increase in median overall survival was observed in patients receiving Avastin + CP compared with CP alone(12.3 months vs 10.3 months). The HR for death was 0.79 (p=0.003). This is the first, randomised phase III trial in NSCLC in which the median overall survival has exceeded 1 year. In addition, this is the first study combining a biological therapy with chemotherapy that has shown an improvement in overall survival in first-line NSCLC. In light of these findings, the study authors suggest that Avastin + CP should be considered a new standard of care for patients with advanced NSCLC with diseas