消化道肿瘤ESMO.pptVIP

* * * * * * * * * * * * * * * * * Slide 14, RADIANT-1: although numbers are small, one might argue that these data are more supportive of octreotide LAR (in line with the PROMID data, slide 12) than of everolimus? I agree, this is indeed a complex study. I have made a small change to the study design box to make it clearer that assignement to octreotide LAR was only driven by the treatment ongoing at the moment of study entry. The (apparently) longer PFS in stratum 2 may thus be the product not only of large confidence-limits due to the small sample size, but also of potential differences in biology and prior treatment between the two strata. I think the only conclusion that we can draw is that everolimus has some antitumor activity in pancreatic NET’s progressing after chemo, independent of previous and concomitant treatment with octerotide LAR. * * * * * * * ESMO Highlights 2010Upper GI * ESPAC-3 PANCREAS LIVER/BILIARY NETs GASTRIC GIP-1 ABC-02 PROMID TOGA AIO-PK0104 EACH A6181111 AVAGAST Prodige IV-Accord 11 RADIANT-1 AIO (2nd line) NC Conko-4/FRAGEM VEGFR polymorphisms ADVANCED ADJUVANT Pancreatic cancer background Adjuvant: Both FU and gemcitabine shown to improve OS Role of RT controversial Advanced: Gemcitabine monotherapy = standard for 10 years Clinical benefit in 20-30% of pts; median OS 6-8 m; 1-y S 20-30% Controversial improvement adding a second cytotoxic (fluoropyrimidines, platinum derivatives: positive meta-analysis but negative single studies) Small improvement (clinical relevance questioned) adding erlotinib; no improvement with other biologics (cetuximab, bevacizumab) Oxaliplatin/FU/LV: best option after gemcitabine failure (2nd line) High incidence of venous thromboembolism (17-30%) Resected pancreatic ductal adenocarcinoma FU/LV vs Gemcitabine (ESPAC-3) Neoptolemos et al. ASCO 2009; Abstract LBA4505 No difference in efficacy Better toxicity profile with gemcitabine(more myelotoxicity but less stomatitis and diarrhea; l