个体化治疗---延长转移性结直肠癌患者生存的新标准.ppt

个体化治疗---延长转移性结直肠癌患者生存的新标准;转移性结直肠癌的基本状况;如何使转移性结直肠癌患者治疗的获益最大化?;优化治疗方案 选择能用最小的肝脏毒性获得最大的肿瘤缩小的治疗方案 一线mCRC患者的个体化治疗 寻求能预知预后的肿瘤生物标记物 在KRAS野生型的mCRC患者中，一线治疗在化疗的基础上加入爱必妥治疗可以明显提高患者的总生存期 增加各医疗团队间的合作 Adoption of a multidisciplinary approach is important for the optimal treatment of patients with mCRC;对于不可切除转移性结直肠癌患者的分类;mCRC: 不同的患者群体，不同的治疗策略;对于不可切除转移性结直肠癌患者的分类;肿瘤的控制对于方案选择尤为重要;;近年来不可切的患者生存时间明显延长;;5FU/LV用于晚期结直肠癌化疗;N9741: 2004年的结果;化疗联合靶向治疗的反应率;AIO 104 and 604: 肿瘤的缩小程度取决于不同的治疗方案;Patients with KRAS wt tumors;联合Erbitux方案的反应率是单用化疗方案的2-3倍;1st-line treatment results : PFS;1st-line treatment results: OS;OS, PFS and RR benefit in randomized trials using biologics vs CT only in 1st-line mCRC;Improving survival in mCRC: The evolutionary pathway;;肿瘤标记物: 个体化治疗产生更好的治疗效果;肿瘤预后因子和疗效预测标记物的检测是发展的方向;EGFR signaling pathway: A rationale for personalized therapy;;对于转移性结直肠癌其他潜在的生物标记物;CRYSTAL and OPUS pooled analysis: Tumor samples;CRYSTAL and OPUS analysis, BRAF mutation: Patients seem to benefit from adding ERBITUX to CT;Pooled analysis of OS in patients with KRAS wt/BRAF wt tumors;Pooled analysis of OS in patients with KRAS wt tumors according to BRAF mutation status;Other potential biomarkers in mCRC;WorkMat Result from European : Patient parameters for intensive/less intensive therapy;WorkMat Result from European : Preferred chemotherapy and targeted therapy options;Expert review from ICACT 2009:Optimizing 1st-line treatment for mCRC;Expert review from ICACT 2009:Optimizing 1st-line treatment for mCRC;Prolonging survival through a personalized approach in mCRC;What’s new from ESMO 2010? ;Early tumor shrinkage:At first CT scan;治疗后第一次评价（第六周）时肿瘤缩小程度评估 (BOND研??);与患者治疗的预后相关?;早期肿瘤缩小与晚期结直肠癌患者的治疗结果相关 (BOND研究);Median OS: 74.9 vs 30.6 weeks p0.0001;CRYSTAL: 8-week tumor regression according to treatment in patients with KRAS wt tumors;CRYSTAL: 早期肿瘤对治疗的反应;CRYSTAL研究：对于爱必妥联合FOLFIRI组早期肿瘤缩小预示患者预后更佳;CRYSTAL研究：对于单独化疗组早期肿瘤缩小未显示显著差异;Summary;What’s new from ASCOGI 2011?;Impact of early tumor shrinkage on