晚期胃癌化疗策略推荐.pptVIP

晚期胃癌化疗临床问题 药物、方案的选择 疗程及后续治疗 化疗与手术或局部治疗的合理应用（新辅助化疗） 手术后辅助化疗 * 疗程及后续治疗 疗程？ 后续治疗？ 一线？二线？维持？停药？ 尚无定论 晚期胃癌对化疗的耐受性和TTF/TTP的预计 * 晚期胃癌化疗临床问题 药物、方案的选择 疗程及后续治疗 化疗与手术或局部治疗的合理应用（新辅助化疗） 手术后辅助化疗 * 化疗与手术或局部治疗的合理应用 新辅助化疗 目的： 提高手术根治性切除率！ 选择：晚期胃癌化疗近期有效率最高、最安全的药物及方案，可以强强联合！ 姑息手术切除，局部治疗：放疗、射频等 * 小 结 目前，在转移性胃癌的治疗中没有一种标准方案各项指标明显优于其它方案。需要更多的研究来优化最佳方案。 合理的综合治疗可以让患者获得最大利益 真正的个体化治疗尚难以确定 靶向药物的应用值得探索 * * * * * There was an extremely high incidence of hematological toxicity and its complications with DCF vs. the FP doublet. Hem AEs TCF FP Neutropenia 82.3 56.8 Febrile Neutropenia/Infection 30.0 13.5 Anemia 18.2 25.6 Platelets 7.7 13.5 * * A variety of triple chemotherapy combinations have been evaluated in advanced gastric and esophagogastric cancer. The combination of epirubicin, cisplatin, and Xeloda was first shown to be active in a phase I study in patients with inoperable tumors of the stomach, esophagus, or gastroesophageal junction [1]. In 29 patients with evaluable disease, one complete response and six partial responses were observed, giving an overall response rate of 24%. Median progression-free survival and overall survival were 5.1 months and 7.8 months, respectively. The combination demonstrated an acceptable safety profile at the recommended dose. The pharmacokinetic profile indicated that prior gastric surgery did not impede absorption of Xeloda. These data suggest Xeloda can be successfully absorbed from the small bowel. REAL-2 is a randomized, controlled, multicenter, phase III study evaluating the role of Xeloda and Eloxatin in previously untreated patients with esophagogastric carcinoma, using a 2 x 2 factorial design [2]. Target enrollment is 600 patients, and 300 patients have been randomized to date. Primary endpoints are overall and disease-free survival, and secondary endpoints include response rates, duration of response, toxicity, and quality of life. Patients are randomized to receive treatment with one of four regimens: epirubicin