NSCLC内科药物治疗综述PPT.pptx

一： 一线化疗第三代含铂方案疗效相当（ECOG1594）二：组织学类型选择（JMDB）三：化疗与靶向联合（ECOG 4599、Avail、FLEX）四：TKI一线治疗（IPASS、OPTIMAL）五：二线治疗(TAX317、TAX320、JMEI、Tailor)六：维持治疗（PARAMOUNT、JMEN、SATURN、INFORM）一线治疗VinorelbineCisplatin CarboplatinSpain RosellIPASS MokOPTIMALEURTAC四架马车ECOG1594突变发现Aug20,31 2009NEJMPrior to2000201120022004靶向治疗化疗晚期非小细胞肺癌治疗史Gefitinib2003泰索帝一线2003First-lineSecond-lineThird-lineNot approvedErlotinibPemetrexed2004泰索帝二线1999PaclitaxelGemcitabine 1998Bevacizumab2006Vinorelbine199412+Medianoverallsurvival,monthsCarboplatin*1989Cisplatin*1978~ 8 - 10~ 6~ 2 - 41970198019902000化疗＋靶向治疗最佳支持治疗铂类单药化疗双药联合化疗*Label does not include NSCLC-specific indication.Food and Drug Administration. Available at /cder/cancer/druglistframe.htm. Accessed August 28, 2006.; National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology. Non-small cell lung cancer v1.2007. Accessed August 15, 2007. Schrump et al. Non-small cell lung cancer. In: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams Wilkins; 2005.晚期NSCLC一线化疗: ECOG 1594研究三代化疗药物的疗效不受组织学类型的影响方案鳞癌(N=224)腺癌(N=647)大细胞癌(N=74)其他(N=194)P值mOS(m)紫杉醇/顺铂60.09吉西他滨/顺铂7.90.63多西紫杉醇/顺铂8.20.91紫杉醇/卡铂6.90.37P值0.180.390.390.82PFS(m)紫杉醇/顺铂2.80.43吉西他滨/顺铂3.40.43多西紫杉醇/顺铂3.60.54紫杉醇/卡铂2.20.25P值60.68WCLC 2009- Tien Hoang, et al. Abstract # PD6.4.1.JMDB研究：力比泰? /顺铂一线对照健择? /顺铂治疗晚期NSCLC的III期研究迄今样本最大且唯一入组1600例晚期NSCLC一线治疗的前瞻性、随机、双盲、全球多中心的III期研究Scagliotti GV, et al. J Clin Oncol. 2008;26(21):3543-51选择性人群为治疗带来突破：组织学类型JMDB—首个不同组织学类型获得生存差异的前瞻性研究 非鳞癌亚组－PC化疗显著提高OSMedian (95% CI)Median (95% CI)CPCG11.8 (10.4-13.2)10.4 (9.6-11.2)CPCG9.4 (8.4-10.2)10.8 (9.5-12.1)1.01.0CP vs CGCP vs CGAdjusted HR: 0.81 (95% CI: 0.70-0.94)Adjusted HR: 1.23(95% CI: 1.00-1.51)0.6Survival ProbabilitySurvival Probability0.20006121824300612182430Survival Time (Mos) in PatientsWith Nonsquamous HistologySurvival Time (Mos) in PatientsWith Squamous Cell CarcinomaJ Clin Oncol. 2008;26:3543-3551. 力比泰? (n=862)500 mg/m2 IV 每3周+ 顺铂75 mg/m2 第1天随机分组健择? (n=863)1250 mg/m2 第1