大肠癌标准课件（含胃癌和肺癌）科室会课件.ppt 106页

将CRYSTAL与OPUS研究结果进行生存率的组间比较，可发现对KRAS野生型患者，西妥昔单抗联合FOLFIRl可将PFS从8.7个月延长到9.9个月(P=0.017)，联合FOLFOX亦然(7.2个月 vs 7.7个月，P=0.016)；但对KRAS突变型患者，西妥昔单抗联合FOLFOX方案则有害无益，PFS从8.6个月降至5.5个月(P=0.0192，表1)；提示在某些无法检测KRAS突变状态的患者中，如考虑使用西妥昔单抗，其联合应用的化疗方案应为FOLFIRI，而并非FOLFOX。 Rapid Improvement of OS over the last 5 years driven by . Introduction of cytotoxics: 5 FU, Irinitecan, Oxaliplatin and more recently targeted agent Avastin . Optimization of regimens: dosage, sequence, frequency … Clinicians are seeking to push OS further while avoiding impact on QOL 一线定义： 入组前已经结束放疗6周或手术3周 第一次复发前已经完成辅助或新辅助化疗12个月 * GP, cisplatin plus gemcitabine; IP, cisplatin plus irinotecan; NP, cisplatin plus vinorelbine; TC, carboplatin plus paclitaxel. * In the * * This slide shows an overview of the two ongoing US trials comparing IriP with PE in ES SCLC. The first of these is being conducted by the SWOG and uses the same design as the trial carried out by the JCOG.1,2 The second, North American (NA), trial employs a 21-day truncation of the 28-day JCOG regimen.1,2 This truncated regimen was selected in recognition of the fact that only 29% of patients in the IriP arm of the JCOG trial received their assigned treatment without dose modification. Patients with a performance status of 2 were initially included in the NA trial, but the trial was amended to exclude these patients due to excessive toxicity. Sandler and colleagues compared the safety of the NA trial and JCOG trials following the recruitment of 122 patients into the NA trial.3 The median age, sex, and performance status of patients was similar between the two trials. The following grade 3 or 4 hematologic toxicities have been observed (JCOG results in parenthesis): leukopenia 20% (27%), neutropenia 35% (65.3%), febrile neutropenia 4% (not reported), anemia 4% (26.7%), and thrombocytopenia 4% (5.3%). Grade 3 or 4 non-hematologic toxicity included the following: grade 3 diarrhea 20% (16% including 5% grade 4), nausea or vomiting 18% (13%), and i