2006ASCO胃癌治疗最新研究结果.PPT

2006ASCO胃癌治疗最新研究结果 北京大学临床肿瘤学院 消化内科 沈 琳 现 状： 在转移性胃癌的治疗中没有公认的治疗“金标准” “FP ，FLP, ECF ……在晚期胃癌中不应该被当作标准治疗方案”，但是常用的试验对照方案 新世纪，新选择… 紫杉烷类 ＋顺铂/5-Fu EOX→ECF CAPE +DDP →5-FU+DDP 伊立替康＋5-Fu OXA ＋5-Fu 其它：CAPE/S-1+DOC/PTX Docetaxel, 5-FU and Cisplatin: V 325 Phase III 研究V325结果 TCF(多西紫杉醇、顺铂、5FU)是用于预后较好的患者的一项新的治疗选择 CPT-11 for AGC——Ⅱ期多中心临床研究（2003 ASCO）FFCD 9803 法国 CPT-11联合5-FU治疗AGC----III期临床试验（2005 ASCO） FOLFOXIRI combination chemotherapy in metastatic or recurrent gastric cancer N=45/48 irinotecan 150 mg/m2 d1 oxaliplatin 85 mg/m2 d1 lv 100 mg/m2/ d 5-FU 2000 mg/m2 48-h ci d1, Q 2 w RR 73.3 % （2 CRs and 31 PR）. SD 9% PD 18% estimated mOS 14.0 m estimated mTTP 8.9 m grade 3/4 toxicities were neutropenia (11% of all cycles) and emesis (12%) 新世纪，新选择… 紫杉烷类 ＋顺铂/5-Fu EOX→ECF CAPE +DDP →5-FU+DDP 伊立替康＋5-Fu OXA ＋5-Fu 其它：CAPE/S-1+DOC/PTX REAL 2 phase III trial: study design REAL-2: Efficacy REAL 2: safety outcomes There was less neutropenia in the Eloxatin-containing arms compared with the cisplatin-containing arms REAL 2: conclusions The primary objective of the trial was met: Capecitabine is not inferior to 5-FU Oxaliplatin is not inferior to cisplatin In these triplet regimens Capecitabine could replace 5-FU Oxaliplatin could replace cisplatin The use of EOX is associated with improved efficacy over ECF ML17032 trial design Primary endpoint met: progression-free survival HR 0.81 Superior response rate with XP vs. FP Similar all-grades hematologic adverse events: XP vs. FP first-line chemotherapy with fluorouracil, leucovorin and oxaliplatin (FLO) versus fluorouracil, leucovorin and cisplatin (FLP) Superior Performance with FLO vs. FLP A phase I study of S-1 plus weekly docetaxel in patients with mGC MTD for this regimen was S-1 90 mg/m2/d + docetaxel 35 mg/m2 RD was S-1 80 mg/m2/d (D1-14) + docetaxel 35 mg/m2 (D1, 8). DLT : diarrhea and febrile neutropenia Capecitabine and docetaxel for advanced gastric cancer part I ：Docetaxel