肺癌靶位治疗时机实习.ppt

PD again, 3 months later 5 months later Stop Iressa Comments / Conclusion Intermittent Iressa treatment does still work Discussion and learning points Resistance to Iressa will be a major problem ? or not ? Because of intermittent use Economic is still a major problem to maintain effective treatment Chemotherapy plus Gefinitib Reasonable ? More effective? [7155] Docetaxel and gefitinib in the first-line treatment of elderly patients (70) with advanced non-small cell lung cancer (ANSCLC): Results of phase II trialG. Bepler(from ASCO 2005) Docetaxel 75 mg/M2 d1? assessed every 2 cycles Gefitinib 250 mg started d1?assessed every two mo if alone until PD M/F 16/14, median age 74, PS 0-1 21 evaluable PR 38% SD 24% CR 0% MS 12.4 mo 1 year survival 60% Favorable toxicity Repeated 21 days [7259] A phase I/II trial of weekly docetaxel and gefitinib in elderly patients (≥ 70) with stage IIIB/IV non-small cell lung cancer (NSCLC) T. E. Stinchcombe Gefitinib 250 mg per day Docetaxel d1, d8, d15 Phase I 30 mg/M2 Phase II 36 mg/M2 M/F 11/9; Median Age 76.2 PS 0/1/2: 3/13/4 IIIB/IV: 4/16 PR 29% SD 17% PD 39% 2 non-evaluable Repeated every 28 days, until PD or unacceptable toxicity Iressa as First Line Therapy in NSCLC Personal details Personal details Mrs. Chen-Lin Female 62 y/o Non-smoker Patient history History Cough, left chest pain for two months Bronchoscopic biopsy and effusion cytology: adenocarcinoma. Performance status ECOG PS 3 Previous treatment Refused any chemotherapy Investigations Image CT scan of chest revealed evidence a huge mass, measured greater than 5.0 cm in diameter to left uppe lobe with pleural effusion. Enlarged LNs to AP window. No evidence of distal mets. T4N2M0, stage IIIB Treatment Refused any chemotherapy again and again Iressa 250 mg per day Outcome Tumor size is getting smaller after two weeks Iressa treatment. Follow up image study: PR Patient can walk well now. Iressa is ongoing till now. No severe side effect except skin eruption but pa