晚期胰腺癌化疗选择思考.pptVIP

* * * * 8.5-6.7 * * * * * * * * * * Key Milestones in the Treatment of Pancreatic CancerFDA Approval for MPC1 1. Drugs@FDA.gov. /scripts/cder/drugsatfda/index.cfm. Accessed June 20, 2012. 2 MPC, metastatic pancreatic cancer, PDAC, pancreatic ductal adenocarcinoma. 2014NCCN指南推荐：晚期胰腺癌一线治疗 分享内容 思考一、化疗方案，孰优孰劣 思考二、预后因素深度分析 思考三、支持治疗，被动？积极？ 思考一、化疗方案，孰优孰劣？ 生存期比较 方案 PFS OS DCR 5-FU 2.5 4.41 35 Gem 3.55 5.65 49.2 S1 3.8 9.7 Gem+特罗凯 3.75 6.24 57.5 Gem+nab-Pac 5.5 8.5 48（33%） Folfirinox 6.4 11.1 70.2 GS 5.7 10.1 晚期胰腺癌专家推荐或者NCCN指南： a For fit patients defined as those with ECOG PS 0/1, 75 years old, no or limited comorbidities, serum bilirubin value 1.5 ULN who are not candidates for FOLFIRINOX or nab-paclitaxel. b For patients with poor performance status, elderly, and/or significant comorbidities. 5-FU, 5-fluorouracil; CapeOx, capecitabine, oxaliplatin; ECOG, Eastern Cooperative Oncology Group; ESMO, European Society for Medical Oncology; FOLFIRINOX, 5-fluorouracil, leucovorin, irinotecan, oxaliplatin; NCCN, National Comprehensive Cancer Network; PC, pancreatic cancer; PS, performance status; pt, patient; ULN, upper limit of normal. 1. NCCN Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma. v1.2013. 2. Verslype C, et al. Ann Oncol. 2012;24:iv5-iv10. Chemotherapy NCCN 20131 ESMO 20122 Combination therapy good performance status FOLFIRINOX 1 Reference treatment Gemcitabine + nab-paclitaxel 1 Reference treatment Gemcitabine + erlotinib 1 Option for fit ptsa Gemcitabine + capecitabine 2A Option for fit ptsa Gemcitabine + cisplatin 2A Option for fit ptsa Fixed dose–rate gemcitabine, docetaxel, capecitabine 2B — Fluoropyrimidine + oxaliplatin 2B — Monotherapy poor performance status Gemcitabine 1 Reserved treatmentb Fixed dose–rate gemcitabine 2B — Capecitabine or continuous 5-FU 2B — Second-line therapy Gemcitabine if not previously treated with gemcitabine 2A — Capecitabine or 5-FU/ leucovorin/oxaliplatin or CapeOx 2A — * 研究方案 奥沙利铂85mg/m2 四氢叶酸400mg/m2