李为民肺癌的靶向治疗.ppt

BR.21研究证实：特罗凯?能有效延长晚期非小细胞肺癌患者生存期。中位生存期6.7个月，较对照组（4.7个月）延长42.5%；死亡危险比（HR）为0.73，降低死亡风险27%；一年生存率31.2%，较对照组提高45%。 ? This is an open-label, non-controlled study of Avastin in combination with carboplatin/paclitaxel, as first-line treatment for patients with advanced or recurrent squamous NSCLC (AVF3744g). Patients will receive two cycles of carboplatin/paclitaxel, then four cycles of carboplatin/paclitaxel plus Avastin 15mg/kg every 3 weeks, followed by Avastin maintenance therapy until disease progression. The objective of the study is to determine whether delayed administration of Avastin will improve safety in patients with squamous cell histology. Primary endpoint: grade ≥3 pulmonary haemorrhage. Secondary endpoints: progression-free survival; baseline and post-baseline factors predictive of severe pulmonary haemorrhage; incidence of select adverse events. AVF3744g study protocol, Roche data on file. Notes: Avastin binds all isoforms of VEGF(-A).2 - At least 4 different VEGF isoforms, with different molecular weights (206, 189, 165, and 121 kD) and heparin-binding properties, are created by alternative splicing of the VEGF(-A) gene.3 Blockade of VEGF with Avastin inhibits VEGF-induced proliferation of endothelial cells in vitro and tumor growth in vivo. References: 1. Avastin? (Avastin) PI. February 2004. 2. Presta LG. Cancer Res. 1997; 57:4593. 3. Ferrara et al. Nat Med. 2003; 9:669. KEY POINT Avastin is a recombinant humanized monoclonal antibody, which binds specifically to the VEGF ligand. FLEX 种族差异 预后因素 腺癌 女性 非吸烟者 ECOG PS 0/1 临床试验后治疗 EGFR TKIs 中位生存 [95% CI] 高加索人群 亚洲人群 FLEX 亚洲人群亚组（n=121） 小样本(总人群的10%)CT组腺癌多临床试验后接受靶向治疗, 不足以在该人群中给予明确结论 基线预后因素 腺癌 临床试验后治疗 EGFR TKIs 高加索人群 高加索人群 FLEX 总结 西妥昔单抗联合顺铂/长春瑞滨一线 化疗治疗NSCLC VS 单化疗,显示 了更佳的生存获益 鳞癌和非鳞癌均能获益 痤疮样皮疹,是西妥昔单抗的主要副 反应，可预见、同时可以控制 注意入组者肿瘤组织均有EGFR表达 血管生成抑制剂 贝伐单抗 1Avastin (bevacizumab). Prescribing Information. 2004; 2Presta et al. Cancer Res. 1997;57:4593. 贝伐单抗 (Avastin)