胃肠间质瘤靶向与近代外科治疗中的若干问题.pptVIP

胃肠间质瘤靶向与近代外科治疗中的若干问题; 胃肠间质瘤（GIST）;甲磺酸伊马替尼之前传统的治疗选择;;;一、有关术前活检的问题：;;;二、有关外科手术后切缘阳性的情况;;三、新辅助治疗与辅助治疗;;Neoadjuvant Therapy;;2004年手术 服药1年后停药 2008年3月复发;08年复发后服药4个月;四、复发、转移性胃肠间质瘤的外科处理;;;;在2008年ASCO会议中Cassier P.A 教授总结出几方面问题:;总体生存率;伊马替尼耐药性问题;治疗周期;选择病人入组;今年ASCO会议新药应用动向索拉非尼的引入; 26例耐药病人用索拉非尼情况;;近十年单用伊马替尼靶向治疗化疗已退出治疗GIST的舞台此次会议中 西班牙又提出了靶向药物 化疗药物联合应用的问题; 实验室的资料;2008年ASCO会议壁报展示;Imatinib Plasma Levels Correlate With Clinical Outcomes;Imatinib Cmin (Trough) Distribution: 400 mg and 600 mg Data Combined;Overall Objective Clinical Benefit by Cmin Quartiles for KIT Exon 11 Patients;PK Data Summary;Tumor Control With Imatinib and Surgery Impact on Outcome;Long-term outcomes of surgery for metastatic recurrent GIST after IM treatment are improved when resection of recurrent or metastasized GIST is performed after best clinical response to IM 80 patients who had received resection of recurrent or metastasized GIST after clinical response to IM were subdivided according to response to IM before surgery; group A with best clinical response (n = 49) and group B with tumor progression (n = 31) Conclusions: Complete resection at time of best clinical response to IM may improve PFS ;Nilotinib (Tasigna?) in GIST;Median OS = 211 days;Response, N= 42 4 PR (10%) Clinical benefit in 15 SD (36%) 45 % of patients Median OS = 211 days Treatment duration 2 months in 22 pts (53%) 4 months in 14 pts (33%) Toxicity-related treatment discontinuation in 5 pts (12 % ) Nausea / Anorexia Asthenia / Anorexia / Nausea / Vomiting Muscle aches / Fatigue / Diarrhea Chest Pain (cardiac) QT prolongation ;Nilotinib has clinical activity in GIST Clinical benefit (PR + SD) in 45 % of patients Nilotinib is well tolerated in GIST 12% toxicity related treatment discontinuation Results warrant further investigation of Nilotinib;Best Overall Tumor Responses;Nilotinib alone and in combination with IM shows activity in imatinib-resis