课件：v结直肠癌NCCN指南解读精选文档.ppt

XELOX——结直肠癌患者辅助化疗的标准方案 XELOX（CapOX）--- 奥沙利铂 130mg/m2 d1 希罗达 1000mg/m2 每日两次 d1–15 每3周为一周期q3w 卡培他滨单药辅助化疗优于5-Fu/Lv方案 Seidman AD, Aapro M. Introduction [J]. The Oncologist, 2019, 7(suppl 6): 1 - 3. Twelves C, Scheithauer W, McKendrick J, et al. Capecitabine versus 5-FU/LV in stage Ⅲ colon cancer: Updated 5-year efficacy data from X-ACT trial and preliminary analysis of relationship between hand-foot syndrome (HFS) and efficacy [J]. American Society of Clinical Oncology Gastrointestinal Cancers Symposium, 2019, 19(Suppl. 6): A274 X-ACT研究结果：希罗达?组的DFS显示出优势趋势 卡培他滨组显著减少3 / 4级血液学毒性 非劣效P0.0001 3年DFS 5年DFS 7年DFS XELOX 70.9% 66.1% 63% FOLFOX 72.2% 66.4% - 1. Haller et al. JCO 2019;29:1465–71 2. André T et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009,27,3109–16. 5年 OS 6年 OS 7年OS XELOX 77.6% 76% 73% FOLFOX - 72.9% - DFS与OS曲线显示：XELOX方案与FOLFOX疗效相当 月 月 XELOX方案的血液学毒性显著低于FOLFOX方案 Schmoll HJ, Cartwright T, Tabernero J, et al. Phase Ⅲ Trial of Capecitabine Plus Oxaliplatin As Adjuvant Therapy for Stage Ⅲ Colon Cancer: A Planned Safety Analysis in 1,864 Patients [J]. Journal of Clinical Oncology, 2019, 25(1): 102 - 9. NO.16968研究与MOSAIC研究的3/4级不良反应交叉对照分析 McCleary N.A.J, Meyerhardt J, Green E, et al. Impact of older age on the efficacy of newer adjuvant therapies in ＞12,500 patients (pts) with stage Ⅱ/Ⅲ colon cancer: Findings from the ACCENT Database. J Clin Oncol 27:15s, 2009 (suppl; abstr 4010). Haller DG, Tabernero J, Maroun J, et al. Capecitabine Plus Oxaliplatin Compared With Fluorouracil and Folinic Acid As Adjuvant Therapy for Stage Ⅲ Colon Cancer [J]. Official Journal of the American Society of Clinical Oncology, 2019, 11(29): 1465 - 71. * Values ＜1 favor oxaliplatin-based therapy vs. 5-FU/LV; # Data for oxaliplatin-based regimens 风险比 (95% CIs) DFS OS ACCENT 分析 1 (FOLFOX/FLOX vs 5-Fu/Lv) 70岁(n=3877) 0.77 (0.68–0.86) 0.81 (0.71–0.93) ≥70 years (n=703) 1.