《肺神经内分泌肿瘤》.ppt

Treatment with α-Interferons (α-IFN:s) Types of α-IFN:S Recommended doses for classical midgut carcinoids Human leukocyte IFN Lymphoblastoid IFN (Welferon) Recombinant IFNα 2a (Roferon) Recombinant IFNα 2b (Intron-A) IFNa 2b 3-5 MU x III-V/week s.c. NB! Individual dosing according to tolerance and leukocyte count (3.0 x 109/l) is recommended α-IFN: Treatment Subjective Responses Biochemical Responses Tumour Responses 50-70% 30-70% 10-15% Treatment with Somatostatin Analogues (Octreotide) Octreotide CarcinoidSyndrome Carcinoid Crises Octreotide LAR Recommended dosing: 100-600 μg/day s.c. given as 2-3 doses Experimental: 1,500-3,000 μg/day s.c. Preoperatively: 100 μg s-c- 30’ prior to operation and thereafter 50 μg/hr i.v. infusion during op., continue postop. either with s.c. or i.v. therapy Octreotide i.v. 50-100 μg/hr (Foregut carcinoid with histamine production, continue with H1 and H2 receptor blockers) Long-acting formulation, dosing 20-30 mg i.m./4 w. Octreotide Treatment Subjective Response Biochemical Response Tumour Response 30-75% (Dose dependent) 30-60% (Dose dependent) 0-15% (Not dose dependent) Somatostatin AnaloguesPROMID: Placebo Controlled, Double Blind, Prospective Randomized Study of the Effect of Octreotide LAR in the control of tumor growth in patients with Metastatic Neuroendocrine Midgut Tumors Primary Endpoint Time to Progression Secondary Endpoints Overall Survival Response Rates Arnold, GI ASCO 2009, abstract #121. 85 patients with well-differentiated metastatic midgut NETs RANDOMIZE Octreotide LAR 30 mg IM q4wks N=42 Placebo IM q4wks N=43 p=0.000072, HR 0.34 (95% CI 0.20-0.59) Time to Progression Overall Survival Octreotide Placebo Median OS not yet reached Sunitinib Phase III Trial-PET 171 patients randomized to sunitinib 37.5 mg or placebo Crossover allowed Study closed early due to benefit of treatment Sunitinib