晚期NSCLC血管靶向治疗新进展.pptVIP

晚期NSCLC治疗的期待 血管生成的开关学说 血管生成的开关学说 Tumour angiogenesis is complex: many cell types and many factors are involved VEGF: 最有效和最重要的促血管生成信号 Tumour characteristics and environment promote VEGF expression 肿瘤血管靶向治疗策略 血管靶向治疗NSCLC新进展 ORR have increased significantly with Avastin-based therapy ECOG 4599：B+CP显著延长OS ECOG 4599：B+CP显著延长PFS SAiL:safety of bevacizumab-based therapy as first-line treatment of NSCLC Sun Y, Wang JW, Liu Y et al, Results of phase III trial of rh-endostatin (YH-16) in advanced non-small lung cancer (NSCLC) patients. Proc ASCO 2005; 23:7138a 恩度TC研究结论 恩度组临床获益率显著提高23%(90.2%vs. 67.2%,P=0.004)，符合抗血管生成药物的疗效特点,即更多的以稳定病人病情为主。 恩度组较对照组明显呈现提高肿瘤缓解率的趋势 ( 39.3% vs. 23%, P＝0.078）；IV期与腺癌患者的ORR较对照组有显著提高，但由于入组例数较少，需要进一步的研究验证. 恩度组显著提高16周和24周的肿瘤无进展率，中位TTP提高0.8个月（7.1月 vs. 6.3月），24周内恩度治疗组疾病进展风险显著降低（风险比0.416，P＝0.012）。提示联合使用恩度组的病情稳定时间明显比单纯化疗者延长。 恩度联合紫杉醇/卡铂方案安全性较好，未观察到增加化疗的毒副反应。 32周以后两组无疾病进展生存曲线逐渐接近，这可能与本研究一线治疗时间较短（中位治疗时间3.1个月，95%CI 2.9--3.4个月），且恩度没有维持使用有关，提示如果恩度长期维持使用可能会带来更大的生存获益。 Endostar Combined with Chemotherapy Versus Chemotherapy Alone for Advanced NSCLCs: A Meta-Analysis. To evaluate the clinical efficacy and safety of rh-endostatin (Endostar) combined with chemotherapy in the treatment of patients with non-small cell lung cancer (NSCLC), we selected data from the Cochrane Library, EMBASE, Medline, SCI,CBM, CNKI, etc to obtain all clinical controlled trials, including the addition of endostar to chemotherapy in advanced NSCLC patients. The quality of included trials was evaluated by two reviewers independently. The software RevMan 5.0 was provided by Cochrane Collaboration and used for meta-analyses. Fifteen trials with 1335 patients were included according to the including criterion. All trials were randomized controlled trials, and two trials were adequate in reporting randomization. Thirteen trials didnt mention the blinding methods. Meta-analysis indicated that the NPE arm (Vinorelbine+ cisplatin+Endostar) had a different response rate compared with NP(Vino