有放矢个体治疗全程管理.ppt

的放矢、个体治疗全程管理  晚期 NSCLO靶向治疗进展 站在不同的角度看待疾病 有的放矢的靶向治疗 耐药后治疗 全程管理  NSCLO的个体化治疗时代 2010 织学驱动的选择 以致癌驱动基因 NSCLO的治疗演变 为靶点* 腺癌 EGFR突 EGFR野生型 鳞癌2008 鳞癌 ■KRAS■PK3CA EGFR HER2■未知 曲 鳞癌今天 大细胞癌 以腺癌中的突变率为例  生存数据比较:有驱动基因无靶向治疗s无 驱动基因vs有驱动基因接受靶向治疗 146 A>>→0 Driver with targeted therapy 三≡邂 Driver with No targeted therapy YEARS Group Median Survival ( 95% CI) Driver, no targeted therapy(A)313 2.4 years(1. 8 to 2.9 No driver(B) 36121 years(1.8to2.5) Driver, targeted therapy(C) 264 3.5 years(3.2 to 4.6) M Chris, et aL. 2013 WCLC PLO307  2014NCCN指南分子靶点更新 TARGETED AGENTS FOR PATIENTS WITH OTHER GENETIC ALTERATIONS Genetic Alteration (ie, Driver event) Available Targeted Agents with Activity Against Driver Event in Lung Cancer EGFR mutations erlotinib, 'gefitinib, 2 afatinib 3 ALK rearrangements crizotinib HER2 mutations trastuzumab. 5 afatinib6 BRAF mutations vemurafenib. 7 dabrafenib MET amplification crizotinib ROS1 gene fusions crizotinib 10 RET gene fusions cabozantinib 11  明智选择 hoosing AscO Wisely merican ociety od Clinical Oncology Five Things Physicians dn enehietene ef the dB/M Foundation and Patients should question Don't use a targeted therapy intended for use against a specific genetic aberration unless a patient's tumor cells have a specific biomarker that predicts an effective response to the targeted therapy. eople with cancer because it can target specific gene products, ie, proteins that cells use to grow and spread, while causing Iittle or no harm to healthy cells. Patients who are most likely to benefit from targeted therapy those who have a specific biomarker in their tumor cells that indicates the presence or absence of a specific gene alteration that makes the tumor Compared to chemotherapy. the cost of targeted therapy is generally higher, as these treatments are newer, more expensive to produce and under patent protection. In addition, like all anti-cancer therapies, there are risks t