EGFR-TKI的皮肤毒性副反应的诊断和处理.pptVIP

2011 年，美国纪念Sloan-Kettering 癌症中心牵头成立全球知名的MASCC（Multinational Association for Supportive Care in Cancer）皮肤毒性管理协作组。该协作组是一个国际多中心合作组织，由著名皮肤病学专家Mario 教授担任组长，包括皮肤病学专家、肿瘤姑息治疗专家，药理毒理学专家和生活质量评估专家等。MASCC 协作组以 “当接受分子靶向治疗时，请关注你的皮肤、毛发和指甲”为口号 通过汇集全球医疗资源， 于2011 年制定了EGFR-TKI 相关皮肤毒性反应的诊疗规范。经讨论认为单纯应用NCICTCAE3.0 版并不能准确评估EGFR-TKI 相关皮疹， 推荐以NCI-CTCAE 4.0 为基础，融合MedDRA 医学术语及分类，特别关注与患者健康相关的生活质量（Health-related quality-of-life, HQOL）、日常活动度（Activities of daily life, ADL）和患者叙述的预后（patient reported outcomes, PROs），同时需遵守FDA 规定对皮肤毒性进行详细描述和随访。NCI-CTCAE 4.0 由美国卫生和公众服务部于2009年4 月发布，对于皮疹的评估较NCI-CTCAE 3.0 版本进行了部分更改（表2）。 Comments. When we take of look of the survival figures between clinical trials, you can see for surgery alone, the 5 yrs survival rate is ~10% (which is signifying cure in ca pancreas). but in the presence of adjuvant chemo, the 5 yr survival rate has improved to 20% in chemo arm in ESPAC-1 and CONKO-01, In current ESPAC-3 study, the results further consolidate the benefits of adjuvant chemotherapy with very similar figure to the chemo arm of previous trials, meaning that the adjuvant chemotherapy could help cure some of the patients. Remember that the 5yr survival rate means cure in patients with Ca pancreas. The ESPAC-3 plays an important role that it further reproduce such survival data. Another crucial findings from ESPAC-3 is that it confirms the prognostic factors namely grading, staging and quality of resection. However, I have to say that this is a negative study. This study is initially designed to domonstrate the superiority of gem over 5FU/FA. But it fails to. Hence it wont help us change the practice too much…but there is some provocative points that there is a trend favoring gemcitabine in terms of toxicity profile and R1 patients. * Comments. When we take of look of the survival figures between clinical trials, you can see for surgery alone, the 5 yrs survival rate is ~10% (which is signifying cure in ca pancreas). but in the presence of adjuvant chemo, the 5 yr survi