《吉西他滨乳腺癌临床应用策略》ppt课件教案.pptVIP

B9E-MC-JHQG The table shows the worst drug-related CTC grade 3 or 4 toxicities observed per patient by arm. All toxicities with a listing =5% were included. Grade 3 /4 leukopenia was also observed in =5% of patients (GT arm), but is not listed here because it was not listed as part of tabular toxicity data in Albain et al.J Clin Oncol 2008;26(24):X-X. Twenty-eight patients on GT and 10 patients on T received ≥1 transfusion(s), mostly of packed red blood cells. B9E-MC-JHQG Overall, the incidence of grade 3 or 4 non-hematologic drug-related toxicities on the two arms was low. Grade 3 or 4 fatigue generally lasted for one cycle (both arms) and was not associated with anemia. Grade 3 or 4 sensory neuropathy occurred at similar frequency;9% on GT had motor neuropathy, versus 3% on T. None of the grade 3 or 4 neuropathies resulted in hospitalization. Two patients (one per arm) died from possible drug-related toxicities (non-neutropenic septicemia and severe asthenia). * * 加入GT vs. T，GD vs. D，等TTP，OS的对比 * * * This is a reminder of the prognostic factors that are associated with shorter overall survival in metastatic breast cancer [read points of interest]. As mentioned on the previous slide, prior systemic factor was a negative prognostic factor in this phase III trial (E1193) conducted by Dr. George Sledge. 即使是内脏转移患者，GT组总体缓解率达35.6%，较T单药组也提高近60%。在我们的注册临床研究中，内脏转移的患者比例均达到73%。对于肺转移和肝转移的患者，GT组也较T单药组更加有效。各位老师都知道，有内脏转移的患者通常症状明显、病情比较凶险，需要更加积极有效的治疗使疾病达到快速缓解，而本研究中GT方案在内脏转移患者中显示了良好疗效。 * 2011年荟萃分析：增加化疗周期可延长晚期乳腺癌患者PFS和OS PFS OS Gennari A. et al. J Clin Oncol.?2011 Jun 1;29(16):2144-9.? 更长的一线化疗时间有显著改善患者OS，肿瘤相关死亡率降低9%（HR=0.91，P=0.046） PFS有显著改善（HR=0.64，P0.001） 不同方案设计间无显著差异一 晚期乳腺癌优化策略路径 维持化疗 诊断 CR/PR/SD PD 疾病进展 一线化疗 后续化疗 等待观察 MBC患者 PD 疾病进展 后续化疗 策略 2 延缓进展,延长总生存 策略 1 同一化疗方案维持的可行性 疗效 安全性 对于一线化疗肿瘤缓解或疾病稳定的患者，继续一线维持化疗 延长患者总生存 不显著降低患者生活质量 健择联合紫杉醇一线治疗后疾病控制的转移性乳腺癌患者，比较维持治疗与观察对照的多中心、随机、III期临床试验 KCSG-BR0702 Park YH, et al. J Clin Oncol.?2013;31(14):1732-9. KCSG-BR0702 研究：GT维持治