晚期nsclc维持治疗策略.pptVIP

晚期NSCLC维持治疗策略;晚期肺癌诊疗模式;问题1: 为何要停下来休息? ;继续一线两药化疗药品直到6个周期;;;;ASCO Guideline改变;ASCO Educational Book 2003;问题２: 停下来休息后果是什么？;晚期肺癌诊疗模式;晚期肺癌诊疗模式;晚期NSCLC维持诊疗研究中对照组PFS结果汇总;近50%患者无法进入二线诊疗 ;多个III期临床研究中, 30%患者未接收二线诊疗;In our opinion, treatment-free intervals remain an option; however, patients must be observed closely with serial radiographic examinations because the median PFS is approximately 2 to 3 months. The optimal timing and method of observing patients for disease progression are unclear, and patients should be informed of the risks associated with a treatment-free interval.;问题３: 有没有其她诊疗选择？;诊疗;晚期NSCLC维持诊疗不一样诊疗策略;晚期NSCLC维持诊疗PFS结果汇总;INFORM研究中PFS;Odds Ratio=3.31(95% CI 1.60-6.82, p=0.0012). 中位症状恶化时间(LCS): 4.3月(gefitinib) v 2.3月(placebo). ;晚期NSCLC维持诊疗OS结果汇总;问题４: 怎样解释没有OS改善？;维持诊疗研究设计;研究;SATURN研究;Randomized studies on first line EGFR TKI in patients with EGFR mutation;JMEN 研究后续诊疗;IFCT-GFPC 0502研究;二线培美曲塞诊疗情况;IFCT-GFPC 0502研究;Real-World Considerations for Maintenance Therapy;Because patients with stage IV NSCLC have longer OS in clinical trials, the impact of any one drug, or the timing of its use, on that survival becomes more difficult to detect as patients receive sequential therapies. This complexity will increase the importance of PFS as an end point in future clinical trials of novel drugs in patients with stage IV NSCLC.;问题５: 怎样实现个体化维持诊疗? ;怎样合理地选择维持诊疗？;两项吉西她滨维持诊疗研究显示:对PS评分好患者进行维持诊疗疗效显著;HR=0.47 95% CI: 0.42–0.61) p 0.00001;SD患者更适合换药维持;;维持诊疗目标争取更多病人能够接收后续诊疗 尽可能地延长患者PFS。 改善/保持很好生活质量 (QoL) 副作用小药品愈加适合作为维持诊疗选择。 很多原因影响患者OS。;;总 结; THANKS !