mCRC整体策略下个体化治疗的思考--牛作兴 教授.ppt

“患者特征”指导下的的治疗策略 --- 年龄 43%患者未接受化疗的原因为年龄问题，仅次于合并症 CT, chemotherapy; mCRC metastatic colorectal cancer. Parakh S, et al. J Geriatr Oncol. July 17, 2015. [Epub ahead of print]. Cunningham D, et al. Lancet Oncol. 2013;14(11):1077-1085; 2. Price TJ, et al. ASCO 2011. Abstract 510; 3. Aparicio T, et al. ASCO 2015. Abstract 3541. 低强度 (单药化疗) 中等强度 (doublet CT) ≥70 years ≥75 years ≥75 years AVEX1* 贝伐珠单抗+卡培他滨 vs 卡培他滨 n=140/n=140 AGITG MAX2 贝伐珠单抗+卡培他滨 vs 卡培他滨 n=32/n=37 PRODIGE203 化疗+贝伐珠单抗 vs 化疗 N=51/n=51 结果 中位PFS HR (95% CI) 中位 OS HR (95% CI) 9.1 vs 5.1 0.53 (0.41?0.69) 20.7 vs 16.8 0.79 (0.57?1.09) 8.8 vs 5.6 15.7 vs 13.4 10.7 vs 7.8 0.60 (0.4–0.95) 21.7 vs 19.7 0.69 (0.4–1.2) *Study was not powered to detect differences in OS between treatment arms. # CT, LV5FU2, FOLFOX, or FOLFIRI Bev, bevacizumab; cape, capecitabine; PFS, progression-free survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; CT, chemotherapy. 中/低强度化疗联合贝伐珠单抗显著延长≥70老年患者PFS Cassidy J, et al. J Cancer Res Clin Oncol. 2010;136:737-743. 0 2 4 6 8 10 12 14 16 18 20 Bevacizumab ≥70 years (n=712) Control Patients with event (%) Bleeding Hypertension Proteinuria ATE VTE WHC Fistulae/abscess GI perforation CHF 贝伐珠单抗显著延长 PFS (HR 0.58; 95% CI 0.49–0.68) OS (HR 0.85; 95% CI 0.74–0.97) *Pooled analysis of 3,007 patients enrolled in 4 metastatic colorectal studies (NO16966, AVF2107g, AVF2192g, and E3200). CI, confidence interval; ATE, arterial thromboembolic event; VTE, venous thromboembolic event; WHC, wound-healing complication; GI, gastrointestinal; CHF, congestive heart failure. 老年患者应用贝伐珠单抗不显著增加各级不良事件发生率 “患者特征”指导下的的治疗策略 --- 既往辅助治疗 两组基线特征相似，且与FIRE-3和CALGB80405研究基线特征相似 既往接受奥沙利铂辅助化疗的患者： FIRE-3研究为入组前6个月内 CALGB80405研究为入组前12个月内 FIRE-3 (58) CALGB80405 (67) 研究中既往接受 奥沙利铂辅助治疗 患者 (N=125) FOLFIRI+贝伐珠单抗 (=56) FOLFIRI+西妥昔单抗 (n=69) 直至疾病进展/死亡/ 不可接受的毒性/手术 R Heinemann V, et al. 2015 ASCO Abstract 3585. FIRE-3CALGB80405研究合并分析：既往接受含奥沙利铂辅助治疗 FOLFIRI+ 西妥昔单抗 贝伐珠单抗 HR; P值 ORR (