周彩存：肺癌的精准治疗.pptx

PrecisionTherapyofLungCancerCaicunZhouShanghaiPulmonaryHospital,Shanghai

Chemotherapy：

ORR20~30%，OS8~10months肿瘤学.同济大学出版社2010年1月第一版:P276.JClinOncol2008:3543-3551SchillerE1594VanMeerbeckEORTCScagliottiILCPKellyS9509TAX-326JMDBITT非鳞癌

PrecisionMedicineinAdvancedNSCLCClinicalLungCancerGenomeProjectandNetworkGenomicMedicine,ScienceTransl.Med.2013Targettherapy

(1st,2nd,and3rdgeneration)NewtargetsIncreaseofbiomarkertestingImmunotherapyＰＤ－Ｌ1ＴＰＳ50%Mutationload200SquamousCarcinomaSmokingadenocarcinomaNoactionabledrivermutationAvastin＋ChemoNon-squamousNSCLCAdenoCaSquamousCa.SCLCNOSLargecell

PFSinIPASS048121620240.00.20.40.60.81.0GefitinibEGFRM+(n=132)

GefitinibEGFRM-(n=91)

Carboplatin/paclitaxelEGFRM+(n=129)Carboplatin/paclitaxelEGFRM-(n=85)Probability

ofPFSEGFRM+HR(95%CI)0.48(0.36,0.64),p0.0001EGFRM-HR(95%CI)2.85(2.05,3.98),p0.0001PrimaryCoxanalysiswithcovariates;ITTpopulation;HR1impliesalowerriskofprogressionongefitinibTreatmentbysubgroupinteractiontest,p0.0001Moketal2009Timefromrandomisation(months)

RandomizedphaseIIItrialson

EGFRTkivschemotherapyROSsiA,etal.CancerTreatmentReviews2013;39:489-497.ZhouCC,etal.LancetOncol2011;12:735–42.WuYL,etal.AuunalofOnco2015.HanJY,etal.JClinOncol2012;30:1122-1128.StudiesArmsN(EGFRm+)ORR(%)ORRPvaluePFS(months)PFSPvalueIPASSGefitinibTaxol/carb247.30.00019.56.30.0001First-SIGNALgefitinibGem/cis261684.637.50.0028.06.30.086WJOG3405GefitinibDox/Cis868662.132.10.00019.66.60.001NEJ002GefitinibTaxol/Carb730.70.00110.85.40.001OPTIMALErlotinibGem/Carbo827283360.000113.14.60.0001ENSUREErlotinibGem/Cis733.60.000111.05.50.0001EURTACErlotinibDoubletA9.75.20.0001CONVINECIcotinibPem/CisorCarbo833.8ＮＡ9.77.20.001

LUX-Lung7:PFSParkK,etal.2015ESMOAsia.afatinib(N=160)Gefitinib(N=159)PFS(month)11.010.9H