非小细胞肺癌治疗近展.pptVIP

二、化疗结合靶点

FASTACT:Sequentialschedulingoferlotinibwithchemotherapyas1st-linetherapyforadvancedNSCLC:subgroupanalysesofarandomizeddouble-blindplacebo-controlledphaseIItrial

LiaoML,1WuYL,2SrimuninnimitV,3LeeJS,4IgnacioJ,5BoyerMJ,6YuCJ,7GintingsAK,8McCloudP,9MokT101ShanghaiChestHospital,affiliatedtoShanghaiJiaotongUniversity,Shanghai,China;2GuangdongProvincialPeoplesHospital,Guangzhou,China;3SirirajHospital,Bangkok,Thailand;4NationalCancerCenter,Seoul,Korea;5PhilippineGeneralHospital,UniversityofthePhilippines,Manila,thePhilippines;6SydneyCancerCentre,RoyalPrinceAlfredHospital,Sydney,Australia;7NationalTaiwanUniversityHospital,Taipei,Taiwan;8CentralArmyHospitalRSPADGatotSoebroto,Jakarta,Indonesia;9DepartmentofStatistics,RocheAustralia;10PrinceofWalesHospital,TheChineseUniversityofHongKong,HongKong,ChinaWithacknowledgementandthankstoalltheinvestigatorswhoparticipated

intheFASTACTstudyFAST-ACTistheFIRSTprospectivemulticenter,randomized,DOUBLE-BLINDEDPANAISANphaseIItrialGC序贯特罗凯组PFS明显改善Log-ranktestp=0.01751.00.80.60.40.20 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36Time(weeks) 38 40 42 44 46 48 50 52 54 56 58 76 74 73 73 65 62 60 59 59 53 51 51 47 38 37 33 27 17 15 78 77 77 76 67 60 58 57 51 44 43 42 35 25 24 22 16 8 7 13 11 10 9 8 6 6 6 3 1 0 5 4 2 1 1 1 1 1 1 1 0No.atriskErlotinibPlacebo23.731.3Adj.HR*=0.57;95%CI:0.38–0.84EarlyandconsistentseparationofcurvesMedianPFS

(weeks)GC-erlotinib31.3GC-placebo23.7*Adjustedforcenter,diseasestage,smokingstatusandhistologyFAST-ACT小结化疗序贯厄洛替尼治疗与单纯一线化疗相比能改善疾病缓解率，明显延长FASTACT研究中所有临床亚组均能看到OFS获益包括男性、吸烟者和非腺癌患者化疗联合厄洛替尼治疗有很好的耐受性，不增加3度以上的毒性反应仍需进一步行Ⅲ期研究二、化疗结合靶点

Flex–研究设计NSCLC湿性Ⅲb/Ⅳ表达EGFR化疗+C-225化疗C-225直到PD或不能耐受毒性化疗C-225顺铂80mg/m2D1初始剂量400mg/m2D1NVB25(30)mg/m2D1,8然后250mg/m2weeklyEvery3weeks,upto6cycles