消化道肿瘤esmo精品医学ppt课件

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1、ESMOHighlights2010UpperGI1ESPAC-3PANCREASLIVER/BILIARYNETsGASTRICGIP-1ABC-02PROMIDTOGAAIO-PK0104EACHA6181111AVAGASTProdigeIV-Accord11RADIANT-1AIO(2ndline)NCT00219557Conko-4/FRAGEMVEGFRpolymorphismsADVANCEDADJUVANTPancreaticcancerbackgroundAdjuvant:BothFUandgemcitabineshowntoi

2、mproveOSRoleofRTcontroversialAdvanced:Gemcitabinemonotherapy=standardfor10yearsClinicalbenefitin20-30%ofpts;medianOS6-8m;1-yS20-30%Controversialimprovementaddingasecondcytotoxic(fluoropyrimidines,platinumderivatives:positivemeta-analysisbutnegativesinglestudies)Smallimprovemen

3、t(clinicalrelevancequestioned)addingerlotinib;noimprovementwithotherbiologics(cetuximab,bevacizumab)Oxaliplatin/FU/LV:bestoptionaftergemcitabinefailure(2ndline)Highincidenceofvenousthromboembolism(17-30%)ResectedpancreaticductaladenocarcinomaFU/LVvsGemcitabine(ESPAC-3)Neoptol

4、emosetal.ASCO2009;AbstractLBA4505NodifferenceinefficacyBettertoxicityprofilewithgemcitabine(moremyelotoxicitybutlessstomatitisanddiarrhea;lesstxrelatedSAEsoverall)GlobalQLscores―nodifference-->ESPAC-4:GEM+/-capecitabineSurvivalbytreatmentPFSbytreatmentSurvival(%)1224364860025

5、5075100MonthsfromresectionX2LR=0.74,p=0.39,HRGEMVSSFU/FA=0.94(95%CI:0.81,1.08)0MedianS(t)=23.0months(95%CI:21.1,25.0)MedianS(t)=23.6months(95%CI:21.4,26.4)5FUFAGEMNo.atrisk5FUFA5514132491093615GEM5374152511034213PFS(%)12243648600255075100MonthsfromresectionX2LR=0.59,p=0.44,HRG

6、EMVSSFU/FA=0.95(95%CI:0.83,1.09)0MedianPFS(t)=14.1months(95%CI:12.5,15.3)MedianPFS(t)=14.3months(95%CI:13.5,15.7)5FUFAGEMNo.atrisk5FUFA551296160642311GEM537319152682211AdvancedpancreaticcancerGemcitabine+/-cisplatin(GIP-1)Additionalnegativerandomizedstudyonagemcitabinedoubletc

7、omparedtogemcitabinealone(previousmeta-analysisnotconfirmed)Coluccietal.ASCO2009:Abstract4504;Coluccietal.JClinOncol2010;28:1645-1651nmOSmonthsmPFmonthsRR,%Gemitabine1998.33.9m10.1Gem/cisplatin2017.23.8m12.9p0.380.800.37AdvancedpancreaticcancerAIO-PK0104Boecketal.ASCO2010;Ab

8、stractLBA4011SimilarOSandoverallTTFwitheithersequence.Gemcit