晚期结直肠癌内科治疗进展

《晚期结直肠癌内科治疗进展》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、晚期结直肠癌内科治疗进展徐建明军事医学科学院307医院肿瘤中心1晚期大肠癌内科治疗现状-可选择的药物和方案较少化疗药物:5-Fu,希罗达，S1，雷替曲塞，草酸铂，CPT-11…..靶向药物：贝伐单抗，西妥昔单抗，帕尼单抗方案：IFL，FOLFIRI，FOLFOX，XELOX，XELIRI,IROX，FOLFOXIRI……化疗－“三类药物，两个方案”靶向药物－expensive！！2晚期结直肠癌治疗几个问题有最佳联合方案吗？整体规划（continuumofcare）Stopandgo？3联合方案的比较IFLFOLFOX

2、FOLFIRIIROXFOLFOXIRI±单抗4CPT-11orOxaliplatin+5-Fu/CF一线治疗ChemotherapyRR%TTP/PFS(M)OS(M)DouillardLancet2000CPT＋LV5FU2(AIO,degramont)416.717.40038SaltzNEJM2000IFL（Fubolus）397.014.8KohneCJCO2005CPT＋AIO(Fuciv)62.28.520.1deGramontJCO2000FOLFOX450.79.016.2TournigandJCO

3、2006FOLFOX7589.021.65CPT-11180mg/m2IV+LV5FU2FOLFIRIFOLFOX6L-OHP100mg/m2IV+LV5FU2RFOLFOX6FOLFIRIPDPDPDArmAArmBPDTournigandC,deGramont,etal.JClinOncol.2004V308Design－ARandomizedGERCORStudy656%0.990.264%15%FOLFIRI(n=69)FOLFOX(n=81)20.621.5OS(months)PFS1stline(mont

4、hs)54%ResponserateFOLFOX(n=111)FOLFIRI(n=109)ArmAArmBpvaluens8.58.00.003PFS2ndline(months)2.54.2Sequentialtreatmentallowstoreach20monthsurvivalTTP1st+2ndline14.211.80.64TournigandC,deGramont,etal.JClinOncol.20047AdditionalStudiesFOLFOXvsFOLFIRI360patientswith

5、StageIVcoloncancerFOLFIRIFOLFOX4RR31%TTP7monthsOS14monthsRR34%TTP7monthsOS15monthsColuccietalJCOAug120058FOLFOXIRI–phaseIIIstudySouglakosJ.etal.BrJCancer2006FOLFIRIFOLFOXIRIn146137RR33.6%43%(NS)medianPFS6.9m8.4m(NS)medianOS(10endpoint)19.5m21.5m(NS)2ndlinethera

6、py70%58%(NS)toxicitymorealopecia,diarrhea,neurotoxicity9FOLFOXIRIvsFOFIRI:phaseIIIFalconeA.2006GISymposiumFOLFIRIFOLFOXIRIn122122RR34%60%(p<0.0001)medianOS16.7m22.6m(p=0.032)S.A.Efortoxicity7%11%10有最佳联合方案吗?IFLandIROXarenotoptimaldoubletsFOLFOXorFOLFIRIrecommend

7、edas1stlinetreatment,andcrossedoveras2ndlinechemoTripletofFOLFOXIRIisnotclearlybetterthandoubletsyet11AdaptedfromGrotheyA,etal.JClinOncol.2004;22:1209-1214;GrotheyA,SargentD.JClinOncol.2005;23:9441-9442.NumberofCytotoxicDrugsReceivedDemonstratesCorrelationWithS

8、urvival2221201918171615141312MedianOS(mo)Patientstreatedwith3drugs(%)P=.000101020304050607080Infusional5-FU/LV+irinotecanInfusional5-FU/LV+oxaliplatinBolus5-FU/LV+irinotecan