胃癌内科治疗中学习资料.ppt

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1、胃癌内科治疗内科治疗的几个问题晚期胃癌的最佳化疗方案；化疗获益后如何安排后续治疗；Alimita,Bortezomib,Cetuximab和bevacizumab的定位；化疗相对敏感；临床疗效一般，主要起姑息作用，但比BSC好；ECF、FAMTX、EAP方案的PR30-50%;CR罕见,缓解期短，OS6-10个月，毒性大；没有标准方案：5-FU/PDD为基础的方案如：ECF、5FU/LV/PDD或5FU/PDD为“参考”方案。90年代的化疗状况AgentNoRR(%)95%CIPaclitaxel21224

2、20-28%Docetaxel1572218-26%Irinotecan1351712-24%Capecitabine692920-38%S1944434-54%单药一线治疗LV5FU2n=45LV5FU2-cisplatinn=44LV5FU2-irinotecann=45CR0%0%0%PR.13%27%40%Overallresp.CI95%13%[3.4-23.3]27%[14.1-40.4]40%[25.7-54.3]SD36%39%20%PD40%20%17%Responserateasperi

3、ndependentreview(eligiblepopulation&WHOcriteria)GastricCancerStudymonths01020304050607080901000123456789101112131415161718192021222324%LV5FU2(n=45)3.2mo.95%CI(1.8-4.6)LV5FU2-P(n=44)4.9mo.95%CI(3.5-6.3)LV5FU2-I(n=45)6.9mo.95%CI(5.5-9.3)Progression-freesurv

4、ivalGastricCancerStudy01020304050607080901000123456789101112131415161718192021222324months%LV5FU2(n=45)6.8mo.95%CI(2.6-11.1)LV5FU2-P(n=44)9.5mo.95%CI(6.9-12.2)LV5FU2-I(n=45)11.3mo.95%CI(9.3-13.3)OverallsurvivalGastricCancerStudyCapecitabineandCisplatinforA

5、GCCapecitabine1250mg/m2pobidDay1-14Cisplatin60mg/m2ivDay1q3weeksNo.ofpatients42Response55%Timetoprogression6.3mMediansurvivaltime10.1mAsianMedicalCenterTrial,KoreaPaclitaxel80mg/m2iv(1h)weeklyx6Cisplatin50mg/m2ivDay8,295-FU2000mg/m2iv(civ)weekl

6、yx6Lv500mg/m2iv(2h)weeklyx6q7weeksNo.ofpatients29Response48%(4CR)Timetoprogression8mMediansurvivaltime11mPaclitaxel,CIFUandCisplatin(TCF)Honecker,AnticancerDrug200214.3%NotEvaluableDCFn=111CFn=112CR2.7%2.7%PR36.0%20.5%OverallRR(CR+PR)38.7%23.2%[9

7、5%CI][29.6-48.5][15.8-32.1]P-value[ChiSquare]p=0.012NC/SD30.6%34.8%PD17.1%27.7%13.5%ResponseRateV325PhaseIIIInterimAnalysisResponsesconfirmedbyExternalResponseReviewp-value=.0008RR=1.704Probability21201918171615141312111098765432101.00.90.80.70.60.50.40.3

8、0.20.10.0Duration(Months)1.00.90.80.70.60.50.40.30.20.10.02120191817161514131211109876543210Duration(Months)292827262524232230Results:V325PhaseIIIDCFCFDCFCFTimetoProgressionOverallSurvivalStudyRegimenNoRR(%)T