最新抗肿瘤药物靶向治疗胃肠道癌-药学医学精品资料.ppt

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1、最新抗肿瘤药物靶向治疗胃肠道癌-药学医学精品资料•参加EGFR筛选的病人:577•其中EGFR表达的病人:474(82%)•随机分组:329EGFR表达阳性且在含伊立替康化疗方案治疗期间或治疗后3个月内出现疾病进展的mCRC患者329人2:1随机分组Irinotecan*+Cetuximab**Cetuximab**n=218n=111ＰＤ主要终点:RR次要终点:TTP,OS,SafetyIrinotecan*+Cetuximab**n=56*Sameregimenaspreviouslyfailed;**initially400mg/m2IV,then250mg/m2IVweekly‘B

2、OND’试验结果：有效率和PFSCetuximab/Irinotecann=218Cetuximabn=111Progression-freesurvival5660[49-62]**1MonoComboN11121850No.events921520.8Median1.54.1*4032HR(95%CI):0.54[24-42]0.6(0.42;0.71)3023p-value<0.0001[18-29]Pr0.4P20oe11proce[6-18]rt0.2n10iotnage00ResponseRateDiseaseControl024681012(CR+PR+SD)MonthsEn

3、dpoint*p=0.0074;**p<0.001;[]=95%CICunninghamDetal.NEJM2004爱必妥/伊立替康基于奥沙利铂的化Survival疗失败后的病人伊立替康Cetuximab+Irinotecan(N=648)Irinotecan(N=650)70p-value=<0.00016061,4504045.830p-value=<0.0001P20erce16,4n10tag4,2e0(%ResponserateDiseaseControl)(CR+PR)(CR+PR+SD)1.0Cetuximab+Irinotecan;N=6480.8Irinotecanalo

4、ne;N=6500.64.0moHR=0.6995%CI=0.617–0.7760.42.6mop<0.00010.2Proporti0.0onPro0369121518grMonthsessSobreroetal.AACR2007ionFreeCetuximab+FOLFIRI西妥昔单抗IV400mg/m2d1,then250mg/m2weekly+伊立替康(180mg/m2)+5-FU(400mg/m2bolus+EGFR表达的R2400mg/m2as46-hrmCRCcontinuousinfusion)+FAevery2weeksFOLFIRI伊立替康(180mg/m2)+5-FU

5、400mg/m2bolus+2400mg/m2as46-hrcontinuousinfusion)+FAevery2weeksFOLFIRIalone,n=599Cetuximab+FOLFIRI,n=59960p*=0.003850相对增长:4047303921%20Perc10entag0e(Responserate%VanCutsemetal,ASCO2007*Co)chran-Mantel-Haenszel(CMH)test1.0Cetuximab+FOLFIRI,n=5990.9FOLFIRI,n=5990.8HR=0.851;95%CI=[0.726-0.998]0.7减少疾

6、病进展的风险15％0.68.9mop=0.04790.58.0moP0.41-yearPFSrateFS23%vs34%e0.3stim0.2ate0.10.002468101214161820Progression-freesurvivaltime(months)VanCutsemetal,ASCO2007Cetuximab+FOLFOX-4400mg/m2initialIVinfusion(day1)then250mg/m2weekly+oxaliplatin85mg/m2+5-FU/FAevery2weeksEGFR-表达的RmCRC患者FOLFOX-4Stratificationf

7、actors:ECOGPS0-1,2oxaliplatin85mg/m2+5-FU/FAevery2weeks治疗直到疾病进展或不能耐受毒性FOLFOX-4Cetuximab+FOLFOX-4908085.281.07060504045.63035.720per10ceOddsratio=1.516,p=0.064*n0tagORRDCRepatie*Cochran-Mantel-Haenszel(CMH)testnts