2010年asco胰腺癌课件

健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. Highlights of ASCO 2010 胰腺癌 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. 概览 辅助治疗 # LBA4012 一线治疗 # LBA4011 #4010 #4035 回顾性分析 #4049 e14504 新辅助治疗 # e14604 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. 概览 辅助治疗 # LBA4012 一线治疗 # LBA4011 #4010 #4035 回顾性分析 #4049 e14504 新辅助治疗 # e14604 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. Oral presentation CapRI: Final results of the open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon-2b (CRI) versus 5 -FU alone for patients with resected pancreatic adenocarcinoma (PAC) A. Marten, et al. Phase III trial # LBA4012 CapRI研究 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI: 背景和设计 基于ACOSOG研究方案，评估化/放疗/免疫联合治疗策略 5-FU/LV的对照组参照ESPAC 3 研究设计 R B(5-FU/FA)组：亚叶酸(20 mg/m2, 静脉推注), 之后5-FU(425 mg/m2,静脉推注1-5天)；每28天 一次; 共治疗6个月 A组(CRI)： 5-FU (200mg/m2/day,持续输注), 顺铂 (每周30mg/m2) , 3百万单位的 IFN- (每周3次)共用5.5周, 同时 联合体外放疗(50.4Gy分28次照 射); 之后超过两个周期的5-FU 持续输注 ；共治疗6个月 R0或R1切除的胰腺癌患 者 术后12周内 KPS70分 N=110 首要研究终点：OS 次要研究终点：毒性、DFS和QOL ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:患者基线特征 ASCO 2010 A. Marten, et al., Abstract # LBA4012 A组 N=53 B组 N=57 两组 N=110 P值 女/男(%)36/6454/4645/550.95 R0/R1(%)55/4566/3461/390.09 T1/T2/T3/T4(%)2/4/92/20/2/96/21/3/95/20.25 N0/N1(%)21/7921/7921/790.71 G1/G2/G3(%)2/64/342/70/282/68/311.00 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:研究结果-毒性 ASCO 2010 A. Marten, et al., Abstract # LBA4012 周期1 A组组 N=53 周期2 A组组 N=51 周期3 A组组 N=46 组组B N=57 发发生不良反应应的患者例数 (%) 32.1- 3级级不良反应发应发 生率5%- 中性粒细细胞减少(%)52.8- 血量不足(%)15.1- 恶恶心/呕吐(%)15.1- 贫贫血(%)5.7- 腹泻(%)5.7-10.5 血小板减少(%)5.7- 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:研究结果-毒性 ASCO 2010 A. Marten, et al., Abstract # LBA4012 周期1 A组组 N=53 周期2 A组组 N=51 周期3 A组组 N=46 组组B N=57 发发生不良反应应的患者例数 (%) 32.1- 4级级不良反应发应发 生率20.8-1.8 急性肾肾功能不全(%)1.9- 中性粒细细胞减少(%)13.2- 血容量不足(%)1.9- 手足综综合征(%)1.9- 恶恶心/呕吐(%)1.9- 腹泻(%)-1.8 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:研究结果-QOL ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:研究结果-OS ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:研究结果-DFS ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:肿瘤复发部位 ASCO 2010 A. Marten, et al., Abstract # LBA4012 A组 N=41 B组 N=45 两组 N=86 P值 局部(%)29.355.643.00.014 肝(%)41.522.231.4NS 肺(%)12.24.48.1NS 淋巴结(%)2.411.17.0NS 腹膜癌(%)12.22.27.0NS 未知(%)2.44.43.5NS 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:预测性标志物的预设检验 ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:预测性标志物的预设检验 ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI:结论 CapRI方案毒性较高但可控 QOL在第1周期会有下降但很快会完全恢复 CapRI方案未能达到首要终点，未能显著延长OS 可以更好的控制R1术后患者的复发 对IFN-的反应与OS相关 ASCO 2010 A. Marten, et al., Abstract # LBA4012 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. CapRI: 争议 没有依据不良预后因素进行分层 缺乏分层可能导致结果偏倚，并隐藏了化放疗/免疫联合 治疗的有效性 与ACOSOG Z05031研究毒性分布差异需要进一步 合理解释 ACOSOG Z05031因严重胃肠道毒性而终止试验 治疗后的随访监督不及时(至少每6月一次) 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. 概览 辅助治疗 # LBA4012 一线治疗 # LBA4011 #4010 #4035 回顾性分析 #4049 e14504 新辅助治疗 # e14604 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. Oral presentation Gemcitabine plus erlotinib (GE) followed by capecitabine (C) versus capecitabine plus erlotinib (CE) followed by gemcitabine (G) in advanced pancreatic cancer (APC): A randomized, cross- over phase III trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO) S. H. Boeck, et al. Phase III trial #LBA4011 AIO: 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 卡培他滨一线治疗的地位？ 临床获益、反应率和生存与吉西他滨单药类似1 AIO研究旨在： 以卡培他滨为初始治疗是否可行？ 非劣效性研究 1. Cartwright et al, JCO. 20:160, 2002 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 研究设计 R 组组B：吉西他滨滨+厄洛替尼 吉西他滨滨1000 mg/m2 (30) q.w, 7/8w, 之后d1, 8, 15, q4w; 厄洛替尼 150 mg/d 组组A：卡培他滨滨+厄洛替尼 卡培他滨滨 2000 mg/m2/d, d1-14 q3w 厄洛替尼 150 mg/d 吉西他滨滨 PD 卡培他滨滨 PD ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 细细胞学或组织组织 学确 诊诊的局部晚期或转转移 性胰腺癌 既往未用化疗疗或放疗疗 KPS60% 分层层因素 中心 分期(局部晚期 vs 转转 移) 注：AIO研究中允许PS稍低者和疾病不同扩散范围者入组 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 首要研究终点 首要终点：TTF2(至二线治疗的治疗失败时间) TTF定义 疾病进展 毒性无法耐受 患者拒绝 死亡 TTF2计算： 一线线：吉西他滨滨或卡培他滨滨 +厄洛替尼 二线线：卡培他滨滨或吉西 他滨滨 PD TTF1 TTFC TTF2(TTF1+TTFC) ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 次要研究终点 ORR(RECIST) TTF1(至一线治疗的治疗失败时间) 毒性 OS QOL ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 患者基线特征 卡培他滨滨+厄洛替尼 吉西 他滨滨 N=147 吉西他滨滨+厄洛替尼 卡培 他滨滨 N=132 男性/女性(%)63/3757/43 中位年龄龄(岁岁) 范围围 63 (38-75) 68 (32-78) 分期 局部进进展/转转移 (%) 18/8216/84 基线线KPS 90-100/60- 80(%) 63/3764/36 基线线中位CA19-9 (范围围) 1559 (1-2419000) 2212 (0.6-1411000) 既往手术术(%)136 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 研究结果-TTF2 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 研究结果-OS ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 吉西他滨+厄洛替尼 卡培他滨组的TTF1 更长 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 研究结果-一线治疗的有效率 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 卡培他滨滨+厄洛替尼 吉西他 滨滨 N=132 吉西他滨滨+厄洛替尼 卡培他 滨滨 N=147 CR(%)01 PR(%)512 SD(%)3235 DCR(%)3748 PD(%)4631 没有评评估1720 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 一线治疗不良反应情况 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 不良反应应(%)卡培他滨滨+厄洛替尼 N=125 吉西他滨滨+厄洛替尼 N=137 1-4级级3-4级级1-4级级3-4级级 中性粒细细胞减少100627 贫贫血4266814 血小板减少734410 手足综综合征388110 皮疹637689 腹泻6111536 口腔炎343182 感染32134817 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 转化性研究分析 收集204例肿瘤组织标本(73%) 统一在慕尼黑大学分子病理学实验室分析 KRAS突变检测 204例中有176例可以检测 53例野生型(30%)，123例突变(70%) ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: KRAS突变与OS 总人群分析 KRAS野生型患者OS显著延长 ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. AIO: 研究结论 试验组(卡培他滨+厄洛替尼 吉西他滨)的TTF2、OS均与对 照组相近(吉西他滨+厄洛替尼卡培他滨) 对照组(吉西他滨+厄洛替尼卡培他滨)的TTF1更长：HR 0.69, P=0.0036 吉西他滨+厄洛替尼是安全性较好的一线治疗方案 吉西他滨治疗晚期胰腺癌的疗效要优于氟嘧啶类的药物 在这项多中心交叉研究中，有51%患者接受了预设二线治疗 厄洛替尼相关皮疹显示出生存预测意义 KRAS突变与预后不良相关（但没有显示预测意义） ASCO 2010 S. H. Boeck, et al., Abstract # LBA4011 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. Oral presentation Randomized phase III trial comparing FOLFIRINOX (F: 5FU/leucovorin LV, irinotecan I, and oxaliplatin O) versus gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial T. Conroy, et al. Phase III trial # 4010 ACCORD：FOLFIRINOX vs. 吉西他滨治疗晚期 胰腺癌 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 背景和设计 l 5-FU/LV/OXA在二线治疗中延长患者生存(CONKO 03研究） l 伊力替康、5FU序贯使用可能具有协同作用(Azrak and Rustum, Clin Cancer Res 10:1121, 2004) l 两者联合治疗在II期研究的结果令人鼓舞(JCO 23:1228,2009) R 吉西他滨 FOLFIRINOX 细胞学或组织学确诊的 局部晚期或转移性胰腺 癌 ECOG PS 0-1 既往未用化疗或腹部放 疗 年龄18-75岁 两组组每2个月CT扫扫描一次，治疗疗均进进行6个月 FOLFIRINOX：奥沙利铂85 mg/m2 d1; 伊立替康 180 mg/m2 d1; 甲酰四氢叶酸400 mg/m2 d1; 5-FU 400 mg/m2d1推注, 2400 mg/m2 46h 持续静脉滴注；每两周为一周期 吉西他滨：吉西他滨1000 mg/m2 q.w, 7/8w, 之后d1, 8, 15, q4w ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD:研究终点 首要终点： OS 次要终点： ORR(RECIST) 毒性(NCI-CTC 3.0 v) PFS QOL(EORTC QLQ-C30 3.0v) ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD:患者基线特征 ASCO 2010 T. Conroy, et al., Abstract # 4010 FOLFIRINOX N=171 吉西他滨滨 N=171 P值值 中位年龄龄(岁岁) 范围围 61 (25-76) 61 (34-75) NS 男性/女性(%)106(62%)/65(38%)105(61.4%)/66(38.6%)NS 基线线PS 0/1/2(%)64(37.4%)/106(62%)/1(0.6%)66(38.6%)/105(61.4%)/0(0.0%)NS 原发发部位 胰头头/其他(%)62(36.3%)/109(63.7%)60(35.1%)/111(64.9%)NS 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 患者疾病特征 特征 FOLFIRINOX N=171 吉西他滨滨 N=171 P值值 胆道转转移159(91.2%)161(94.%)NS 不同时间时间 的转转移15(8.8%)10(5.8%)NS 平均转转移的部位2(1-6)2(1-6)NS CA19-959 ULN68(41.5%)77(46.7%)NS 评评估部位 肝149 (88.2%)150 (87.7%)NS 胰腺89(52.7%)91(53.2%)NS 淋巴结结48(28.4%)39(22.8%)NS 肺33(19.5%)49(28.7%)0.049 腹膜33(19.5%)32(18.7%)NS ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-血液学毒性 ASCO 2010 T. Conroy, et al., Abstract # 4010 不良反应应(%)FOLFIRINOX N=167 吉西他滨滨 N=169 P 所有3-4级级所有3-4级级3-4级级 中性粒细细胞减少79.945.76218.70.0001 粒缺性发热发热7.25.4680.60.009 贫贫血90.47.8445.4NS 血小板减少75.29.1482.40.008 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-主要的非血液学毒性 ASCO 2010 T. Conroy, et al., Abstract # 4010 不良反应应(%)FOLFIRINOX N=167 吉西他滨滨 N=169 P 所有3-4级级所有3-4级级3-4级级 非粒缺性发热发热61.27.11.8NS 周围围神经经病变变70.590.600.0001 呕吐61.414.543.24.70.002 乏力87.323.278.714.20.036 腹泻73.312.730.81.20.0001 脱发发32.511.43.00.60.0001 ALT异常64.87.383.818.60.0022 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-ORR ASCO 2010 T. Conroy, et al., Abstract # 4010 FOLFIRINOX N=171 吉西他滨滨 N=171 P值值 CR0.06%0% PR CR/PR 95%CI 31% (24.3-39.1%) 9.4% (5.9-15.4%) 0.0001 SD38.6%41.5% DCR70.2%50.9%0.0003 PD15.2%34.5%0.058 未评评估14.6%14.6% 反应应持续时间续时间 (月)5.94NS 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-PFS ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-OS 中位随访时间为26.6个月(95% CI: 20.5-44.9) FOLFIRINOX N=171 吉西他滨滨 N=171 P值值HR mOS (95% CI) 11.1 (9-13.1) 6.8 (5.5-7.6) 0.00010.57 1年生存率48.4%20.6% 2年生存率18.6%6% ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，局部晚期或已转移的胰腺癌 培美曲塞在中国批准的适应症为：联合顺铂用于治疗不可手术的恶性胸膜间皮瘤 Any reproduction, adaptation, distribution, dissemination or making available of such copyright works to the public is strictly prohibited. ACCORD: 研究结果-OS ASCO 2010 T. Conroy, et al., Abstract # 4010 健择在中国批准的适应症为：局部晚期或已转移的非小细胞肺癌，