




版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
1、2021 ASCO 结直肠癌热点荟萃陈功中山大学肿瘤医院2021.062021 ASCO 的CRC专场 口头报告专场Oral session 临床科学论坛Clinical Science Symposium (CSS) 壁报讨论Poster Discussion (PD) 教育专场Educational session (ED) 潜在可切除mCRC:MDT病例讨论 ASCO/ECCO结合论坛:医疗的价值 争辩:mCRC内科治疗中的争议 RAS WT一线:抗VEGF vs 抗EGFR?维持治疗 vs 化疗假期; 部分进展期直肠癌治疗中的问题 去手术化?去新辅助治疗化?辅助化疗方式? 教授有约Me
2、et The Professor (MTP) 直肠癌的影像学2021 ASCO 的CRC专场 口头报告专场Oral session 临床科学论坛Clinical Science Symposium (CSS) 壁报讨论Poster Discussion (PD) 教育专场Educational session (ED) 潜在可切除mCRC:MDT病例讨论 争辩:mCRC内科治疗中的争议 RAS WT一线:抗VEGF vs 抗EGFR?维持治疗 vs 化疗假期; 部分进展期直肠癌治疗中的问题 去手术化?去新辅助治疗化?辅助化疗方式?2021 ASCO 的CRC专场 口头报告专场Oral sess
3、ion 临床科学论坛Clinical Science Symposium (CSS) 壁报讨论Poster Discussion (PD) 教育专场Educational session (ED) 潜在可切除mCRC:MDT病例讨论 争辩:mCRC内科治疗中的争议 RAS WT一线:抗VEGF vs 抗EGFR?维持治疗 vs 化疗假期; 部分进展期直肠癌治疗中的问题 去手术化?去新辅助治疗化?辅助化疗方式?口头报告专场 PART 1:Immunotherapy beyond “MSI后MSI时代的免疫治疗 4个研讨#3500# 3503 免疫专场:1个研讨# PART 2:Side Matt
4、ers“肿瘤部位很重要 3个研讨 #3504#3506 PART 3:Is Less More?“更少的治疗更好? 2个研讨 #3507-#3508口头报告专场 PART 1:Immunotherapy beyond “MSI后MSI时代的免疫治疗 PART 2:Side Matters“肿瘤部位很重要 #3504:CALGB/SWOG 80405“左右半生存数据更新 #3505:美国SEER“部位与生存数据分析 #3506:原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3:Is Less More?“更少的治疗更好? #3507:CREST - 梗阻性左半结肠癌支架植入变急诊手术为
5、择期手术 #3508:JCOG 0212 II/III期中低位直肠癌, LLND能否必要?口头报告专场 PART 2:Side Matters“肿瘤部位很重要 #3504:CALGB/SWOG 80405“左右半生存数据更新 #3505:美国SEER“部位与生存数据分析 #3506:原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3:Is Less More?“更少的治疗更好? #3507:CREST - 梗阻性左半结肠癌支架植入变急诊手术为择期手术 #3508:JCOG 0212 II/III期低位直肠癌, LLND能否必要?#3507 Hill et alCREST - 梗阻性结肠
6、癌支架植入变急诊手术为择期手术#3508 Fujita et alJCOG 0212: II/III期低位直肠癌LLND的必要性我的解读 CREST: 证明了支架植入可以平安桥接,把急诊手术变为择期手术,减少造口率,不影响肿瘤学效果 JCOG 0212 低位LARC,假设单纯直接手术,建议LLND 未来应该对比: TME + 术后CRT vs TME + LLND CRT + TME vs TME + LLND口头报告专场 PART 2:Side Matters“肿瘤部位很重要 #3504:CALGB/SWOG 80405“左右半生存数据更新 #3505:美国SEER“部位与生存数据分析 #3
7、506:原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3:Is Less More?“更少的治疗更好? #3507:CREST - 梗阻性左半结肠癌支架植入变急诊手术为择期手术 #3508:JCOG 0212 II/III期低位直肠癌, LLND能否必要?#3504 Venook et alCALGB/SWOG 80405“左右半生存数据更新#3504, ,Venook et alImpact of primary tumor location on Overall Survival and Progression Free Survival in patients with met
8、astatic colorectal cancer: Analysis of CALGB/SWOG 80405 (Alliance)A Venook, D Niedzwiecki, F Innocenti, B Fruth, C Greene, BH ONeil, J Shaw, J Atkins, LE Horvath, B Polite, JA Meyerhardt, EM OReilly, R Goldberg, HS Hochster, CD Blanke, R Schilsky, RJ Mayer, M Bertagnolli, HJ Lenz for SWOG and the AL
9、LIANCE CALGB/SWOG 80405Chemo + CetuximabChemo + Bevacizumab1ST LINEMET / ADVANCEDCOLORECTALKRAS wtCodons 12 & 13FOLFIRIor FOLFOXMD choiceASCO, JUNE, 2021Chemo + CetuximabChemo + CetuximabOS = 29.9 mosOS = 29.9 mosPFS = 10.4 mosPFS = 10.4 mosChemo + BevacizumabChemo + BevacizumabOS = 29.0 mosOS =
10、 29.0 mosPFS = 10.8 mosPFS = 10.8 mosN = 1CONCLUSION: NO DIFFERENCE OS better than anticipated in both arms: Treatment effect and/or Patient selectionAll RAS wtAll RAS wtOS = 32.0 mosOS = 32.0 mosPFS =11.4 mosPFS =11.4 mosOS = 31.2 mosOS = 31.2 mosPFS = 11.3 mosPFS = 11.3 mosESMO, SEP, 2021ESMO, SEP
11、, 2021N = 526N = 526Patient Characteristics by Tumor Side, 80405 (KRAS wt) RIGHT-SIDEDRIGHT-SIDED (N = 293) (N = 293) LEFT-SIDEDLEFT-SIDED (N = 732) (N = 732) TOTALTOTAL* * (N = 1137) (N = 1137) P PAge (mean) 61.2 57.3 58.4 0.0001Gender (M %) 54.9% 65.0 % 62.1%0.002Synchronous Stage IV 86.9% 76.0% 7
12、9.3%0.0009Prior Adjuvant 10.6% 15.7% 14.2%0.03FOLFOX / FOLFIRI 74.4 / 25.6 72.4 / 27.6 73.4 / 26.60.51Primary in place 19.2% 29.6% 26.6%0.0007Pattern mets: liver only liver mets extra-hepatic 27.5% 40.5% 32.0 % 32.1% 43.2% 24.7% 30.9% 42.8% 28.5%0.02*Transverse colon 66 (excluded from analysis); unk
13、nown - 46*Test of any liver metastases versus extrahepatic80405: Overall Survival by SidednessSideSideN (N (Events)Events)Median Median ( (95% CI)95% CI)HRHR( (95% CI)95% CI)p pLeftLeft732 (732 (550)550)33.333.3(31.4-35.7(31.4-35.7) )1.551.55( (1.32-1.82)1.32-1.82) 0.0001 0.0001RightRight293 (293 (2
14、42)242)19.419.4( (16.7-23.6)16.7-23.6) RightLeft80405: OS by Sidedness (Bevacizumab)Presented by:SideSideN (N (Events)Events)Median Median ( (95% CI)95% CI)HR(95% CI)HR(95% CI)p pLeftLeft356 (356 (280)280)31.431.4( (28.3-33.6)28.3-33.6)1.321.32(1.05-1.65)(1.05-1.65)0.010.01RightRight150 (150 (121)12
15、1)24.224.2( (17.9-30.3)17.9-30.3)LeftRight80405: OS by Sidedness (Cetuximab)Presented by:SideSideN (N (Events)Events)Median Median ( (95% CI)95% CI)HRHR( (95% CI)95% CI)p pLeftLeft376 (376 (270)270)36.036.0( (32.6-40.3)32.6-40.3)1.871.87(1.48-2.32)(1.48-2.32)0.00010.0001RightRight143 (143 (121)121)1
16、6.716.7( (13.1-19.4)13.1-19.4)LeftRight80405: Sidedness is PrognosticProgression Free Survival (PFS) Presented by: KRASKRAS wt wt N = 1025 N = 1025Right Right 1 1Median PFS(mos)Median PFS(mos)Left Left 1 1Median PFS(mos)Median PFS(mos)Hazard RatioHazard Ratio95% CI95% CIP (adjustedP (adjusted* *) )A
17、llAll pts pts8.98.911.711.71.03 (1.11, 1.50) 1.03 (1.11, 1.50) P = 0.0006P = 0.0006Cet Cet 7.8 7.8 12.412.4 1.56 (1.26, 1.94)1.56 (1.26, 1.94)P 0.0001P 0.0001BV BV 9.69.611.2 11.2 1.06 (0.86, 1.31)1.06 (0.86, 1.31) P = 0.55P = 0.55*Adjusted for biologic, protocol chemotherapy, prior adjuvant therapy
18、, prior RT, age, sex , synchronous disease, in place primary, liver metastases80405: Sidedness is Prognostic Overall Survival (OS)Presented by: KRASKRAS wt wt N = 1025 N = 1025Right Right 1 1Median OS(mos)Median OS(mos)Left Left 1 1Median OS(mos)Median OS(mos)Hazard RatioHazard Ratio95% CI(adjusted9
19、5% CI(adjusted* *) )P (adjustedP (adjusted* *) )All ptsAll pts19.419.433.333.31.55 (1.32,1.82)1.55 (1.32,1.82)P 0.0001P 0.0001Cet Cet 16.716.736.036.01.87 (1.48, 2.32)1.87 (1.48, 2.32)P 0.0001P 0.0001BevBev24.224.231.431.41.321.32 (1.05, 1.65) (1.05, 1.65)P = 0.01P = 0.01*Adjusted for biologic, prot
20、ocol chemotherapy, prior adjuvant therapy, prior RT, age, sex, synchronous disease, in place primary, liver metastases 19.3 MONTHS IS A BIG DIFFERENCE ! Median OS by Sidedness:80405 and FIRE-3* Right Right 1 1Median OS (mos)Median OS (mos)Left Left 1 1Median OS (mos)Median OS (mos)P (adjusted)P (adj
21、usted)CALGB/SWOG 80405CALGB/SWOG 80405N=293N=293N=732N=732Cet Cet 16.716.736.036.0P 0.0001P 0.0001BevBev24.224.231.431.4P = 0.01P = 0.01FIRE-3 FIRE-3 N = 88 N = 88 N = 306 N = 306Cet Cet 18.3 18.3 38.3 38.3 P 0.00001P 0.00001Bev Bev 23.023.028.0 28.0 P = 0.038P = 0.038KRAS wtKRAS wtN=1025N=1025All R
22、AS All RAS wt wt N=394N=394 * Sebastian Stintzing,MD, personal communication Heinemann, et al, ASCO, 2021 80405: Sidedness Predictive for Biologics Biologic by 1 Side Interaction BIOLOGICBIOLOGIC SIDE SIDE OF PRIMARY OF PRIMARY HAZARDHAZARD RATIO (95% CI)RATIO (95% CI) P(adjusted P(adjusted* *) ) An
23、y biologic Any biologic OS and PFS OS and PFS Cetux Cetux v Bev; left v Bev; left Cetux v Bev; right Cetux v Bev; right1.531.53 (1.13, 2.08) (1.13, 2.08) P Pint int = 0.005= 0.005Cet vs BevCet vs Bev OSOSLeftLeft0.82 0.82 (0.69, 0.96)(0.69, 0.96) p p = 0.01 = 0.01PFSPFS0.84 (0.72, 0.98)0.84 (0.72, 0
24、.98)Cet vs BevCet vs BevOSOS Right Right1.26 (0.98, 1.63)1.26 (0.98, 1.63) p = 0.08 p = 0.08PFSPFS1.26 (1.00, 1.62)1.26 (1.00, 1.62)*Adjusted for biologic, protocol chemotherapy, prior adjuvant therapy, prior RT, age, sex, synchronous disease, in place primary, liver metastases Overall Survival by S
25、idedness and Biologic CALGB/SWOG 80405: Sidedness in KRAS wt mCRC Prognostic Pts w/ L-sided primary have markedly better OS than pts w/ R-sided primary tumor regardless of treatment arm. Predictive 1st-line Cetuximab and Bevacizumab have different treatment effects in subgroups defined by sidedness
26、in this analysis.Presented by: Sidedness in mCRC: Biological surrogate Non-random distribution of mutations BRAF R-sided, not enough to account for diffference Transcriptional subtypes Hypermethylation Epiregulin, Amphiregulin Immunological effect MicrobiomePresented by:#3505 Schrag et alSEER数据库“CRC
27、部位与生存关系分析#3506 Lee et alEGFR单抗治疗后肿瘤部位、分子特征与生存关系分析mCRC中原发灶部位的价值 预后价值: 一定的,尤其在III、IV期 左侧好于右侧,独立于各种治疗手段 疗效预测价值:需求从以下几个层面来搜集数据 部位与抗VEGF的疗效预测 化疗+VEGF单抗 vs 单纯化疗:AVF 2107g,NO 16966 部位与抗EGFR靶向治疗的疗效预测: 化疗+EGFR单抗 vs 单纯化疗:CO 17,BOND,CRYSTAL, OPUS, PRIME RAS WT群体:化疗+EGFR单抗 vs 化疗+VEGF单抗 FIRE-3,CALGB/SWOG 80405,P
28、EAKmCRC中原发灶部位的价值:抗VEGF疗效Loupakis et al. JNCI 2021;107(3): dju427纳入三个研讨的分析PROVETTAN=200治疗:FOLFIRI + BevAVF2107g559治疗分组: IFL BevNO 169661268治疗分组:FOLFOX/XELOX BevmCRC中原发灶部位的价值:抗VEGF疗效Loupakis et al. JNCI 2021;107(3): dju427mCRC中原发灶部位的价值:抗EGFR疗效Brule SY. J Euro Cancer.2021;51:1405-14CO 17研讨对规范治疗失败的mCRC(
29、5-FU、奥沙利铂、伊立替康)N=572治疗分组:西妥昔单抗 vs BSCmCRC中原发灶部位的价值:抗EGFR疗效Brule SY. J Euro Cancer.2021;51:1405-14抗EGFR治疗后,左右半结肠癌间的生存差距拉大1. Sunakawa Y, et al. J Clin Oncol 34, 2021 (suppl 4S; abstr 613). 2. von Einem JC, et al. J Cancer Res Clin Oncol. 2021;140(9):1607-1614. 3. Lu HJ, et al. Asia Pac J Clin Oncol. 2
30、021 Mar 3. doi: 10.1111/ajco.12469. 4. Houts AC, et al. J Clin Oncol 34, 2021 (suppl 4S; abstr 550). 5. CRYSTAL Presented at 2021 ASCO meeting. 6. FIRE-3 Presented at 2021 ASCO meeting. 7. CALGB 80405 Presented at 2021 ASCO meeting. 8. He WZ, et al. J Clin Oncol 34, 2021 (suppl 4S; abstr 683). 9. Loupakis F, et al. J Natl Cancer Inst
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 公司月度室内活动方案
- 公司甜品台活动策划方案
- 2025年音乐学院入学考试曲目及答案
- 2025年智能制造技术应用考试卷及答案
- 2025年信息系统与工程职业能力综合考核试卷及答案
- 2025年社会创业推动者职业资格考试试卷及答案
- 2025年室内设计师职业资格考试试卷及答案
- 译林版(2024)七年级下册英语期末复习综合练习试卷(含答案)
- 2025年金融从业资格证考试题及答案
- 2025年口腔医师资格考试题及答案
- GPS与惯导系统的组合导航技术课件
- 工厂产品出入库统计明细表范本
- 中医学基础--奇恒之腑共23张课件
- AC-10C沥青混合料配合比设计检验报告
- CNC机加工作业指导书
- HALCON编程基础与工程应用全书ppt课件汇总(完整版)
- 冀教版小学美术六年级下册教案
- 《一级学科下属专业证明模板》
- Stein-膀胱癌淋巴清扫资料课件
- 小柳树和小枣树(1)
- 市场营销学期末复习题知识分享
评论
0/150
提交评论