肺癌讨论-张力

1、Ab 7003, 7004, 7005 点评1Ab 7003MIC x 2 / 3 wkMitomycin:6 mg/m/d1Ifosfamide: 1.5 g/m/d1-3Cisplatin: 30 mg/m/d1-3 Surgery Surgery If OR: +2 MIC pT3, pN2: RT 60 GyRandomizationDepierre et al, J Clin Oncol 2001; 20:247-5323“将一大组异质性病人的平均规律用于指导具体个例的治疗，可能造成危险的误导” Indeed, concentration exclusively on overall

2、 average effects produced by pooling biologically different disease entities can result in dangerously misleading advice for individual patients.2003 ST Gallen Breast Cancer Guide Lines45寻找耐药基因6 含顺铂类术后化疗Meta-分析(LACE)JCO 2008; Vol 26:3552-3559HR = 0.89 (95% CI, 0.82-0.96; P=0 .005)7IALT 研究 2006 Updat

3、eNEJM 2006 ERCC1 ERCC1 +8ERCC1和RRM1与早期肺癌预后NEJM 2007;356:800-8Stage I (187例)9NSCLCpT1(x2cm)pT2N0M0R0 resectionPS 0-1N98AssignmentCisplatin-Gemcitabine x 4vsObservationSurgerySpecimen CollectionERCC1 & RRM1Testing (AQUA)EnrollmentS0720: Proof of Concept Study:Biomarker-directed Adjuvant Therapy of Sta

4、ge I NSCLCPI: BeplerRRMI 40.5ANDERCC1 66.0Active Monitoring All Others (RRM1 40.5 OR ERCC1 75% of patients assigned)寻找更准确的分期12JCO 2007; Vol 25:5506-5518 辅助化疗的获益 13肺癌的分子分期 -3基因组 J Clin Oncol 2007；Vol 25:5562-5569I 期II 期III 期14肺癌的分子分期 -蛋白表达 J Clin Oncol 2009中山大学附属肿瘤医院研究结果15 肺癌新辅助/辅助化疗的未来 所有病人均接受经过大型随机

5、临床研究的结果证实的最好治疗(EBM)每个病人根据个体的分子生物学差异决定接受某一种治疗: 对个体的生物学差异理解不够Genetic的个体化分析16Daniel Karp, MDUT M. D. Anderson Cancer CenterE5597: Phase III Chemoprevention Trial of Selenium Supplementation in Persons with Resected Stage I Non-Small Cell Lung CancerDaniel D. Karp, Sandra Lee, Gail Shaw Wright, David Jo

6、hnson, Michael Johnston, Gary Goodman, Gerald Clayman, Gordon Okawara, Randolph Marks, Jack RuckdeschelEastern Cooperative Oncology GroupTogether withCancer and Acute Leukemia Group BNCI Canada Treatment Group North Central Cancer Treatment GroupRadiation Therapy Oncology GroupSouthwest Oncology Gro

7、upEnrollment from Oct. 2000 Nov. 2009Ab 7004Daniel Karp, MDUT M. D. Anderson Cancer CenterResults 4. E5597 Selenium Prevention Study: SPTs and Recurrence Worst for Active Smokers* stratified log rank (p=0.016) corrects for treatmentOverall Lung Cancer Risk at 5 yearsActive smokers30%Former smokers24%Never smokers20%50%19Ab 7005Pts with completely resected stage IB,II, and IIIA NSCLCStratified by - stage - histology - post-op RT - sex - adjuvant chemotherapy*Gefitinib250 mg podaily x 2 yrsPlacebo0 mg po daily x 2 yrs Randomized 1:1*Pr