asco结直肠癌热点荟萃北京共70张课件

1、21、没有人陪你走一辈子，所以你要适应孤独，没有人会帮你一辈子，所以你要奋斗一生。22、当眼泪流尽的时候，留下的应该是坚强。23、要改变命运，首先改变自己。24、勇气很有理由被当作人类德性之首，因为这种德性保证了所有其余的德性。-温斯顿丘吉尔。25、梯子的梯阶从来不是用来搁脚的，它只是让人们的脚放上一段时间，以便让别一只脚能够再往上登。asco结直肠癌热点荟萃北京asco结直肠癌热点荟萃北京21、没有人陪你走一辈子，所以你要适应孤独，没有人会帮你一辈子，所以你要奋斗一生。22、当眼泪流尽的时候，留下的应该是坚强。23、要改变命运，首先改变自己。24、勇气很有理由被当作人类德性之首，因为这种德性

2、保证了所有其余的德性。-温斯顿丘吉尔。25、梯子的梯阶从来不是用来搁脚的，它只是让人们的脚放上一段时间，以便让别一只脚能够再往上登。asco结直肠癌热点荟萃北京2016 ASCO 结直肠癌热点荟萃陈功中山大学肿瘤医院2016.062016 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联合论坛：医疗的价值辩论：mCRC内科治疗中的争议RAS WT一

3、线：抗VEGF vs 抗EGFR？维持治疗 vs 化疗假期；局部进展期直肠癌治疗中的问题去手术化？去新辅助治疗化？辅助化疗模式？教授有约Meet The Professor (MTP)直肠癌的影像学21、没有人陪你走一辈子，所以你要适应孤独，没有人会帮你一辈2016 ASCO 结直肠癌热点荟萃陈功中山大学肿瘤医院2016.062016 ASCO 结直肠癌热点荟萃陈功中山大学肿2016 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Educatio

4、nal session (ED)潜在可切除mCRC：MDT病例讨论ASCO/ECCO联合论坛：医疗的价值辩论：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；局部进展期直肠癌治疗中的问题去手术化？去新辅助治疗化？辅助化疗模式？教授有约Meet The Professor (MTP)直肠癌的影像学2016 ASCO 的CRC专场口头报告专场Oral ses2016 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 (P

5、D)教育专场Educational session (ED)潜在可切除mCRC：MDT病例讨论辩论：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；局部进展期直肠癌治疗中的问题去手术化？去新辅助治疗化？辅助化疗模式？2016 ASCO 的CRC专场口头报告专场Oral ses2016 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：

6、MDT病例讨论辩论：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；局部进展期直肠癌治疗中的问题去手术化？去新辅助治疗化？辅助化疗模式？2016 ASCO 的CRC专场口头报告专场Oral ses口头报告专场PART 1：Immunotherapy beyond “MSI后MSI时代的免疫治疗”4个研究#3500# 3503免疫专场：1个研究#PART 2：Side Matters“肿瘤部位很重要”3个研究 #3504#3506PART 3：Is Less More?“更少的治疗更好？”2个研究 #3507-#3508口头报告专场PART 1：

7、Immunotherapy bey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择期手术#3508：JCOG 0212 II/III期中低位直肠癌， LLND是否必要？口头报告专场PART 1：Im

8、munotherapy bey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是否必要？口头报告专场PART 2：Side Matters“肿瘤部位#3507 Hill et alCREST - 梗阻性结肠癌支架

9、植入变急诊手术为择期手术#3507 Hill et alCREST - 梗阻性结肠asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件#3508 Fujita et alJCOG 0212: II/III期低位直肠癌LLND的必要性#3508 Fujita et alJCOG 0212: asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件a

10、sco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件我的解读CREST：证实了支架植入可以安全桥接，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，如果单纯直接手术，建议LLND未来应该对比：TME + 术后CRT vs TME + LLNDCRT + TME vs TME + LLND我的解读CREST：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

11、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是否必要？口头报告专场PART 2：Side Matters“肿瘤部位#3504 Venook et alCALGB/SWOG 80405“左右半”生存数据更新#3504 Venook et alCALGB/SWOG #3504，Venook et alImpact of primary tumor locati

12、on on Overall Survival and Progression Free Survival in patients with metastatic 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

13、 Blanke, R Schilsky, RJ Mayer, M Bertagnolli, HJ Lenz for SWOG and the ALLIANCE #3504，Venook et alImpact of p CALGB/SWOG 80405Chemo + CetuximabChemo + Bevacizumab1ST LINEMET / ADVANCEDCOLORECTALKRAS wtCodons 12 & 13FOLFIRIor FOLFOXMD choiceASCO, JUNE, 2014Chemo + CetuximabOS = 29.9 mosPFS = 10.4 mos

14、Chemo + BevacizumabOS = 29.0 mosPFS = 10.8 mosN = 1137CONCLUSION: NO DIFFERENCE OS better than anticipated in both arms: Treatment effect and/or Patient selectionAll RAS wtOS = 32.0 mosPFS =11.4 mosOS = 31.2 mosPFS = 11.3 mosESMO, SEP, 2014N = 526 CALGB/SWOG 80405ChPatient Characteristics by Tumor S

15、ide, 80405 (KRAS wt) RIGHT-SIDED (N = 293) LEFT-SIDED (N = 732) TOTAL* (N = 1137) 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% 79.3%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 pl

16、ace 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); unknown - 46*Test of any liver metastases versus extrahepaticPatient Characteristics by Tum80405: Overall Survival by

17、SidednessSideN (Events)Median (95% CI)HR(95% CI)pLeft732 (550)33.3(31.4-35.7)1.55(1.32-1.82) 0.0001Right293 (242)19.4(16.7-23.6) RightLeft80405: Overall Survival by Sid80405: OS by Sidedness (Bevacizumab)Presented by:SideN (Events)Median (95% CI)HR(95% CI)pLeft356 (280)31.4(28.3-33.6)1.32(1.05-1.65)

18、0.01Right150 (121)24.2(17.9-30.3)LeftRight80405: OS by Sidedness (Bevaci80405: OS by Sidedness (Cetuximab)Presented by:SideN (Events)Median (95% CI)HR(95% CI)pLeft376 (270)36.0(32.6-40.3)1.87(1.48-2.32)0.0001Right143 (121)16.7(13.1-19.4)LeftRight80405: OS by Sidedness (Cetuxi80405: Sidedness is Prog

19、nosticProgression Free Survival (PFS) Presented by: KRAS wt N = 1025Right 1Median PFS(mos)Left 1Median PFS(mos)Hazard Ratio95% CIP (adjusted*)All pts8.911.71.03 (1.11, 1.50) P = 0.0006Cet 7.8 12.4 1.56 (1.26, 1.94)P 0.0001BV 9.611.2 1.06 (0.86, 1.31) P = 0.55*Adjusted for biologic, protocol chemothe

20、rapy, prior adjuvant therapy, prior RT, age, sex , synchronous disease, in place primary, liver metastases80405: Sidedness is Prognostic80405: Sidedness is Prognostic Overall Survival (OS)Presented by: KRAS wt N = 1025Right 1Median OS(mos)Left 1Median OS(mos)Hazard Ratio95% CI(adjusted*)P (adjusted*

21、)All pts19.433.31.55 (1.32,1.82)P 0.0001Cet 16.736.01.87 (1.48, 2.32)P 0.0001Bev24.231.41.32 (1.05, 1.65)P = 0.01*Adjusted for biologic, protocol chemotherapy, prior adjuvant therapy, prior RT, age, sex, synchronous disease, in place primary, liver metastases 19.3 MONTHS IS A BIG DIFFERENCE !80405:

22、Sidedness is Prognostic Median OS by Sidedness:80405 and FIRE-3* Right 1Median OS (mos)Left 1Median OS (mos)P (adjusted)CALGB/SWOG 80405N=293N=732Cet 16.736.0P 0.0001Bev24.231.4P = 0.01FIRE-3 N = 88 N = 306Cet 18.3 38.3 P 0.00001Bev 23.028.0 P = 0.038KRAS wtN=1025All RAS wt N=394 * Sebastian Stintzi

23、ng,MD, personal communication Heinemann, et al, ASCO, 2014 Median OS by Sidedness:80405 80405: Sidedness Predictive for Biologics Biologic by 1 Side Interaction BIOLOGIC SIDE OF PRIMARY HAZARD RATIO (95% CI) P(adjusted*) Any biologic OS and PFS Cetux v Bev; left Cetux v Bev; right1.53 (1.13, 2.08) P

24、int = 0.005Cet vs Bev OSLeft0.82 (0.69, 0.96) p = 0.01PFS0.84 (0.72, 0.98)Cet vs BevOS Right1.26 (0.98, 1.63) p = 0.08PFS1.26 (1.00, 1.62)*Adjusted for biologic, protocol chemotherapy, prior adjuvant therapy, prior RT, age, sex, synchronous disease, in place primary, liver metastases 80405: Sidednes

25、s PredictiveOverall Survival by Sidedness and BiologicOverall Survival by Sidedness CALGB/SWOG 80405: Sidedness in KRAS wt mCRCPrognosticPts w/ L-sided primary have markedly better OS than pts w/ R-sided primary tumor regardless of treatment arm.Predictive1st-line Cetuximab and Bevacizumab have diff

26、erent treatment effects in subgroups defined by sidedness in this analysis.Presented by: CALGB/SWOG 8040 Sidedness in mCRC: Biological surrogateNon-random distribution of mutationsBRAF R-sided, not enough to account for diffference Transcriptional subtypesHypermethylation Epiregulin, AmphiregulinImm

27、unological effectMicrobiomePresented by: Sidedness in mCRC: Biolog#3505 Schrag et alSEER数据库“CRC部位与生存关系分析”#3505 Schrag et alSEER数据库“CRasco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠

28、癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件#3506 Lee et alEGFR单抗治疗后肿瘤部位、分子特征与生存关系分析#3506 Lee et alEGFR单抗治疗后肿瘤部位asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课件asco结直肠癌热点荟萃北京共70张课

29、件mCRC中原发灶部位的价值预后价值：肯定的，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：需要从以下几个层面来收集数据部位与抗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, PRIMERAS WT群体：化疗+EGFR单抗 vs 化疗+VEGF单抗FIRE-3，CALGB/SWOG 80405，PEAKmCRC中原发灶部位的价值预后价值：mCRC中原发灶部位的价值：抗VEGF疗效Loupakis et al.

30、JNCI 2015;107(3): dju427纳入三个研究的分析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 mCRC中原发灶部位的价值：抗VEGF疗效Loupakis et al. JNCI 2015;107(3): dju427mCRC中原发灶部位的价值：抗VEGF疗效Loupakis mCRC中原发灶部位的价值：抗EGFR疗效Brule SY. J Euro Cancer.2015;51:1405-14

31、CO 17研究对标准治疗失败的mCRC(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.mCRC中原发灶部位的价值：抗EGFR疗效Brule SY. J Euro Cancer.2015;51:1405-14mCRC中原发灶部位的价值：抗EGFR疗效Brule SY.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, 2016 (suppl 4S; abstr 613). 2. von Einem JC, et al. J Cancer

32、Res Clin Oncol. 2014;140(9):1607-1614. 3. Lu HJ, et al. Asia Pac J Clin Oncol. 2016 Mar 3. doi: 10.1111/ajco.12469. 4. Houts AC, et al. J Clin Oncol 34, 2016 (suppl 4S; abstr 550). 5. CRYSTAL Presented at 2016 ASCO meeting. 6. FIRE-3 Presented at 2016 ASCO meeting. 7. CALGB 80405 Presented at 2016 ASCO meeting. 8. He WZ, et al. J Clin Oncol 34, 2016 (suppl 4S; abstr 683). 9. Loupakis F, et al. J Natl Cancer Inst. 2015 Feb 24;107(3)