晚期胃癌的二线治疗

晚期胃癌的二线治疗安徽省立医院肿瘤科胡冰HighincidenceAge-adjustedgastriccancerincidenceper100000HighincidenceHighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatmentchemotherapypredicativefactorstargettherapypredicativefactorsOtherendpointsTakehomemessageHighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatmentchemotherapypredicativefactorstargettherapypredicativefactorsOtherendpointsTakehomemessageOverreviewoffirstlinetreatmentOverreviewoffirstlinetreatmentOverreviewoffirstlinetreatmentOverreviewoffirstlinetreatmentOverreviewoffirstlinetreatmentHighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatmentchemotherapy

predicativefactorstargettherapypredicativefactorsOtherendpointsTakehomemessageSecond-linetreatmentFirst-linetreatmentSecond-linetreatmentPDBenefit?Second-linetreatmentSecond-linetreatment1.Irinotecanhasbeenshowntohaveactivityingastrointestinalcancers2.usedinasecond-linesettingformetastaticcoloncancer,eitheraloneorincombinationwithotheragents(eg,fuorouracil,bevacizumab,orcetuximab)TopoisomeraseIinhibitorsLancet1998;352:1407-1412TopoisomeraseIinhibitorsMonotherapyJpnJCancerChemother1994;21:1033-38Tumori2003；89:405-07.TopoisomeraseIinhibitorsCombinationtherapyAnticancerRes2006;26:1595-1599AmJClin

Oncol2005;28:581-588JChemother2003;15:275-278TaxanesJClinOncol2006;24:4991-4997.Taxanes,whichbindandstabilisemicrotubulesleadingtocell-cyclearrest,havebeenusedinthefirst-linesettingforadvancedgastriccancer.

TaxanesAnnOncol2000;11:1263-66AnticancerRes2003;23:4219-22CancerChemother

Pharmacol2008;61:631-637PlatinumagentsPlatinumdrugsgivenaloneassecond-linereatment

havefallenoutoffavourinadvancedgastriccancer,mainlyduetotheirfrequentuseinthefirst-linesetting2.However,itisstillreasonabletoconsidertheminpatientswhohavenotbeenpreviouslyexposedtoplatinumagents.PlatinumagentsMonotherapyEurJCancerClinOncol1985;21:1321-1324JpnJOncol1990;20:169-176PlatinumagentsCombinationtherapyAnnOncol2003;14:383-387.CancerChemother

Pharmacol2008;63:433-39Fluorouracil-basedregimensDespitethefactthatallofthewell-establishedfront-lineregimensforadvancedGCcontainfuorouracil

oritsprodrugs,thereiscontinuedinterestintheuseoftheseagentsinthesecond-linesetting.Fluorouracil-basedregimensS-1AnticancerDrugs2008;19:303-307.BrJCancer2007;97:458-63ReasonabletoxicityConvenienceoforaladministrationModestresponserate

HighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatmentchemotherapypredicativefactorstargettherapypredicativefactorsOtherendpointsTakehomemessageperformancestatushistoryofagentsuseddegreeofresponsetothefirst-linesettingamountofmetastaticdiseaseClinOncol(RCollRadiol)2005;17:81-90Predictivefactors---1Predictivefactors---2low-riskgroup,patientswithnoprognosticfactorintermediate-riskgroup,patientswithoneortwonegativeprognosticfactorhigh-riskgroup,patientswiththreetofivenegativeprognosticfactorBritishJournalofCancer(2008)99,1402-1407MultivariateanalysisPredictivefactors---2low-riskgroup,patientswithnoprognosticfactorintermediate-riskgroup,patientswithoneortwonegativeprognosticfactorhigh-riskgroup,patientswiththreetofivenegativeprognosticfactorBritishJournalofCancer(2008)99,1402-1407Predictivefactors---2ECOGperformancestatus2Haemoglobin≤11.5g/dlCEA>50ng/mlNumberofmetastaticsites3–4TTPofthefirst-linechemotherapy≤6monthsBritishJournalofCancer(2008)99,1402-1407Predictivefactors---3MultivariateanalysisBMCCancer2009,9:110doi:10.1186/1471-2407-9-110Conclusion:

Performancestatus,alongwithbaselinehemoglobinlevel,couldbeusedtoidentifythesubgroupofpatientsmostlikelytobenefitfromsecond-linechemotherapyforAGC.HighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatment

chemotherapypredicativefactorstargettherapy

predicativefactorsOtherendpointsTakehomemessageCurrentlynotargetedagentshavebeenapprovedinthetreatmentofadvancedgastriccancer.

TargetedtherapyTargetedtherapyFirst-linetherapyTargetedtherapyFirst-linetherapyTargetedtherapySecond-linetherapyHighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatment

chemotherapypredicativefactorstargettherapypredicativefactorsOtherendpointsTakehomemessagePredictivefactorsCancerChemother

Pharmacol

DOI10.1007/s00280-009-1067-9MethodsThirty-twopatientswithMGCwereincludedinthestudy.Cetuximabwasdelivered,oftencombinedwithirinotecan-basedchemotherapy.ThirtypatientswereanalyzedforK-rasmutationsviadirectsequencingofthetumorDNA.PredictivefactorsResultsCancerChemother

Pharmacol

DOI10.1007/s00280-009-1067-9PredictivefactorsPFSPFSOSOSResultsConclusionThestudysuggeststhatMGCpatientswithgoodperformancestatusandskinrashbenefitmostfromsalvagecetuximabcombinedwithchemotherapy,eveninheavilypretreatedstatus.PredictivefactorsCancerChemother

Pharmacol

DOI10.1007/s00280-009-1067-9HighlightstodayOverreviewoffirstlinetreatmentSecond-linetreatmentchemotherapypredicativefactorstargettherapypredica