肺癌靶位治疗的时机课件

IressaasFirstLineTherapyinNSCLC肺癌靶位治疗的时机PersonaldetailsPersonaldetails

Mrs.Chen-LinFemale62y/oNon-smoker肺癌靶位治疗的时机PatienthistoryHistoryCough,leftchestpainfortwomonthsBronchoscopicbiopsyandeffusioncytology:adenocarcinoma.PerformancestatusECOGPS3PrevioustreatmentRefusedanychemotherapy肺癌靶位治疗的时机InvestigationsImageCTscanofchestrevealedevidenceahugemass,measuredgreaterthan5.0cmindiametertoleftuppelobewithpleuraleffusion.EnlargedLNstoAPwindow.Noevidenceofdistalmets.T4N2M0,stageIIIB肺癌靶位治疗的时机TreatmentRefusedanychemotherapyagainandagainIressa250mgperday肺癌靶位治疗的时机OutcomeTumorsizeisgettingsmalleraftertwoweeksIressatreatment.Followupimagestudy:PRPatientcanwalkwellnow.Iressaisongoingtillnow.Noseveresideeffectexceptskineruptionbutpatientcantolerateit.肺癌靶位治疗的时机IRESSA250mgTwoweekslater肺癌靶位治疗的时机TenweekslaterIressa250/day,Ongoing肺癌靶位治疗的时机Comments/ConclusionIressaasfirstlinetherapyiseffective.Poorperformancescale:Iressawillimproveitifeffective.FemaleAdenocarcinomaNon-smokerOriental肺癌靶位治疗的时机DiscussionandlearningpointsIressainfirstlinetherapyofNSCLCpatients?Lesssideeffect.Wellqualityoflife.肺癌靶位治疗的时机[7256]PhaseIItrialoffirst-linegefitinibinpatientsunsuitableforchemotherapywithstageIII/IVnon-small-celllungcancer

D.Swinson.UKGefitinib250mgperdayM/F29/16,unfit/declinedCT25/20Medianage:76PS0/1/2/3:1/15/27/141evaluablePR9.8%SD36.6%PD53.4%Medianoversurvival82daysDiseasecontrolrate46.4%atonemonth肺癌靶位治疗的时机IressaasThirdLineTherapy

(apatientwithboneandbrainmetsafterGemzarpluscisplatinandTaxotere)肺癌靶位治疗的时机PersonaldetailsPersonaldetails

Mr.ChenMale43Y/OCigarettesmoking:40pack-years肺癌靶位治疗的时机PatienthistoryHistoryCough,hemoptysisDxafterimageandbronchoscopicstudiesBronchogeniccarcinoma,LLL,adeno-type肺癌靶位治疗的时机InvestigationsCTscanTumorsize5.3cmLNsmets,bilateralPleuraleffusion,leftBonescanMultiplebonemetsISSStagingT4N3M1,bonemets,stageIVPerformancestatusECOGPS0肺癌靶位治疗的时机TreatmentGemzar1000mg/M2plusCisplatin75mg/m2PDafterthreecyclestreatmentTaxotere25-30mg/m2,weeklyscheduleSDofChestimagestudiesUnstablegaitwithrefractorynausea,hiccupafter4cyclestaxoteretreatmentMultiplebrainmetsdiagnosedwithCTscanIressa250mgperdayafteracourseofwholebrainirradiation.肺癌靶位治疗的时机GemzarpluscisplatinProgressivedisease3cycles11/JUN/2002Taxotere肺癌靶位治疗的时机13/NOV/2003Iressa250mgperdayBrainmetsRadiotherapy肺癌靶位治疗的时机17/DEC/2003rightnowGefinitib肺癌靶位治疗的时机OutcomeTumorsizeinlungandpericardial,pleuraleffusionvolumereducedafteronemonthGefitinibtreatmentBrainmets,underwellcontrolCNSconditionisstableandhecanwalkanddosomeeasythingECOGPSaround0-1nowIressa250mgperdayisongoing肺癌靶位治疗的时机Comments/ConclusionIressaiseffectiveeveninlife-threateningconditionoffar-advancedlungcancerBrainmetsisstilleffective?肺癌靶位治疗的时机DiscussionandlearningpointsIressaandbrainbloodbarrier?Iressaasthirdlinetherapyisstandardaftertaxaneandcisplatinfailure肺癌靶位治疗的时机IrregulartreatmentofIressainapatientofNSCLC肺癌靶位治疗的时机PersonaldetailsPersonaldetails

Mr.ChenMale42y/oCigarettesmoking,20pack-years肺癌靶位治疗的时机PatienthistoryHistoryReferredfromotherhospitalbecauseofbronchogeniccarcinoma,RLL,T4N2M1[distalspinalmets]withparaplegia.PerformancestatusECOGPS3-4PrevioustreatmentC/TwithGemzarpluscisplatin肺癌靶位治疗的时机InvestigationsCTscanofchestTumormass,measured85mmtoRLLwithRLLcollapsePleuraleffusiontorightsideMediastinalLNsmetsBonescanMultipleincreaseduptaketoLumbarandthoracicspine肺癌靶位治疗的时机TreatmentTaxoterewasgivenafteradmissionSteroidandRadiotherapyforspinalmetsPDafterthreecyclesweeklyscheduletherapywithtaxotere25-30mg/M2Iressa250mgQD,onemonthlaterPleuraleffusiondisappearedTumorsizereducedto3.5cm肺癌靶位治疗的时机PDafterGemzarpluscisplatinasfirstlineAndTaxotereassecondlineIressa250mg/daysixmonthslater肺癌靶位治疗的时机OutcomePatientstoppedIressatherapybecauseofeconomicproblemTumorisgettinglarger,measured70mmtwomonthslaterIressa250mgQDagainSD肺癌靶位治疗的时机StopIressa,sixmonthslaterIressa250mg/dayagain3monthslater肺癌靶位治疗的时机PDagain,3monthslater5monthslaterStopIressa肺癌靶位治疗的时机Comments/ConclusionIntermittentIressatreatmentdoesstillwork肺癌靶位治疗的时机DiscussionandlearningpointsResistancetoIressawillbeamajorproblem?ornot?BecauseofintermittentuseEconomicisstillamajorproblemtomaintaineffectivetreatment肺癌靶位治疗的时机ChemotherapyplusGefinitibReasonable?Moreeffective?肺癌靶位治疗的时机[7155]Docetaxelandgefitinibinthefirst-linetreatmentofelderlypatients(>70)withadvancednon-smallcelllungcancer(ANSCLC):ResultsofphaseIItrial

G.Bepler(fromASCO2005)Docetaxel75mg/M2d1assessedevery2cyclesGefitinib250mgstartedd1assessedeverytwomoifaloneuntilPDM/F16/14,medianage74,PS0-121evaluablePR38%SD24%CR0%MS12.4mo1yearsurvival60%FavorabletoxicityRepeated21days肺癌靶位治疗的时机[7259]AphaseI/IItrialofweeklydocetaxelandgefitinibinelderlypatients(≥70)withstageIIIB/IVnon-smallcelllungcancer