肺癌靶位治療的時機

1、Iressa as First Line Therapy in NSCLCPersonal detailsPersonal details Mrs. Chen-LinFemale62 y/oNon-smokerPatient historyHistory Cough, left chest pain for two monthsBronchoscopic biopsy and effusion cytology: adenocarcinoma.Performance statusECOG PS 3Previous treatmentRefused any chemotherapyInvesti

2、gationsImageCT scan of chest revealed evidence a huge mass, measured greater than 5.0 cm in diameter to left uppe lobe with pleural effusion. Enlarged LNs to AP window. No evidence of distal mets. T4N2M0, stage IIIBTreatmentRefused any chemotherapy again and againIressa 250 mg per dayOutcomeTumor si

3、ze is getting smaller after two weeks Iressa treatment.Follow up image study: PRPatient can walk well now.Iressa is ongoing till now.No severe side effect except skin eruption but patient can tolerate it.IRESSA 250 mgTwo weeks laterTen weeks laterIressa 250/day,OngoingComments / ConclusionIressa as

4、first line therapy is effective.Poor performance scale: Iressa will improve it if effective.Female AdenocarcinomaNon-smokerOrientalDiscussion and learning pointsIressa in first line therapy of NSCLC patients ?Less side effect.Well quality of life.7256 Phase II trial of first-line gefitinib in patien

5、ts unsuitable for chemotherapy with stage III/IV non-small-cell lung cancerD. Swinson. UKGefitinib 250 mg per dayM/F 29/16, unfit/declined CT 25/20Median age: 76PS 0/1/2/3: 1/15/27/141 evaluablePR 9.8%SD 36.6%PD 53.4%Median over survival 82 days Disease control rate 46.4% at one monthIressa as Third

6、 Line Therapy (a patient with bone and brain mets after Gemzar plus cisplatin and Taxotere)Personal detailsPersonal details Mr. ChenMale43 Y/OCigarette smoking: 40 pack-yearsPatient historyHistory Cough, hemoptysisDx after image and bronchoscopic studiesBronchogenic carcinoma, LLL, adeno-typeInvesti

7、gationsCT scanTumor size 5.3 cmLNs mets, bilateralPleural effusion, left Bone scanMultiple bone metsISS StagingT4N3M1, bone mets, stage IVPerformance statusECOG PS 0TreatmentGemzar 1000mg/M2 plus Cisplatin 75mg/m 2PD after three cycles treatmentTaxotere 25-30 mg/m2, weekly scheduleSD of Chest image

8、studiesUnstable gait with refractory nausea, hiccup after 4 cycles taxotere treatmentMultiple brain mets diagnosed with CT scanIressa 250 mg per day after a course of whole brain irradiation.Gemzar plus cisplatinProgressive disease3 cycles11/JUN/2002Taxotere13/NOV/2003Iressa 250 mg per dayBrain mets

9、Radiotherapy17/DEC/2003right nowGefinitibOutcomeTumor size in lung and pericardial , pleural effusion volume reduced after one month Gefitinib treatmentBrain mets, under well controlCNS condition is stable and he can walk and do some easy thingECOG PS around 0-1 nowIressa 250 mg per day is ongoingCo

10、mments / ConclusionIressa is effective even in life-threatening condition of far-advanced lung cancerBrain mets is still effective ?Discussion and learning pointsIressa and brain blood barrier ?Iressa as third line therapy is standard after taxane and cisplatin failureIrregular treatment of Iressa i

11、n a patient of NSCLC Personal detailsPersonal details Mr. ChenMale42 y/oCigarette smoking, 20 pack-yearsPatient historyHistory Referred from other hospital because of bronchogenic carcinoma, RLL, T4N2M1distal spinal mets with paraplegia.Performance statusECOG PS 3-4Previous treatmentC/T with Gemzar

12、plus cisplatinInvestigationsCT scan of chestTumor mass, measured 85 mm to RLL with RLL collapsePleural effusion to right sideMediastinal LNs metsBone scanMultiple increased uptake to Lumbar and thoracic spineTreatmentTaxotere was given after admissionSteroid and Radiotherapy for spinal metsPD after

13、three cycles weekly schedule therapy with taxotere 25-30 mg/M2Iressa 250 mg QD, one month laterPleural effusion disappearedTumor size reduced to 3.5 cmPD after Gemzar plus cisplatin as first lineAnd Taxotere as second lineIressa 250 mg/day six months laterOutcomePatient stopped Iressa therapy becaus

14、e of economic problemTumor is getting larger, measured 70 mm two months laterIressa 250 mg QD againSDStop Iressa, six months laterIressa 250 mg/day again3 months laterPD again, 3 months later5 months laterStop Iressa Comments / ConclusionIntermittent Iressa treatment does still workDiscussion and le

15、arning pointsResistance to Iressa will be a major problem ? or not ? Because of intermittent useEconomic is still a major problem to maintain effective treatmentChemotherapy plus GefinitibReasonable ?More effective?7155 Docetaxel and gefitinib in the first-line treatment of elderly patients (70) wit

16、h advanced non-small cell lung cancer (ANSCLC): Results of phase II trialG. Bepler(from ASCO 2005)Docetaxel 75 mg/M2 d1 assessed every 2 cyclesGefitinib 250 mg started d1assessed every two mo if alone until PDM/F 16/14, median age 74, PS 0-121 evaluable PR 38%SD 24%CR 0%MS 12.4 mo1 year survival 60%Favorable toxicityRepeated 21 days7259 A phase I/II trial of weekly docetaxel and gefitinib in elderly patients ( 70) with stage IIIB/IV non-small cell