伊立替康+順鉑治療31張課件

1、伊立替康+順鉑治療小細(xì)胞肺癌多中心隨機(jī)對(duì)照臨床研究解放軍總醫(yī)院腫瘤內(nèi)科伊立替康+順鉑治療小細(xì)胞肺癌研究背景WHo2000年:全球死于肺癌人數(shù)占惡性腫瘤死亡的19%,居惡性腫瘤死因的首位我國(guó)近20年肺癌發(fā)病率以每年11%速度遞增ScLC約占肺癌2025%SCLc對(duì)化療和放療都非常敏感多種治療方案未能使患者長(zhǎng)期生存研究背景研究背景局限期小細(xì)胞肺癌( LD-SCLC)占30-40%中位生存期:1016個(gè)月5年生存率:18%廣泛期小細(xì)胞肺癌( ED-SCLC占60-70%中位生存期:612個(gè)月5年存活率:2%預(yù)后好的因素:一般狀況好、女性、70歲以下、白種人、LDH正常、足量聯(lián)合化療、單發(fā)轉(zhuǎn)移灶研究背

2、景研究背景手術(shù):非常規(guī)首選,嚴(yán)格適應(yīng)征縱隔鏡、PET-CT:精確分期TNM-IAIBA:LD期Ig:ED期放療:LD期:RCT優(yōu)于單純cT(2007AScO:3年絕對(duì)獲益+5%)同步優(yōu)于序貫:MS272mVs197m美國(guó)同步,歐洲序貫預(yù)防性腦放療:LD期:3年絕對(duì)獲益+54%降低腦轉(zhuǎn)移25.3%研究背景研究背景一線化療:A:EP優(yōu)于cAV2Y:25%Vs8%5Y:10%Vs3%B:P優(yōu)于EPRR:84%Vs64%MS: 12.8m vs 9. 4mPFS: 6.9m vs 4.8mC:PEM+CBP優(yōu)于PEM+DDPMS:10.8m vs 7.9m1Y:43%Vs28.8%研究背景研究背景二線

3、化療:7080%LD、100%ED進(jìn)展或復(fù)發(fā)拓?fù)涮婵?鉑類培美曲塞+鉑類紫杉醇+鉑類?靶向治療:小樣本,無(wú)確切療效研究背景NCCN in aonecl gy l a Small Cell Lung CancerTESTING RESULTINITIAL TREATNENTIpreferred) andChemothera例ymediastinal lymphnegativenode dissectionmediastinal RTKClinical stag T1-2, NOGood performanceChemotherapy concurrents status(PS 0-2thorac

4、ic RT(categary 1)medi aspinal staindue to sCLcChemotherapyRTked treatmentor PS (3-4due to SCLcluding s upportive careregimensChemotherapyLimited diseaPoor Ps阝4excess ofTdue to SCLC chemotherapyRrkPoor PS(3-4)notIndividualized treatmentincuding supportive careNCCN in aonecl gy l a Small CeNCCN Pn ach

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6、egimensdebilitatedSee NCCN Palliative Care Guidelines.Lobar alI Plain-film x-raysBcnestructural impairmentExtensiveof bone s canxtensive staceSeaNCCN Bone cancers Guidelineslocalizedweight- bearingymptomatic sitesSpinal cord-+ soe NCCN CNS TumorsChemotherapy symptomatic field rtmptomatic-, May admin

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8、 TREATMENT SURVEILLANCEFOLLOWING INITIAL THERAPYComplete responseAfter recovery from primaryor radiation scarringPCIkn(category 1)br10%硎 originalExtensive diseaseOncology follow-up vis its everymass cn ct scanPCIK, n(category 1)2-3 mo duing y 1, every 34 mouning y 2-3, every 4-5mopr/adrenal cTduring

9、 y 4-5, then annuallyaging bloodwork asTherapyISCL-51irradiation(PCi) to be.Other imag ing studie Consider PcimJollow-up should initiate workupinvolvement, ascl inically indi caleda CBC, plateletsElectrolytes, LFTS, Ca,See palliationGuidlines indExsCc Tabe d contentsin Oncology -V1.2 08 Small Cell L

10、ung CancerSavino Ms EsferRrcEPROGRESSIE DISEASE SUBSEQUENT THERAPY/PALLIATIONSubsequentContinue untiximal benefit orClinical trialinical trialrefractory to therapyor develpment ofBest supporcareBest supportive careunacceptable toxicityPalliative symptom managemer, including local ized RTClinical trialSubsequent chemotherapy(PS 0-2)sCc Tabe d contents伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊立替康+順鉑治療31張課件伊