asco結(jié)直腸癌熱點薈萃北京課件

2016ASCO

結(jié)直腸癌熱點薈萃

2016.062016ASCO的CRC專場口頭報告專場Oralsession臨床科學論壇ClinicalScienceSymposium(CSS)壁報討論PosterDiscussion(PD)教育專場Educationalsession(ED)潛在可切除mCRC：MDT病例討論ASCO/ECCO聯(lián)合論壇：醫(yī)療的價值辯論：mCRC內(nèi)科治療中的爭議RASWT一線：抗VEGFvs抗EGFR？維持治療vs化療假期；局部進展期直腸癌治療中的問題去手術(shù)化？去新輔助治療化？輔助化療模式？教授有約MeetTheProfessor(MTP)直腸癌的影像學2016ASCO的CRC專場口頭報告專場Oralsession臨床科學論壇ClinicalScienceSymposium(CSS)壁報討論PosterDiscussion(PD)教育專場Educationalsession(ED)潛在可切除mCRC：MDT病例討論辯論：mCRC內(nèi)科治療中的爭議RASWT一線：抗VEGFvs抗EGFR？維持治療vs化療假期；局部進展期直腸癌治療中的問題去手術(shù)化？去新輔助治療化？輔助化療模式？口頭報告專場PART1：Immunotherapybeyond“MSI后MSI時代的免疫治療”4個研究#3500~#3503免疫專場：1個研究#PART2：SideMatters“腫瘤部位很重要”3個研究#3504~#3506PART3：IsLessMore?“更少的治療更好？”2個研究#3507-#3508口頭報告專場PART1：Immunotherapybeyond“MSI后MSI時代的免疫治療”PART2：SideMatters“腫瘤部位很重要”#3504：CALGB/SWOG80405“左右半”生存數(shù)據(jù)更新#3505：美國SEER“部位與生存數(shù)據(jù)分析”#3506：原發(fā)灶部位、分子特征與EGFR單抗療效的關(guān)系PART3：IsLessMore?“更少的治療更好？”#3507：CREST-梗阻性左半結(jié)腸癌支架植入變急診手術(shù)為擇期手術(shù)#3508：JCOG0212–II/III期中低位直腸癌，LLND是否必要？口頭報告專場PART2：SideMatters“腫瘤部位很重要”#3504：CALGB/SWOG80405“左右半”生存數(shù)據(jù)更新#3505：美國SEER“部位與生存數(shù)據(jù)分析”#3506：原發(fā)灶部位、分子特征與EGFR單抗療效的關(guān)系PART3：IsLessMore?“更少的治療更好？”#3507：CREST-梗阻性左半結(jié)腸癌支架植入變急診手術(shù)為擇期手術(shù)#3508：JCOG0212–II/III期低位直腸癌，LLND是否必要？#3508Fujitaetal

JCOG0212:II/III期低位直腸癌LLND的必要性我的解讀CREST：證實了支架植入可以安全橋接，把急診手術(shù)變?yōu)閾衿谑中g(shù)，減少造口率，不影響腫瘤學效果JCOG0212低位LARC，如果單純直接手術(shù)，建議LLND未來應(yīng)該對比：TME+術(shù)后CRTvsTME+LLNDCRT+TMEvsTME+LLND#3504Venooketal

CALGB/SWOG80405“左右半”生存數(shù)據(jù)更新#3504，Venooketal

Impactofprimarytumorlocationon

OverallSurvivalandProgressionFreeSurvival

inpatientswithmetastaticcolorectalcancer:

AnalysisofCALGB/SWOG80405(Alliance)AVenook,DNiedzwiecki,FInnocenti,BFruth,CGreene,BHO’Neil,JShaw,JAtkins,LEHorvath,BPolite,JAMeyerhardt,EMO’Reilly,RGoldberg,HSHochster,CDBlanke,RSchilsky,RJMayer,MBertagnolli,HJLenzforSWOGandtheALLIANCE80405:OverallSurvivalbySidednessSideN(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:OSbySidedness(Bevacizumab)

SideN(Events)Median(95%CI)HR(95%CI)pLeft356(280)31.4(28.3-33.6)1.32(1.05-1.65)

0.01

Right150(121)24.2(17.9-30.3)LeftRightPresentedby:80405:OSbySidedness(Cetuximab)SideN(Events)Median(95%CI)HR(95%CI)pLeft376(270)36.0(32.6-40.3)1.87(1.48-2.32)

<0.0001

Right143(121)16.7(13.1-19.4)LeftRightPresentedby:80405:SidednessisPrognostic

ProgressionFreeSurvival(PFS)

KRASwtN=1025Right1°MedianPFS(mos)Left1°MedianPFS(mos)HazardRatio95%CIP(adjusted*)Allpts8.911.71.03(1.11,1.50)P=0.0006Cet7.812.4

1.56(1.26,1.94)P<0.0001BV9.611.21.06(0.86,1.31)

P=0.55*Adjustedforbiologic,protocolchemotherapy,prioradjuvanttherapy,priorRT,age,sex,synchronousdisease,inplaceprimary,livermetastasesPresentedby:80405:SidednessisPrognostic

OverallSurvival(OS)

KRASwtN=1025Right1°MedianOS(mos)Left1°MedianOS(mos)HazardRatio95%CI(adjusted*)P(adjusted*)Allpts19.433.31.55(1.32,1.82)P<0.0001Cet16.736.01.87(1.48,2.32)P<0.0001Bev24.231.41.32(1.05,1.65)P=0.01*Adjustedforbiologic,protocolchemotherapy,prioradjuvanttherapy,priorRT,age,sex,synchronousdisease,inplaceprimary,livermetastases 19.3MONTHSISABIGDIFFERENCE!!Presentedby:MedianOSbySidedness:

80405andFIRE-3*

Right1°MedianOS(mos)Left1°MedianOS(mos)P(adjusted)CALGB/SWOG80405N=293N=732Cet16.736.0P<0.0001Bev24.231.4P=0.01FIRE-3N=88N=306Cet18.338.3P<0.00001Bev23.028.0P=0.038KRAS

wtN=1025AllRAS

wtN=394*SebastianStintzing,MD,personalcommunicationHeinemann,etal,ASCO,201480405:SidednessPredictiveforBiologics

Biologicby1°SideInteractionBIOLOGICSIDEOFPRIMARY

HAZARD

RATIO(95%CI)P(adjusted*)AnybiologicOSandPFSCetuxvBev;leftCetuxvBev;right1.53(1.13,2.08)Pint=0.005CetvsBev

OSLeft0.82(0.69,0.96)p=0.01PFS0.84(0.72,0.98)CetvsBevOSRight1.26(0.98,1.63)

p=0.08PFS1.26(1.00,1.62)*Adjustedforbiologic,protocolchemotherapy,prioradjuvanttherapy,priorRT,age,sex,synchronousdisease,inplaceprimary,livermetastasesOverallSurvivalbySidednessandBiologic

CALGB/SWOG80405:

SidednessinKRASwtmCRCPrognosticPtsw/L-sidedprimaryhavemarkedlybetterOSthanptsw/R-sidedprimarytumorregardlessoftreatmentarm.Predictive1st-lineCetuximabandBevacizumabhavedifferenttreatmenteffectsinsubgroupsdefinedbysidednessinthisanalysis.Presentedby:SidednessinmCRC:BiologicalsurrogateNon-randomdistributionofmutationsBRAFR-sided,notenoughtoaccountfordiffferenceTranscriptionalsubtypesHypermethylationEpiregulin,AmphiregulinImmunologicaleffectMicrobiomePresentedby:#3505Schragetal

SEER數(shù)據(jù)庫“CRC部位與生存關(guān)系分析”#3506Leeetal

EGFR單抗治療后腫瘤部位、分子特征與生存關(guān)系分析mCRC中原發(fā)灶部位的價值預(yù)后價值：肯定的，尤其在III、IV期左側(cè)好于右側(cè)，獨立于各種治療手段療效預(yù)測價值：需要從以下幾個層面來收集數(shù)據(jù)部位與抗VEGF的療效預(yù)測化療+VEGF單抗vs單純化療：AVF2107g，NO16966部位與抗EGFR靶向治療的療效預(yù)測：化療+EGFR單抗vs單純化療：CO17，BOND，CRYSTAL,OPUS,PRIMERASWT群體：化療+EGFR單抗vs化療+VEGF單抗FIRE-3，CALGB/SWOG80405，PEAKmCRC中原發(fā)灶部位的價值：抗VEGF療效Loupakisetal.JNCI2015;107(3):dju427納入三個研究的分析PROVETTAN=200治療：FOLFIRI+BevAVF2107g559治療分組：IFL±BevNO169661268治療分組：FOLFOX/XELOX±BevmCRC中原發(fā)灶部位的價值：抗VEGF療效Loupakisetal.JNCI2015;107(3):dju427mCRC中原發(fā)灶部位的價值：抗EGFR療效BruleSY.JEuroCancer.2015;51:1405-14CO17研究對標準治療失敗的mCRC(5-FU、奧沙利鉑、伊立替康)N=572治療分組：西妥昔單抗vsBSCmCRC中原發(fā)灶部位的價值：抗EGFR療效BruleSY.JEuroCancer.2015;51:1405-14抗EGFR治療后，左右半結(jié)腸癌間的生存差距拉大1.SunakawaY,etal.JClinOncol34,2016(suppl4S;abstr613).2.vonEinemJC,etal.JCancerResClinOncol.2014;140(9):1607-1614.3.LuHJ,etal.AsiaPacJClinOncol.2016Mar3.doi:10.1111/ajco.12469.4.HoutsAC,etal.JClinOncol34,2016(suppl4S;abstr550).5.CRYSTALPresentedat2016ASCOmeeting.6.FIRE-3Presentedat2016ASCOmeeting.7.CALGB80405Presentedat2016ASCOmeeting.8.HeWZ,etal.JClinOncol34,2016(suppl4S;abstr683).9.LoupakisF,etal.JNatlCancerInst.2015Feb24;107(3).JACCROCC-05/06#JACCROCC-05/06ωAIOKRK-0104LuHJ.AsiaPacJClinOncol.2016真實世界研究CRYSTALFIRE-3CALGB80405LuHJ.AsiaPacJClinOncol.2016HeWZ.JClinOncol.2016AVF2107gNO16966FIRE-3CALGB80405中位OS（月）