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,High incidence,Age-adjusted gastric cancer incidence per 100 000,High incidence,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,Overreview of first line treatment,Overreview of first line treatment,Overreview of first line treatment,Overreview of first line treatment,Overreview of first line treatment,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,Second-line treatment,First-line treatment,Second-line treatment,PD,Benefit?,Second-line treatment,Second-line treatment,1. Irinotecan has been shown to have activity in gastrointestinal cancers 2. used in a second-line setting for metastatic colon cancer, either alone or in combination with other agents (eg, fuorouracil, bevacizumab, or cetuximab),Topoisomerase I inhibitors,Lancet 1998; 352: 1407-1412,Topoisomerase I inhibitors,Monotherapy,Jpn J Cancer Chemother 1994; 21: 1033-38Tumori 2003；89: 405-07.,Topoisomerase I inhibitors,Combination therapy,Anticancer Res 2006; 26: 1595-1599Am J Clin Oncol 2005; 28: 581-588J Chemother 2003; 15: 275-278,Taxanes,J Clin Oncol 2006; 24: 4991-4997.,Taxanes, which bind and stabilise microtubules leading to cell-cycle arrest, have been used in the first-line setting for advanced gastric cancer.,Taxanes,Ann Oncol 2000; 11: 1263-66Anticancer Res 2003; 23: 4219-22Cancer Chemother Pharmacol 2008; 61: 631-637,Platinum agents,Platinum drugs given alone as second-line reatment have fallen out of favour in advanced gastric cancer, mainly due to their frequent use in the first-line setting2. However, it is still reasonable to consider them in patients who have not been previously exposed to platinum agents.,Platinum agents,Monotherapy,Eur J Cancer Clin Oncol 1985; 21: 1321-1324Jpn J Oncol 1990; 20: 169-176,Platinum agents,Combination therapy,Ann Oncol 2003; 14: 383-387.Cancer Chemother Pharmacol 2008; 63: 433-39,Fluorouracil-based regimens,Despite the fact that all of the well-established front-line regimens for advanced GC contain fuorouracil or its prodrugs,there is continued interest in the use of these agents in the second-line setting.,Fluorouracil-based regimens,S-1,Anticancer Drugs 2008; 19: 303-307.Br J Cancer 2007; 97: 458-63,Reasonable toxicityConvenience of oral administrationModest response rate,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,performance status history of agents used degree of response to the first-line settingamount of metastatic disease,Clin Oncol (R Coll Radiol) 2005; 17: 81-90,Predictive factors-1,Predictive factors-2,low-risk group,patients with no prognostic factorintermediate-riskgroup,patients with one or two negative prognostic factorhigh-riskgroup,patients with three to five negative prognostic factor,British Journal of Cancer (2008) 99, 1402-1407,Multivariate analysis,Predictive factors-2,low-risk group,patients with no prognostic factorintermediate-riskgroup,patients with one or two negative prognostic factorhigh-riskgroup,patients with three to five negative prognostic factor,British Journal of Cancer (2008) 99, 1402-1407,Predictive factors-2,ECOG performance status 2Haemoglobin11.5g/dlCEA50 ng/mlNumber of metastatic sites 3 4TTP of the first-line chemotherapy 6 months,British Journal of Cancer (2008) 99, 1402-1407,Predictive factors-3,Multivariate analysis,BMC Cancer 2009, 9:110 doi:10.1186/1471-2407-9-110,Conclusion: Performance status, along with baseline hemoglobin level, could be used to identify the subgroup of patients most likely to benefit from second-line chemotherapy for AGC.,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,Currently no targeted agents have been approved in the treatment of advanced gastric cancer.,Targeted therapy,Targeted therapy,First-line therapy,Targeted therapy,First-line therapy,Targeted therapy,Second-line therapy,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy predicative factors Other endpointsTake home message,Predictive factors,Cancer Chemother Pharmacol DOI 10.1007/s00280-009-1067-9,Methods Thirty-two patients with MGC were included in the study. Cetuximab was delivered, often combined withirinotecan-based chemotherapy. Thirty patients were analyzed for K-ras mutations via direct sequencing of the tumor DNA.,Predictive factors,Results,Cancer Chemother Pharmacol DOI 10.1007/s00280-009-1067-9,Predictive factors,PFS,PFS,OS,OS,Results,ConclusionThe study suggests that MGC patients withgood performance status and skin rash benefit most fromsalvage cetuximab combined with chemotherapy, even inheavily pretreated status.,Predictive factors,Cancer Chemother Pharmacol DOI 10.1007/s00280-009-1067-9,Highlights today,Overreview of first line treatmentSecond-line treatment chemotherapy predicative factors target therapy p