伊立替康+顺铂治疗31张课件

1、伊立替康+顺铂治疗小细胞肺癌多中心随机对照临床研究解放军总医院肿瘤内科伊立替康+顺铂治疗小细胞肺癌研究背景WHo2000年:全球死于肺癌人数占恶性肿瘤死亡的19%,居恶性肿瘤死因的首位我国近20年肺癌发病率以每年11%速度递增ScLC约占肺癌2025%SCLc对化疗和放疗都非常敏感多种治疗方案未能使患者长期生存研究背景研究背景局限期小细胞肺癌( LD-SCLC)占30-40%中位生存期:1016个月5年生存率:18%广泛期小细胞肺癌( ED-SCLC占60-70%中位生存期:612个月5年存活率:2%预后好的因素:一般状况好、女性、70岁以下、白种人、LDH正常、足量联合化疗、单发转移灶研究背

2、景研究背景手术:非常规首选,严格适应征纵隔镜、PET-CT:精确分期TNM-IAIBA:LD期Ig:ED期放疗:LD期:RCT优于单纯cT(2007AScO:3年绝对获益+5%)同步优于序贯:MS272mVs197m美国同步,欧洲序贯预防性脑放疗:LD期:3年绝对获益+54%降低脑转移25.3%研究背景研究背景一线化疗:A:EP优于cAV2Y:25%Vs8%5Y:10%Vs3%B:P优于EPRR:84%Vs64%MS: 12.8m vs 9. 4mPFS: 6.9m vs 4.8mC:PEM+CBP优于PEM+DDPMS:10.8m vs 7.9m1Y:43%Vs28.8%研究背景研究背景二线

3、化疗:7080%LD、100%ED进展或复发拓扑替康+铂类培美曲塞+铂类紫杉醇+铂类?靶向治疗:小样本,无确切疗效研究背景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

5、ico gy deli. o8 Small Cell Lung CancerSCLC Abad CorlanStagno, M. RFdemEnmAsTAGEADDITIONAL WORKUPINITIAL TREATMENTCombination che mothe rapy m ineludingsupportive care regimenslocalizedSee NccN Palliative Care Guidelinesmatic site:Poor Ps(3-4)Individualized the rapy includingSeverelysupportive care r

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+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊立替康+顺铂治疗31张课件伊