肺癌討論-張力

1、Ab 7003, 7004, 7005 點評1Ab 7003MIC x 2 / 3 wkMitomycin:6 mg/m/d1Ifosfamide: 1.5 g/m/d1-3Cisplatin: 30 mg/m/d1-3 Surgery Surgery If OR: +2 MIC pT3, pN2: RT 60 GyRandomizationDepierre et al, J Clin Oncol 2001; 20:247-5323“將一大組異質(zhì)性病人的平均規(guī)律用于指導具體個例的治療，可能造成危險的誤導” Indeed, concentration exclusively on overall

2、 average effects produced by pooling biologically different disease entities can result in dangerously misleading advice for individual patients.2003 ST Gallen Breast Cancer Guide Lines45尋找耐藥基因6 含順鉑類術(shù)后化療Meta-分析(LACE)JCO 2008; Vol 26:3552-3559HR = 0.89 (95% CI, 0.82-0.96; P=0 .005)7IALT 研究 2006 Updat

3、eNEJM 2006 ERCC1 ERCC1 +8ERCC1和RRM1與早期肺癌預后NEJM 2007;356:800-8Stage I (187例)9NSCLCpT1(x2cm)pT2N0M0R0 resectionPS 0-1N98AssignmentCisplatin-Gemcitabine x 4vsObservationSurgerySpecimen CollectionERCC1 & RRM1Testing (AQUA)EnrollmentS0720: Proof of Concept Study:Biomarker-directed Adjuvant Therapy of Sta

4、ge I NSCLCPI: BeplerRRMI 40.5ANDERCC1 66.0Active Monitoring All Others (RRM1 40.5 OR ERCC1 75% of patients assigned)尋找更準確的分期12JCO 2007; Vol 25:5506-5518 輔助化療的獲益 13肺癌的分子分期 -3基因組 J Clin Oncol 2007；Vol 25:5562-5569I 期II 期III 期14肺癌的分子分期 -蛋白表達 J Clin Oncol 2009中山大學附屬腫瘤醫(yī)院研究結(jié)果15 肺癌新輔助/輔助化療的未來 所有病人均接受經(jīng)過大型隨機

5、臨床研究的結(jié)果證實的最好治療(EBM)每個病人根據(jù)個體的分子生物學差異決定接受某一種治療: 對個體的生物學差異理解不夠Genetic的個體化分析16Daniel Karp, MDUT M. D. Anderson Cancer CenterE5597: Phase III Chemoprevention Trial of Selenium Supplementation in Persons with Resected Stage I Non-Small Cell Lung CancerDaniel D. Karp, Sandra Lee, Gail Shaw Wright, David Jo

6、hnson, Michael Johnston, Gary Goodman, Gerald Clayman, Gordon Okawara, Randolph Marks, Jack RuckdeschelEastern Cooperative Oncology GroupTogether withCancer and Acute Leukemia Group BNCI Canada Treatment Group North Central Cancer Treatment GroupRadiation Therapy Oncology GroupSouthwest Oncology Gro

7、upEnrollment from Oct. 2000 Nov. 2009Ab 7004Daniel Karp, MDUT M. D. Anderson Cancer CenterResults 4. E5597 Selenium Prevention Study: SPTs and Recurrence Worst for Active Smokers* stratified log rank (p=0.016) corrects for treatmentOverall Lung Cancer Risk at 5 yearsActive smokers30%Former smokers24%Never smokers20%50%19Ab 7005Pts with completely resected stage IB,II, and IIIA NSCLCStratified by - stage - histology - post-op RT - sex - adjuvant chemotherapy*Gefitinib250 mg podaily x 2 yrsPlacebo0 mg po daily x 2 yrs Randomized 1:1*Pr