肺癌簡介(英文版) 課件

肺癌簡介(英文版)課件2FranklySpeakingAboutLungCancer“WhatYouNeedtoKnowAboutLungCancer&ItsTreatment”

2FranklySpeakingAboutLungC3FranklySpeakingAboutLungCancerPowerfulfacts:177,000casesannuallyLungcanceristhe#1causeofcancer-relateddeathsbyfarintheU.S. …morethanbreast,prostate,andcoloncancercombined. 3FranklySpeakingAboutLungC4FranklySpeakingAboutLungCancerRiskFactors:Smoking(90%ofallcases)Second-handsmoke(25%ofnon-smokercases)Occupational/environmental

4FranklySpeakingAboutLungC5FranklySpeakingAboutLungCancerNon-SmallCellLungCancer(NSCLC)Comprises

85%ofalllungcancersTypesofNSCLC:Adenocarcinoma(mostcommon)SquamouscellBronchoalveolarCarcinomaLargeCellCarcinomaAdenosquamous5FranklySpeakingAboutLungC6FranklySpeakingAboutLungCancer SmallCellLungCancer(SCLC)Comprises

15-20%ofalllungcancersSpreadsmoreaggressivelythanNSCLCIsmoreresponsivetochemotherapyFrequentlyfoundinsmokersorformersmokers6FranklySpeakingAboutLungC7FranklySpeakingAboutLungCancerStagesofNon-SmallCellLungCancerStageI confinedtolungtissuealoneStageII lungtissueandlymphnodesin lungStageIII lungtissueandlymphnodes outsideofthelungStageIV distantspread(liver,adrenal glands,bone,brain,othersites)7FranklySpeakingAboutLungC8FranklySpeakingAboutLungCancer

LUNGCANCERSTAGING(TNM) T=Primarytumorsize(T1-T4) N=Lymphnodeinvolvement(N1-N3) M=Distantmetastasis(M0-M1)

8FranklySpeakingAboutLungC9FranklySpeakingAboutLungCancerTreatmentofStageINSCLCEvaluateforsurgerySurgeryaloneisthestandardofcarePathologicstageI:67%cureClinicaltrialsareevaluatingthevalueofadjuvant(aftersurgery)therapy9FranklySpeakingAboutLungC10FranklySpeakingAboutLungCancerTreatmentofStageIINSCLCEvaluatefortypeofsurgerySurgeryaloneisthestandardofcarePathologicstageII:40-50%cureClinicaltrialsareevaluatingthevalueofadjuvant(aftersurgery)therapy10FranklySpeakingAboutLung11FranklySpeakingAboutLungCancer‘Theoretical’AdvantagesofCombiningDifferentTypesofCancerTherapiesChemotherapy:

Controlsmicro-metastasesthatmayberesponsibleforsystemicrecurrenceafter“successful”surgery

ActssynergisticallywithXRTtodownstageNSCLCandmaketumor-freemarginsurgerymorelikelyRadiationTherapy

“Sterilizes”surgicalmarginsmakinglocalrecurrencelesslikely

11FranklySpeakingAboutLung12FranklySpeakingAboutLungCancerSummary:TreatmentStageI&IINSCLCSurgeryisthestandardofcareNeoadjuvant(givenbeforesurgery)therapyispromisingAdjuvant(givenaftersurgery)chemotherapyorradiationtherapyshownoimprovement12FranklySpeakingAboutLung13FranklySpeakingAboutLungCancerStageIIINon-SmallCellLungCancer2types:StageIIIAandStageIIIBRadiationalonewasthestandardcareuntil1990’sChemotherapy+radiationisthenewstandardbasedonresultsofclinicaltrialsNewerradiationtechniquesminimizesideeffectsoftreatment

13FranklySpeakingAboutLung14FranklySpeakingAboutLungCancerTreatmentofStageIIINSCLCChemo+radiation=standardofcareRoleofsurgeryisundefinedUnansweredquestions:-Whichchemoisbest?Howdoesonedecide?-When&howshouldchemotherapybegiven?-When&howshouldradiationbegiven?14FranklySpeakingAboutLung15FranklySpeakingAboutLungCancerStageIIIANon-SmallCellLungCancerBulkyvs.minimaldiseaseChemotherapy+radiationCommonlyusedchemotherapydrugs:Platinum-basedNon-platinumbasedRoleofsurgeryundefined15FranklySpeakingAboutLung16FranklySpeakingAboutLungCancerStageIIIBNon-SmallCellLungCancerPleuraleffusionaffectstreatmentplanChemotherapy+radiationorradiationaloneCommonlyusedchemotherapydrugs:Platinum-basedNon-platinumbased

16FranklySpeakingAboutLung17FranklySpeakingAboutLungCancerTreatmentofStageIIIB-IVNSCLCReduceChemotherapyToxicityRecentstudy:Combinationof2drugsprovidesamebenefitas3,butwithfewersideeffects:Lessnausea/vomitingLesshairlossLessnervedamageLowerriskofinfectionGemcitabine+vinorelbineslightlylesstoxicitybutequivalentresponse(Cancer,Vol.95,No.6,2002)17FranklySpeakingAboutLung18FranklySpeakingAboutLungCancerStageIVNSCLC

NCIRecommendedFirst-LineChemotherapy:gemcitabine+cisplatinpaclitaxel+carboplatinorcisplatinvinorelbine+cisplatindocetaxel+cisplatinOtherdrugcombinations

18FranklySpeakingAboutLung19FranklySpeakingAboutLungCancerTreatmentofRecurrentNSCLCChallengesofdecision-makingGeneralhealthstatusofthepatientSeveraltreatmentoptionswithequivalentresultsbutwidelyvaryingsideeffectsBalancingqualityoflifewithsideeffectsPatient’sgoalsandwishes

19FranklySpeakingAboutLung20TreatmentofSmallCellLungCancerLimitedstage:chemo+xrt=standardofcareetoposide+cisplatin+radiationcisplatin+irinotecanExtensivestage:first-linechemotherapyetoposide(VP-16)+cisplatin(orcarboplatin)+ radiationcisplatin+irinotecanCAV,CAEinclinicaltrials20TreatmentofSmallCellLung21TreatmentofRecurrentSmallCellLungCancerPossibleChemotherapyAgents:topotecan(Hycamtin):onlyFDA-approveddrugforrecurrentdiseaseoraletoposide(VP-16)paclitaxel(Taxol)irinotecan/CPT-11(Camptosar)CAVothersinclinicaltrialsPalliativeradiationtorelievesymptoms21TreatmentofRecurrentSmall22NewerStrategies:TargetedTherapyChemotherapytargetsgeneralfeaturesofcells,includingbothcancercellsandnormalcellsNormalcellsusuallyrecover,whilecancercellsmaynotHowever,chemotherapyisassociatedwithsideeffects22NewerStrategies:TargetedT23EpidermalGrowthFactorReceptorsAngiogenesisAntisenseProteinKinaseCC-kitPDGF-rCox-2RasinhibitorsRafinhibitorsMapkinaseOthersExamplesofLungCancerTargetedTherapyinDevelopment23EpidermalGrowthFactorRece24FranklySpeakingAboutLungCancerEpidermalGrowthFactorReceptors

Iressa(AstraZeneca)Tarceva(Genentech)Erbitux(Imclone,BMS)Manyothersindevelopment24FranklySpeakingAboutLung25FranklySpeakingAboutLungCancerAngiogenesisInhibitors“Angio”=bloodvessel,“Genesis”=formationorbeginningManyagentsbeingtestedtoinhibitthisprocess:Anti-VEGFThalidomideAngiostatin/EndostatinAnti-VEGFtyrosinekinaseinhibitorsOthers

25FranklySpeakingAboutLung26FranklySpeakingAboutLungCancerAntisenseDrugsAffinitac(Lilly)AntisensedrugtoproteinkinaseCPhaseIIstudiescompletedcombiningwithchemotherapyEvaluatingeffectivenessinrecurrentlungcancerPhaseIIItrialsunderwaycomparingchemotherapy+drug

26FranklySpeakingAboutLung27FranklySpeakingAboutLungCancer“WhatYouNeedtoKnowAboutLungCancer&ItsTreatment” QuestionsandDiscussion27FranklySpeakingAboutLung28FranklySpeakingAboutLungCancer

PATIENTACTIVEBREAK28FranklySpeakingAboutLung29FranklySpeakingAboutLungCancer“IssuestoDiscussWithYourDoctorWhenMakingDecisionsAboutLungCancerTreatment:APatientActiveApproach”29FranklySpeakingAboutLung30FranklySpeakingAboutLungCancerMakingdecisionsaboutcancertreatmentisacomplexandsometimesoverwhelmingexperience.Youhavechoices.Butyouneedtobeinformed&youneedtoevaluatemanyaspectsofyourcare.30FranklySpeakingAboutLung31FranklySpeakingAboutLungCancerWhatisthegoalofmycancertherapy?Isitprolongationoflife?Istocontrolsymptoms?Isitpalliation?31FranklySpeakingAboutLung32FranklySpeakingAboutLungCancerWhatisaclinicaltrialandwouldonebeareasonabletreatmentoptionforme?Whataretherisksandbenefits?32FranklySpeakingAboutLung33FranklySpeakingAboutLungCancerWhatisaclinicaltrialandwouldonebeareasonabletreatmentoptionforme?Whataretherisksandbenefits?33FranklySpeakingAboutLung34FranklySpeakingAboutLungCancerAmIreadyandwillingtoparticipatefullyandactivelyinmytreatmentplan?DoIknowwhatthepotentialsideeffectsoftherapyareandhowbesttopreventormanagethem?HaveIcommunicatedwithmyphysicianwhat‘qualityoflife’meanstome?34FranklySpeakingAboutLung35FranklySpeakingAboutLungCancerMakingdecisionsaboutlungcanceranditstreatmentisnevereasy.Bybeinginformed&partneringwithyourphysician&healthcareteam,youcanimprovethequalityofyourlifeandmayenhancethepossibilityofyourrecovery.35FranklySpeakingAboutLung36FranklySpeakingAboutLungCancerMakingDecisionsAboutLungCancerTreatmentQuestionsandDiscussion36FranklySpeakingAboutLung肺癌簡介(英文版)課件38FranklySpeakingAboutLungCancer“WhatYouNeedtoKnowAboutLungCancer&ItsTreatment”

2FranklySpeakingAboutLungC39FranklySpeakingAboutLungCancerPowerfulfacts:177,000casesannuallyLungcanceristhe#1causeofcancer-relateddeathsbyfarintheU.S. …morethanbreast,prostate,andcoloncancercombined. 3FranklySpeakingAboutLungC40FranklySpeakingAboutLungCancerRiskFactors:Smoking(90%ofallcases)Second-handsmoke(25%ofnon-smokercases)Occupational/environmental

4FranklySpeakingAboutLungC41FranklySpeakingAboutLungCancerNon-SmallCellLungCancer(NSCLC)Comprises

85%ofalllungcancersTypesofNSCLC:Adenocarcinoma(mostcommon)SquamouscellBronchoalveolarCarcinomaLargeCellCarcinomaAdenosquamous5FranklySpeakingAboutLungC42FranklySpeakingAboutLungCancer SmallCellLungCancer(SCLC)Comprises

15-20%ofalllungcancersSpreadsmoreaggressivelythanNSCLCIsmoreresponsivetochemotherapyFrequentlyfoundinsmokersorformersmokers6FranklySpeakingAboutLungC43FranklySpeakingAboutLungCancerStagesofNon-SmallCellLungCancerStageI confinedtolungtissuealoneStageII lungtissueandlymphnodesin lungStageIII lungtissueandlymphnodes outsideofthelungStageIV distantspread(liver,adrenal glands,bone,brain,othersites)7FranklySpeakingAboutLungC44FranklySpeakingAboutLungCancer

LUNGCANCERSTAGING(TNM) T=Primarytumorsize(T1-T4) N=Lymphnodeinvolvement(N1-N3) M=Distantmetastasis(M0-M1)

8FranklySpeakingAboutLungC45FranklySpeakingAboutLungCancerTreatmentofStageINSCLCEvaluateforsurgerySurgeryaloneisthestandardofcarePathologicstageI:67%cureClinicaltrialsareevaluatingthevalueofadjuvant(aftersurgery)therapy9FranklySpeakingAboutLungC46FranklySpeakingAboutLungCancerTreatmentofStageIINSCLCEvaluatefortypeofsurgerySurgeryaloneisthestandardofcarePathologicstageII:40-50%cureClinicaltrialsareevaluatingthevalueofadjuvant(aftersurgery)therapy10FranklySpeakingAboutLung47FranklySpeakingAboutLungCancer‘Theoretical’AdvantagesofCombiningDifferentTypesofCancerTherapiesChemotherapy:

Controlsmicro-metastasesthatmayberesponsibleforsystemicrecurrenceafter“successful”surgery

ActssynergisticallywithXRTtodownstageNSCLCandmaketumor-freemarginsurgerymorelikelyRadiationTherapy

“Sterilizes”surgicalmarginsmakinglocalrecurrencelesslikely

11FranklySpeakingAboutLung48FranklySpeakingAboutLungCancerSummary:TreatmentStageI&IINSCLCSurgeryisthestandardofcareNeoadjuvant(givenbeforesurgery)therapyispromisingAdjuvant(givenaftersurgery)chemotherapyorradiationtherapyshownoimprovement12FranklySpeakingAboutLung49FranklySpeakingAboutLungCancerStageIIINon-SmallCellLungCancer2types:StageIIIAandStageIIIBRadiationalonewasthestandardcareuntil1990’sChemotherapy+radiationisthenewstandardbasedonresultsofclinicaltrialsNewerradiationtechniquesminimizesideeffectsoftreatment

13FranklySpeakingAboutLung50FranklySpeakingAboutLungCancerTreatmentofStageIIINSCLCChemo+radiation=standardofcareRoleofsurgeryisundefinedUnansweredquestions:-Whichchemoisbest?Howdoesonedecide?-When&howshouldchemotherapybegiven?-When&howshouldradiationbegiven?14FranklySpeakingAboutLung51FranklySpeakingAboutLungCancerStageIIIANon-SmallCellLungCancerBulkyvs.minimaldiseaseChemotherapy+radiationCommonlyusedchemotherapydrugs:Platinum-basedNon-platinumbasedRoleofsurgeryundefined15FranklySpeakingAboutLung52FranklySpeakingAboutLungCancerStageIIIBNon-SmallCellLungCancerPleuraleffusionaffectstreatmentplanChemotherapy+radiationorradiationaloneCommonlyusedchemotherapydrugs:Platinum-basedNon-platinumbased

16FranklySpeakingAboutLung53FranklySpeakingAboutLungCancerTreatmentofStageIIIB-IVNSCLCReduceChemotherapyToxicityRecentstudy:Combinationof2drugsprovidesamebenefitas3,butwithfewersideeffects:Lessnausea/vomitingLesshairlossLessnervedamageLowerriskofinfectionGemcitabine+vinorelbineslightlylesstoxicitybutequivalentresponse(Cancer,Vol.95,No.6,2002)17FranklySpeakingAboutLung54FranklySpeakingAboutLungCancerStageIVNSCLC

NCIRecommendedFirst-LineChemotherapy:gemcitabine+cisplatinpaclitaxel+carboplatinorcisplatinvinorelbine+cisplatindocetaxel+cisplatinOtherdrugcombinations

18FranklySpeakingAboutLung55FranklySpeakingAboutLungCancerTreatmentofRecurrentNSCLCChallengesofdecision-makingGeneralhealthstatusofthepatientSeveraltreatmentoptionswithequivalentresultsbutwidelyvaryingsideeffectsBalancingqualityoflifewithsideeffectsPatient’sgoalsandwishes

19FranklySpeakingAboutLung56TreatmentofSmallCellLungCancerLimitedstage:chemo+xrt=standardofcareetoposide+cisplatin+radiationcisplatin+irinotecanExtensivestage:first-linechemotherapyetoposide(VP-16)+cisplatin(orcarboplatin)+ radiationcisplatin+irinotecanCAV,CAEinclinicaltrials20TreatmentofSmallCellLung57TreatmentofRecurrentSmallCellLungCancerPossibleChemotherapyAgents:topotecan(Hycamtin):onlyFDA-approveddrugforrecurrentdiseaseoraletoposide(VP-16)paclitaxel(Taxol)irinotecan/CPT-11(Camptosar)CAVothersinclinicaltrialsPalliativeradiationtorelievesymptoms21TreatmentofRecurrentSmall58NewerStrategies:TargetedTherapyChemotherapytargetsgeneralfeaturesofcells,includingbothcancercellsandnormalcellsNormalcellsusuallyrecover,whilecancercellsmaynotHowever,chemotherapyisassociatedwithsideeffects22NewerStrategies:TargetedT59EpidermalGrowthFactorReceptorsAngiogenesisAntisenseProteinKinaseCC-kitPDGF-rCox-2RasinhibitorsRafinhibitorsMapkinaseOthersExamplesofLungCancerTargetedTherapyinDevelopment23EpidermalGrowthFactorRece60FranklySpeakingAboutLungCancerEpidermalGrowthFactorReceptors

Iressa(AstraZeneca)Tarceva(Genentech)Erbitux(Imclone,BMS)Manyothersindevelopment24FranklySpeakingAboutLung61FranklySpeakingAboutLungCancerAngiogenesisInhibitors“Angio”=bloodvessel,“Genesis”=formationorbeginningManyagentsbeingtestedtoinhibitthisprocess:Anti-VEGFThalidomideAngiostatin/EndostatinAnti-VEGFtyrosinekinaseinhibitorsOthers

25FranklySpeakingAboutLung62FranklySpeakingAboutLungCancerAntisenseDrugsAffinitac(Lilly)AntisensedrugtoproteinkinaseCPhaseIIstudiescompletedcombiningwithchemotherapyEvaluatingeffectivenessinrecurrentlungcancerPhaseIIItrialsunderwaycomparingchemotherapy+drug

26FranklySpeakingAboutLung63FranklySpeakingAboutLungCancer“WhatYouNeedtoKnowAboutLungCancer&ItsTreatment” QuestionsandDiscussion27FranklySpeakingAboutLung64FranklySpeakingAboutLungCa