化療方案手冊英文版050608ColorMatrix Cancer Staging and Treatment

Color-MatrixCancerStagingandTreatmentHandbookEdwandH.Lin,MD·RichardLozano,RPh·DanielD,Karp,MDTHEUNIVERSITYOFTEXASMDANDERSONMakingCancerHistoryThirdEdition2004【僅選取化療方案部分】AIDS-RelatedKaposi’sSarcomaDrugDoseandScheduleLiposomalDaunorubicinLiposomaldaunorubicin(DaunoXome)40mg/m2IVover60minutesRepeatevery14days.LiposomalDoxorubicinLiposomaldoxorubicin(Doxil)20mg/m2IVover60minutesRepeatevery21days.PaclitaxelPaclitaxel135mg/m2IVover3hoursRepeatevery21days.orPaclitaxel135mg/m2IVover1hoursRepeatevery14days.BreastCancer-AdjuvantTherapyRegimenDrugDosesandSchedulesDFSRateOSRateGrade3and4SideEffects;Reference(s)FACFluorouracil500mg/m2IVdays1and4Doxorubicin50mg/m2CIover72hoursStartingday1Cyclophosphamide500mg/m2IVday1Repeatevery21daysfor6cycles.63%at7yr(stagell)69%at7yr(stagell)Neutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverBuzdarA.In:salmonSE,ed.AdjuvantTherapyofCancerVll.Philadeophia,Lippincott,1993.Cancer53:384,1984.SequentialPaclitaxel→FACPaclitaxel80mg/m2IVover1hoursWeeklyfor12weeksfollowedbyFAC(asabove)for4cycles86%at48moTooearlyNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverClinCancerRes8:1073,2002FECFluorouracil500mg/m2IVday1Epirubicin100mg/m2IVday1Cyclophosphamide500mg/m2IVday1Repeatevery21daysfor6cycles.66.3%at5yr50.7%at10yr77.4%at5yr54.8%at10yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol19:602,2001ProcAmSocClinOncolA93,2003CEF*Cyclophosphamide75mg/m2POdays1-14Epirubicin60mg/m2IVday1and8Fluorouracil500mg/m2IVdays1and8Repeatevery21daysfor6cycles.*Requiresprophylacticantibioticsorgrowthfactorsupport.63%at60mo(vs53%forCMF)52%at10yr(vs45%forCMF)77%at60mo(vs70%forCMF)62%at10yr(vs58%forCMF)Neutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol6:2651,1998SanAntonioBreastCancerSymposiumA17,2002ACDoxorubicin60mg/m2IVday1Cyclophosphamide600mg/m2IVday1Repeatevery21daysfor4cycles.62%at3yr83%at3yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol8:1483,1990SequentialAC→paclitaxelDoxorubicin60mg/m2IVday1Cyclophosphamide600mg/m2IVday1Repeatevery21daysfor4cycles.followedbyPaclitaxel175mg/m2IVover3hoursRepeatevery21daysfor4cycles.70%at5yr80%at5yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverSeminOncol22:18,1995JClinOncol21:976,2003CAFCyclophosphamide600mg/m2IVday1Doxorubicin60mg/m2IVbolusday1Fluorouracil600mg/m2IVdays1and8Repeatevery28daysfor6cycles.74%at3yr92%at3yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJNatlCasncerInst90:1205,1998NEnglJMed330:1253,1994EC(60)Epirubicin60mg/m2IVday1Cyclophosphamide500mg/m2IVday1Repeatevery21daysfor8cycles.72%at3yr89%at3yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol19:3103,2001EC(100)Epirubicin100mg/m2IVday1Cyclophosphamide830mg/m2IVday1Repeatevery21daysfor8cycles.80%at3yr92%at3yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol19:3103,2001TAC*Docetaxel75mg/m2IVover1hourday1Doxorubicin50mg/m2IVday1Cyclophosphamide500mg/m2IVday1Repeatevery21daysfor6cycles.*Requiresgrowthfactorsupportprophylacticantibiotics.Doxorubicinshouldbegivenbeforedocetaxel.75%at5yr87%at5yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverMartinM,etal.SanAntonioBreastCancerSymplsium,A43,2003CMFOralCyclophosphamide100mg/m2/dayPOdays1-14Methotrexate40mg/m2IVdays1and8*Fluorouracil600mg/m2IVdays1and8*Repeatevery28daysfor6cycles.*Forpatients>60years,reducemethotrexatedoseto30mg/m2andfouorouracildoseto400mg/m2.71%at12yr80%at12yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverNEnglJMed294:405,1976NEnglJMed332:901,1995CMFIVCyclophosphamide600mg/m2IVday1Methotrexate40mg/m2IVday1Fluorouracil600mg/m2IVdays1and8Repeatevery28daysfor6cycles.82%at5yr88%at5yrNeutropenia,Mucositis,Nauseaorvomiting,NeutropenicfeverJClinOncol14:1982,1996TamoxifenTamoxifen20mgPOdailyfor5yearsinHormonereceptor-positivewomenRegardlessofmenopausalstatusorage79.2%at10yr(vs64.3%forplacebo)Therewasa58%reductionintheriskofontralateralbreastcancer.78.9%at10yr(vs73.3%forplacebo)Lancet351:1451,1998Anastrozole阿那曲唑Anastrozole1mgPOdailyfor5yearsInhormonereceptor-positivePostmenopausalwomensequentiallyafterChemotherapy.DatanotmatureCancer98:1802,2003Tam→Letrozole來曲唑Tamoxifen20mgPOdailyfor5yearsFollowedbyLetrozole2.5mgdailyfor5yearsInhormonereceptor-positivePostmenopausalwomensequentiallyafterChemotherapy.DatanotmatureNEnglJMed349:19,2003Tam→Exemestane依西美坦Tamoxifen20mgPOdailyfor2-3yearsFollowedbyExemestane25mgPOdailyforRemainderof5yearstotalhormonaltherapy.Inhormonereceptor-positivePostmenopausalwomensequentiallyafterChemotherapy.91.5%at3yr(vs86.8%fortam×5years)MedianFollow-up,30.6moDatanotmatureNEnglJMed350:1081,2004BreastCancer-Metastatic-AllPatientSubgroupsRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;ReferencePaclitaxel紫杉醇(every3weeks)Paclitaxel175mg/m2IVover3hoursRepeatevery21days.(Studyconductedwith200mg/m2.)29%5.3mo17.3moNauseaorvomiting,34%;Fatigue,12%JClinOncol17:2355,1999Paclitaxel(weekly)Paclitaxel80mg/m2or100mg/m2IVover1hoursweekly53%NotstatedNotstatedJClinOncol16:3353,1998Docetaxel多西紫杉醇(every3weeks)Docetaxel60-100mg/m2IVover1hoursRepeatevery21days.1st-line:38-68%2nd-1ine32-57%4.9mo4-7.5mo16.4mo9moJClinOncol24:513,1997Docetaxel(weekly)Docetaxel40mg/m2over1hoursevery7daysfor6weeks.Repeatevery8weeks.41%NotstatedNotstatedJClinOncol18:1212,2000Docetaxel+CapecitabineDocetaxel75mg/m2IVover1hourd1Capecitabine1,000mg/m2POBIDdays1-14(totaldose=2,000mg/m2/day)Repeatevery21days.44%+6.1mo14.5moHand-footsyndrome,24%;Diarrhea,13%;Stomatitis,27%;Nausea,8%Neutropenicfever,25%JClinOncol20:2812,2002Capecitabine卡培他濱Capecitabine1,000mg/m2/dayPOBIDdays1-14(totaldose=2,000mg/m2/day)Repeatevery21days.20%3.3mo12.8moJClinOncol17:485,1999ATDoxorubicin50mg/m2IVover15minutes(orbolus)followedbyDocetaxel75mg/m2IVover1hourRepeatevery21days.Caution:Lifetimecumulativedoseofdoxorubicingivenasashortinfusionorboluswityataxaneshouodnotexceed360mg/m2.59%22.5mo37.3moJClinOncol21:968,2003ETEpirubicin70-90mg/m2IVover15minutes(orbolus)followedbyDocetaxel70-90mg/m2IVover1hourRepeatevery21daysfor6cycles.Caution:Lifetimecumulativedoseofepirubicingivenasashortinfusionorboluswithataxaneshouldnotexceed6-8cycles.67%10.8mo19.5moCancerChemotherPharmacol53:75,2004VinorelbineVinorelbine30mg/m2IVover10minutesdays1and8Repeatevery21days.25%6moNotstatedCan92:2267,2001Gemcitabine吉西他濱Gemcitabine600-1,000mg/m2IVdays1,8,and15Repeatevery28days.(Oftennotabletogiveday-15dose.)25%Notstated11.5moJClinOncol13:2731,1995LiposomalDoxorubicin(Doxil)Doxil30-50mg/m2IVinD5Wover30minutesRepeatevery21-28days.31%NotstatedNotstatedJClinOncol15:3185,1997DoxorubicinDoxorubicin50-75mg/m2CIover72hoursRepeatevery21-28days.(Lifetimecumulativedoseofdoxorubicingivenasashortinfusionorbolusshouldnotexceed450mg/m2.)28%4.4mo10.2moBrJCancer77:2257,1998EpirubicinEpirubicin90-120mg/m2IVover15minutes(orbolus)Repeatevery21-28days.(Lifetimecumulativedoseofepirubicingivenasashortinfusionshouldnotexceed900mg/m2.)36%5.3mo10.8moBrJCancer77:2257,1998BreastCancer-Metastatic-Premenopausal,HR+RegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)TamoxifenTamoxifen20mgPOdaily31-45%--CancerTreatmentReports64:787,1980CancerTreatmentReports64:779,1980JClinOncol4:178,1986Goserelin戈舍瑞林Goserelin3.6mgSCevery28daysor10.8mgSCevery3months31%23weeds127weedsEurJCancer31A:137,1995Leuprolide醋酸亮丙瑞林Leuprolide7.5mgIMevery28daysor22.5mgIMevery3monthsor30mgIMevery4months44%NotstatedNotstatedJClinOncol3:1068,1995Triptorelin曲普瑞林Triptorelin3.75mgIMevery28daysOr11.25mgIMevery3months70%NotstatedNotstatedAmJClinOncol19:455,1996TamoxifenTamoxifen20mgPOdaily16-32%NotstatedSeearomataseinhibitorsectionsBelow.AnastrozoleAnastrozole1mgPOdaily20.9%11.1moNotstatedJClinOncol18:3758,2000LetrozoleLetrozole2.5mgPOdaily31%9.3moNotstatedJClinOncol19:2596,2001ExemestaneExemestane25mgPOdaily42%8.9moNotstatedParidaensR,etal.ProcASCOA316,2000Fulvestrant氟維司群Fulvestrant250mgIMevery28days17.5%5.4moNotstatedJClinOncol20:3386,2002BreastCancer-Metastatic-HER2/neu3+byIHCorFISHRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;ReferencePaclitaxel+Trastuzumab曲妥單抗Paclitaxel90mg/m2IVeveryweekTrastuzumab4mg/kgloadingdoseIVthen2mg/kgIVweekly56.8%NotstatedNotstatedJClinOncol19:2587,2001Paclitaxel+TrastuzumabPaclitaxel175mg/m2IVevery3weeksTrastuzumab4mg/kgloadingdoseIVthen2mg/kgIVweekly50%7.4mo25.1moNEnglJMed344:783,2001Docetaxel+TrastuzumabDocetaxel35mg/m2IVeveryweekTrastuzumab4mg/kgloadingdoselvthen2mg/kglVweekly63%9moNotstatedJClinOncol20:1800,2002Vinorelbine+TrastuzumabVinorelbine25mg/m2IVweeklyslidingscaleTrastuzumab4mg/kgloadingdoselvthen2mg/kglVweekly75%8.5mofrontlineNotyetReachedFrontlineJClinOncol19:2722,2001TrastuzumabTrastuzumab4mg/kglVloadingdosethen2mg/kglVweekly15%11mo13moJClinOncol17:2639,1999TCHPaclitaxel175mg/m2over3hoursday1CauboplatinAUC6IVday1Trastuzumab4mg/kgIVloadingdosethen2mg/kgIVmaintenancetherapyeveryweekRepeatevery21days.57%7.4moNotstatedLeyland-JonesRN,etal.SanAntonioBreastCancerSymposiumA35,2002ColonCancer-AdjuvantTherapyKeyPoints:Thecombinationoffluorouracil(5-FU)andleucovorin(LV)remainsthestandardfortheadjuvanttreatmentofstagelllcolorectalcancer.TheFOLFOX4regimenwasassociatedwitha23%relativeimprovementindisease-freesurvivalcomparedwith5-FU+LValone.TheIFLregimenshouldnotbeusedintheadjuvantsetting.Arandomizedphaselllstudy(Pan-EuropeanTrialsinAdjuvantColonCancer,PETACC)onFOLFIRIvsinfusional5-FU+LVhasnotyetmatured.Therearenodataontheuseofbevacizunabintheadjuvantsetting.RegimenDrugDosesandSchedulesDFSRateOSRateGrade3and4SideEffects;ReferenceFluorouracil+Leucovorin(mayoclinicRegimen)Fluorouracil425mg/m2/dayIVdays1-5Leucovorin20mg/m2/dayIVdays1-5Repeatevery28daysfor6cycles.74%at5yr75%at5yrNeutropenia,Mucositis,DiarrheaJClinOncol15:246,1997Fluorouracil+Leucovorin(RoswellparkCancerInstituteRegimen)Fluorouracil500mg/m2IVweekly×6Leucovorin500mg/m2IVweekly×6Repeatevery8weeksfor4cycles.73%at3yr60-63%at5yr84%at3yr65%at5yrMucositis,DiarrheaJClinOncol11:1879,1993FOLFOX4Oxaliplatin85mg/m2IVday1Leucovorin200mg/m2IVd1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery14daysfor12cycles.77.8%at3yr(vs72.8%for5-FU+LV)Stagelll:71.8%at3yr(vs65.5%for5-FU+LV)Stagell:86.6%at3yr(VS83.9%for5-FU+LV)NotavailableNeutropenia,Diarrhea,Nauseaorvomiting,Paresthesias(12%)DeGramontA,etal.ProcASCOA1015,2003MetastaticColorectalCancer—FrontlineTreatmentKeyPoints:Managedthroughamultidisciplinaryteamandoptimalsequenceofactiveagents,patientswithmetastaticCRCareexpectedtoenjoyabenchmarkmedianoverallsurvialof20+months.lnfusional5-FU/LValoneorincombinationissuperiortobolus5-FU/LVforimprovedefficacyandreducedtoxities.Oxaliplatinisassociatedwithcumulativesensoryneurotoxicitiesincontrasttothepotentiallydose-limitingdiarrheaofirinotecan,whichgenerallyoccurswithinthefirsttwocyclesoftreatmentandmustbetreatedwithmodifieddoseorschedule.Bevacizumabdemonstratedimprovedoverallsurvivalwhencombinedwithbolus5-FU/LV±irinotecan.Phasellcapecitabinepluseitheroxaliplatinoririnotecanalsoappearedpromising.RegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)AlO+Irinotecan依立替康lrinotecan80mg/m2IVover30minutesweeks1,2,3,4,5,and6Leucovorin500mg/m2IVover2hoursweeks1,2,3,4,5,and6Fluorouracil2,000mg/m2Clover24hoursweeks1,2,3,4,5,and6Repeatevery7weeks.54.2%8.8mo20moDiarrhea,23%Stomatitis,5%Neutropenia,7%Cardiovascular,1%KohneCH,etal.ProcASCOA1018,2003FOLFOX7(Modifiedat100mg/m2)Oxaliplatin100-130mg/m2IVday1onlyLeucovorin400mgIVover2hoursday1Fluorouracil2,400mg/m2Clover46hoursRepeatevery2weeks.FollowtheStop-and-goapproach.64%12.3mo17-20moNeuropenia,20%Neuropathy,13%Diarrhea,9%DegramontA,etal.ProcASCEA1015,2003MetastaticColorectalCancer—FrontlineTreatmentRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)FOLFIRIlrinotecan180mg/m2IVday1onlyLeucovorin400mg/m2IVover2hday1Fluorouracil400mg/m2IVbolusday1Fluorouracil2,400mg/m2CIover46hoursRepeatevery2weeksuntilProgressivedisease;thenadministerFOLFOX6.56%8.5mo21.5moNeutropenia,24%Nausea,13%Diarrhea,14%Mucositis,10%JClinOncol22:229,2004FOLFOX6Oxaliplatin100mg/m2IVday1onlyLeucovorin400mgIVover2hoursday1Fluorouracil400mg/m2IVbolusday1Fluorouracil2,400-3,000mg/m2CIover46hoursRepeatevery2weeksuntilProgressivedisease;thenadministerFOLFIRI.54%8mo21.5moNeuropenia,40%Diarrhea,10%Neuropathy,30%JClinOncol22:229,2004貝伐單抗+Fluorouracil+LeucovorinLeucovorin500mg/m2IVover2hoursweeks1,2,3,4,5,and6Fluorouracil500mg/m2IVatmidpointweeks1,2,3,4,5,and6Repeatevery8weeksormayConsider3weekson,1weekoff.40%9mo17.7moAsthenia,10%Hypertension,10%Diarrhea,28%Neutropenia,6%Thromboticevents,14%JClinOncol21:60,2003HurwitzH,etal.ProcASCOA3646,2003+IFLIFL(asregimendescribedlaterinchart)Repeatevery6weeksormayConsider2weekson,1weekoff.45%10.6mo20.3moSideeffectsofIFLregimenPlus:Bleeding,3.1%Hypertension,11%Gastrointestnalperforation,2%Thromboticevents,19%HurwitzH,etal.ProcASCOA3646,2003FOLFOX4Oxaliplatin100mg/m2IVday1onlyLeucovorin200mgIVover2hoursday1and2Fluorouracil400mg/m2IVbolusdays1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery2weeks.8-9mo16.2-19moNeuropenia,40%Diarrhea,10%Neuropathy,30%JClinOncol18:2938,2000GoldbergRm,ProcASCOA1009,2003mg/m2IVday1onlyLeucovorin200mgIVover2hoursdays1and2Fluorouracil400mg/m2IVbolusdays1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery2weeks.35%6.7mo17.4moDiarrhea,44%Stomatitis,5%Neutropenia,29%Vomiting,11%Lancet355:1041,2000Leucovorin500mg/m2IVover2hoursweeks1,2,3,4,5,and6Fluorouracil2,000mg/m2CIover24hoursweeks1,2,3,4,5,and6Repeatevery7weeks.31.5%6.3mo17moDiarrhea,16%,Stomatitis,1%Neutropenia,4%Nausea,4%KohneCH,etal.ProcASCOA1018,2003Oxaliplatin130mg/m2IVday1Capecitabine1,000mg/m2POBID(totaldose=2,000mg/m2/day)days1-14Repeatevery21days.55%7.6-10.5mo>19.5moNeuropenia,6%;Neuropathy,4%Diarrhea,14%Nauseaorvomiting,12%Hand-footsyndrome,4%AnnOncol13(Suppl5):80,2002JClinOncol21:1307,2003mg/m2POBID(totaldose=2,000mg/m2/day)days1-141,2Irinotecan200-250mg/m2IVday11orlrinotecan80mg/m2IVdays1and82Repeatevery21days.41-46%7.1-8.2mo>15.8moNeuropenia,25%Hand-footsyndrome,6%Diarrhea,20%Anorexia,2%Nauseaorvomiting,12%1.PattYZ,etal.ASCOGICancerssymposiumA228,20042.GrotheyA,etal.ASCOGICancersSymposiumA1022,2004lrinotecan200mg/m2IVdays1Oxaliplatin85mg/m2IVdays1Repeatevery21days.30%6.7mo17moNeuropenia,36%Diarrhea,27%;Vomiting,22%Paresthesia,7%GoldbergRM,etal.ProcASCOA1009,2003lrinotecan200mg/m2IVover90minutesweeks1,2,3,and4Leucovorin20mgIVweeks1,2,3,and4Fluorouracil425-500mg/m2IVweeks1,2,3,and4Repeatevery6weeksor2weekson,1weekoff.39%7.0mo14.8moNeuropenia,54%Diarrhea,23%Nausea,10%Cardiovascular,2%Sixty-daymortalityrate,3.4NEnglJMed343:905,2000mg/m2POBID(totaldose=2,000-2,500mg/m2/day)days1-14Repeatevery21days.25%4.3mo12.5moDiarrhea,15%Hand-footsyndrome,18%Stomatitis,3%JClinOncol21:1307,2003MetastaticColorectalCancer—Second-orThird-LineTreatmentKeyPoints:lninotecanwithorwithoutcetuximabiseffectivesalvagetherapy;oxaliplatinmustbeadministeredwith5-FU/LVinsecondlinesetting.AlthoughtheuseofcetuximabrequirestestingoftheEGFRinthetumortissue,studydidnotrevealanycorrelationbetweentheEGFRstatusandtumorresponsetocetuximab,Onsetofskinrashwithcetuximabappearedtocorrelatewithimprovementoftumorresponseandsurvival.RegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)IrinotecanafterFluorouracilIrinotecan100-125mg/m2IVweeks1,2,3,and4Repeatevery6weeks.orIrinotecan200-250mg/m2IVRepeatevery3weeks.15%6.4mo9.2-10.8moDiarrhea,22%Neuropenia,17%Lancet352:1413,1998JClinOncol12:251,1997FOLFOX4AfterIFLOxaliplatin85mg/m2IVday1onlyLeucovorin200mgIVover2hoursday1and2Fluorouracil400mg/m2IVbolusdays1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery2weeks.9.9%5.6mo9.8moNeuropenia,47%Neuropathy,6%Nausea,10%Diarrhea,14%RothenbergML,etal.ProcASCOA1011,2003MetastaticColorectalCancer—Second-orThird-LineTreatmentRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)FOLFIRIinpatientswithfailureonFOLFOX6Irinotecan180mg/m2day1onlyLeucovorin200mgIVover2hoursday1and2Fluorouracil400mg/m2IVbolusd1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery2weeks.4%2.5mo-Neuropenia,17%Diarrhea,22%Mucositis,4%Neuropathy,24%JClinOncol22:29,2004FOLFOX6inpatientswithfailureonFOLFIFIOxaliplatin100mg/m2day1onlyLeucovorin200mgIVover2hoursday1and2Fluorouracil400mg/m2IVbolusdays1and2Fluorouracil600mg/m2CIover22hoursdays1and2Repeatevery2weeks.15%4.2mo-Neuropenia,21%Diarrhea,12%Mucositis,4%Neuropathy,24%JClinOncol22:29,2004Irinotecan+Cetuximab西妥昔單抗afterIFLIrinotecan100-125mg/m2IVweeks1,2,3,and4Repeatevery6weeks.orIrinotecan200-250mg/m2IVevery3weeksCetuximab400mg/m2IVloadingdosethen250mg/m2IVweekly22.9%4-6mo8.4moAsthenia,16%Diarrhea,22%Neuropenia,21%Acne,14%Infusionreaction,3%SaltzL,etal.ProcASCOA7,2001SaltzL,etal.ProcASCOA504,2002CumminghamD,etal.ProcASCOA1012,2003MetastaticColonCancer—Second-orThird-LineTreatmentRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)Cetuximab西妥昔單抗Cetuximab400mg/m2IVloadingdosethen250mg/m2IVweekly9%1.5mo6.4moAcne,16%Infusionreaction,5%Asthenia,16%;Diarrhea,22%JClinOncol22:29,2004ChemoradiationforLocallyAdvancedRectalCancer(T3N0,orT3N1,or>T3)KeyPoints:Theuseofinfusional5-FU+LVremainsthestandardofcare.Earlydatafromphaselandlltrialssuggestedthatcapecitabinemaybeusedinlieuofcontinuous-infusion5-FU,althoughdatafromphasellltrialsarelacking.RegimenDrugDosesandSchedulesChemoradiation45Gyin25fractionstothepelvis;50.4-52.4Gyin30fractionstothetumorandperirectalnodes.plusoneofthefollowing:Fluorouracil200-300mg/m2/dayCIMonday-FridayorCapecitabine825mg/m2/dayPOdailyduringradiationtherapyorCapecitabine825-1,000mg/m2POBIDMonday-FridayFollowedby4monthsofadjuvant5FU/LVorotherappropriateregimens.ChemoradiationforMetastaticcolorectalcancerRegimenDrugDosesandSchedulesChemoradiation35Gy(palliative)over14fractions(3weeks)or45-50.4Gy(definitive)over20fractions(5weeks)plusoneofthefollowingFluorouracil200-300mg/m2/dayCIMonday-FridayorCapecitabine825mg/m2/dayPOduringradiotherapyorCapecitabine900-1,000mg/m2POBIDduringradiotherapySpuamousCellCarcinomaoftheAnalCanalNote:ForTX,NX,M0disease.LRC=locoregionalcontrol;CFS=freesurvival.RegimenDrugDosesandSchedulesXRTDose5-YearLRCRate5-YearCFCRate5-YearDFCRate5-YearOSRateReference5-Fluorouracil+Cisplatin5-Fluorouracil250mg/m2/dayCICisplatin4mg/m2/dayCIday1-5;8-12,15-19,22-26,29-33,36-4055Gy83%(93%followingsalvagesurgery)83%77%85%Cancer97:1195,20035-Fluorouracil+Cisplatin5-Fluorouracil1gm/m2/dayCIday1-4Cisplatin25mg/m2/dayIVBolusdays1-445Gy80%(93%followingsalvagesurgery)71%90%84%Cancer92:77,20015-Fluorouracil+Mitomycinc(RTOG)5-Fluorouracil1,000mg/m2/dayCIday1-5and28-33MitomycinC10mg/m2IVbolusdays1and2845Gy-71%73%73%JClinOncol14:2527,1996SpuamousCellCarcinomaoftheAnalCanalRegimenDrugDosesandSchedulesXRTDose5-YearLRCRate5-YearCFCRate5-YearDFCRate5-YearOSRateReference5-Fluorouracil+Mitomycinc(UKCCCR)5-Fluorouracil1,000mg/m2/dayCIdays1-4or750mg/m2/daydays1-5MitomycinC12mg/m2IVbolusday145Gy-61%-65%Lancet348:1049,1996EsophagealCancer—AdjuvantTherapyRegimenDrugDosesandSchedulesMedianDFSMedianOSGrade3and4SideEffects;ReferenceFluorouracil+Chemoradio-therapy+FluorouracilForpatientswithgastroesophagealjunctioncarcinomaafterRoresectionCategory1evidenceChemotherapy(one28-daycycle):Fluorouracil425mg/m2/dayIVdays1-5Folinicacid20mg/m2/dayIVdays1-5Chemoradiotherapy(5weeks):Fluorouracil400mg/m2/dayIVdays1-4andlast3daysofradiotherapyFolinicacid20mg/m2/dayIVdays1-4andlast3daysofradiotherapyExternal-beamradiotherapy,45Gyat1.8Gyperday,5daysperweekOne-monthrecoveryperiodChemotherapy(two28-daycycles):Fluorouracil425mg/m2/dayIVdays1-5Folinicacid20mg/m2/dayIVdays1-530mo(vs19moforsurgeryalone)30mo(vs27moforsurgeryalone)Hematologic,54%Gastrointestinal,33%NEnglJMed345:725,2001AdvancedUnresectableEsophagealcancer(patientsMedicallyUnfitforSurgery)RegimenDrugDosesandSchedulesFluorouracil+Cisplatin+DefinitiveRadiotherapyFluorouracil1,000mg/m2/dayCIdays1-4,29-32,50-53,and71-74Cisplatin75mg/m2IVdays1,29,50,and71External-beamradiotherapy,50.4Gyat1.8Gyperday,5daysperweekAdvanced(Metastatic)EsophagealCancerRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)ECFEpirubicin50mg/m2IVday1Cisplatin60mg/m2IVday1Fluorouracil200mg/m2/dayCIdays1-21Repeatevery3weeks.45%(vs21%forFAMTX)-8.9mo((vs5.7moforFAMTX)Neuropenia,35%Nauseaorvomiting,17%Leukopenia,12%Alopecia,56%JClinOncol15:261,1997EOXEpirubicin50mg/m2IVday1Oxaliplatin130mg/m2IVday1Capecitabine1,000-1,250mg/m2/dayPOcontinuouslyRepeatevery3weeks.(Datafrominterimanalysis.)52%(vs31%forECF,33%forEOFand35%forECX)--For1,000mg/m2/dayCapecitabinedose:Diarrhea,6.4%;Palmar-plantarerythema,3.2%;Neuropenia,43.8%SumpterKA,etal.ProcASCOA1031,2003Advanced(Metastatic)EsophagealCancerRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)Irinotecan+CisplatinIrinotecan65mg/m2IVdays1,8,15,and22(ordays1and8of3-weekcycle)Cisplatin30mg/m2IVdays1,8,15,and22(ordays1and8of3-weekcycle)Repeatevery6weeks(orconsider2weekson,1weekoff).57%-15moNeuropenia,9%Diarrhea,11%SeminOncol21:493,1994VinorelbineForpatientswithsquamouscellcarcinomaVinorelbine25mg/m2IVweekly20%-6moNeuropenia,59%JClinOncol14:164,1996PancreaticCancerKeypoint:Gemcitabineremainsthecurrentstandardofcareformetastaticpancreaticcancer,althoughcombinationtreatmentwithotheragentshasresultedinmodestlyimprovedoveralltumorresponserates,mediantimetoprogression,andmedianoverallsurvival.RegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)GemcitabineGemcitabine1,000mg/m2IVweeklyfor7weeks,followedbya1-weekrestthenGemcitabine1,000mg/m2IVweeklyfor3weeksRepeatevery28days.23.8%(clinicalbenefit)2.1mo5.7moNeuropenia,26%Thrombocytopenia,10%Anemia,10%Nauseaorvomiting,13%JClinOncol15:2403,1997PancreaticCancerRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)Gemcitabine(fixeddoserate)Gemcitabine1,500mg/m2at10mg/m2/mindays1,8,and15Repeatevery28days.5.9%3.4mo8moNeuropenia,48%Thrombocytopenia,37%Anemia,,23%Nauseaorvomiting,21%JClinOncol21:3402,2003Gemcitabine+Cisplatin(modified)Gemcitabine600-750mg/m2IVdays1and15Cisplatin25-30mg/m2IVdays1and15Repeatevery28days.23%7mo11moMyelosuppression,26%EpilbaumR,cASCOA1202,2003Gemcitabine+Oxaliplatin(GemOx)Gemcitabine1,000mg/m2IVday1Oxaliplatin100mg/m2IVday2Repeatevery14days.30.6%5.3mo9.2moNeuropenia,11%Thrombocytopenia,11%Nauseaorvomiting,114%Diarrhea,6.2%;Neuropathy,11%JClinOncol20:1512,2002Gemcitabine+Cisplatin(fixeddoserate)Gemcitabine1,000mg/m2IVat10mg/m2/mindays1and8Cisplatin20mg/m2IVdays1and8Repeatevery21days.18.4%3.4mo8.6moNeuropenia,57%Anemia,17%Thrombocytopenia,11%KoAH,cASCOA127,2004PancreaticCancerRegimenDrugDosesandSchedulesRRMedianTTPMedianOSGrade3and4SideEffects;Reference(s)Gemcitabine+DocetaxelGemcitabine,600mg/m2IVdays1,8,and15Docetaxel60mg/m2IVday1Repeatevery28days.18%4.7mo8.9moFatigue,27%;DyspneaorPneumonitis,15%;Anorexia,15%Nauseaorvomiting,21%Diarrhea,12%;Neuropathy,9%Cancer94:97,2002Gemcitabine+lrinotecan(Gemlri)Gemcitabine1,000mg/m2IVdays1and8Irinotecan100mg/m2IVdays1and8Repeatevery21days.24%2.8mo5.7moNeutropenia,18%Thrombocytopenia,9%Vomiting,4%;Diarrhea,7%JClinOncol20:1182,2002Gemcitabine+Docetaxel+Capecitabine(GTX)Gemcitabine600-750mg/m2IVdays4and11Docetaxel30mg/m2IVdays4and11Capecitabine1,000-1,250mg/m2/daydays1-14Repeatevery21-28days.47%N/AN/ADiarrhea,20%Hand-footsyndrome,20%Neutropenia,25%Asthenia(grade2),20%FineRL,etal.ProcASCOA1129,2003GastricCancer—adjuvantTherapyRegimenDrugDosesandSchedulesMedianDFSMedianOSGrade3and4SideEffects;ReferenceFluorouracil+Chemoradio-therapy+FluorouracilForpatientswithsurgicalstagelb-IVdisease,R0resectionChemotherapy(one28-daycycle):Fluorou