肺癌靶位治療的時機課件

IressaasFirstLineTherapyinNSCLC肺癌靶位治療的時機PersonaldetailsPersonaldetails

Mrs.Chen-LinFemale62y/oNon-smoker肺癌靶位治療的時機PatienthistoryHistoryCough,leftchestpainfortwomonthsBronchoscopicbiopsyandeffusioncytology:adenocarcinoma.PerformancestatusECOGPS3PrevioustreatmentRefusedanychemotherapy肺癌靶位治療的時機InvestigationsImageCTscanofchestrevealedevidenceahugemass,measuredgreaterthan5.0cmindiametertoleftuppelobewithpleuraleffusion.EnlargedLNstoAPwindow.Noevidenceofdistalmets.T4N2M0,stageIIIB肺癌靶位治療的時機TreatmentRefusedanychemotherapyagainandagainIressa250mgperday肺癌靶位治療的時機OutcomeTumorsizeisgettingsmalleraftertwoweeksIressatreatment.Followupimagestudy:PRPatientcanwalkwellnow.Iressaisongoingtillnow.Noseveresideeffectexceptskineruptionbutpatientcantolerateit.肺癌靶位治療的時機IRESSA250mgTwoweekslater肺癌靶位治療的時機TenweekslaterIressa250/day,Ongoing肺癌靶位治療的時機Comments/ConclusionIressaasfirstlinetherapyiseffective.Poorperformancescale:Iressawillimproveitifeffective.FemaleAdenocarcinomaNon-smokerOriental肺癌靶位治療的時機DiscussionandlearningpointsIressainfirstlinetherapyofNSCLCpatients?Lesssideeffect.Wellqualityoflife.肺癌靶位治療的時機[7256]PhaseIItrialoffirst-linegefitinibinpatientsunsuitableforchemotherapywithstageIII/IVnon-small-celllungcancer

D.Swinson.UKGefitinib250mgperdayM/F29/16,unfit/declinedCT25/20Medianage:76PS0/1/2/3:1/15/27/141evaluablePR9.8%SD36.6%PD53.4%Medianoversurvival82daysDiseasecontrolrate46.4%atonemonth肺癌靶位治療的時機IressaasThirdLineTherapy

(apatientwithboneandbrainmetsafterGemzarpluscisplatinandTaxotere)肺癌靶位治療的時機PersonaldetailsPersonaldetails

Mr.ChenMale43Y/OCigarettesmoking:40pack-years肺癌靶位治療的時機PatienthistoryHistoryCough,hemoptysisDxafterimageandbronchoscopicstudiesBronchogeniccarcinoma,LLL,adeno-type肺癌靶位治療的時機InvestigationsCTscanTumorsize5.3cmLNsmets,bilateralPleuraleffusion,leftBonescanMultiplebonemetsISSStagingT4N3M1,bonemets,stageIVPerformancestatusECOGPS0肺癌靶位治療的時機TreatmentGemzar1000mg/M2plusCisplatin75mg/m2PDafterthreecyclestreatmentTaxotere25-30mg/m2,weeklyscheduleSDofChestimagestudiesUnstablegaitwithrefractorynausea,hiccupafter4cyclestaxoteretreatmentMultiplebrainmetsdiagnosedwithCTscanIressa250mgperdayafteracourseofwholebrainirradiation.肺癌靶位治療的時機GemzarpluscisplatinProgressivedisease3cycles11/JUN/2002Taxotere肺癌靶位治療的時機13/NOV/2003Iressa250mgperdayBrainmetsRadiotherapy肺癌靶位治療的時機17/DEC/2003rightnowGefinitib肺癌靶位治療的時機OutcomeTumorsizeinlungandpericardial,pleuraleffusionvolumereducedafteronemonthGefitinibtreatmentBrainmets,underwellcontrolCNSconditionisstableandhecanwalkanddosomeeasythingECOGPSaround0-1nowIressa250mgperdayisongoing肺癌靶位治療的時機Comments/ConclusionIressaiseffectiveeveninlife-threateningconditionoffar-advancedlungcancerBrainmetsisstilleffective?肺癌靶位治療的時機DiscussionandlearningpointsIressaandbrainbloodbarrier?Iressaasthirdlinetherapyisstandardaftertaxaneandcisplatinfailure肺癌靶位治療的時機IrregulartreatmentofIressainapatientofNSCLC肺癌靶位治療的時機PersonaldetailsPersonaldetails

Mr.ChenMale42y/oCigarettesmoking,20pack-years肺癌靶位治療的時機PatienthistoryHistoryReferredfromotherhospitalbecauseofbronchogeniccarcinoma,RLL,T4N2M1[distalspinalmets]withparaplegia.PerformancestatusECOGPS3-4PrevioustreatmentC/TwithGemzarpluscisplatin肺癌靶位治療的時機InvestigationsCTscanofchestTumormass,measured85mmtoRLLwithRLLcollapsePleuraleffusiontorightsideMediastinalLNsmetsBonescanMultipleincreaseduptaketoLumbarandthoracicspine肺癌靶位治療的時機TreatmentTaxoterewasgivenafteradmissionSteroidandRadiotherapyforspinalmetsPDafterthreecyclesweeklyscheduletherapywithtaxotere25-30mg/M2Iressa250mgQD,onemonthlaterPleuraleffusiondisappearedTumorsizereducedto3.5cm肺癌靶位治療的時機PDafterGemzarpluscisplatinasfirstlineAndTaxotereassecondlineIressa250mg/daysixmonthslater肺癌靶位治療的時機OutcomePatientstoppedIressatherapybecauseofeconomicproblemTumorisgettinglarger,measured70mmtwomonthslaterIressa250mgQDagainSD肺癌靶位治療的時機StopIressa,sixmonthslaterIressa250mg/dayagain3monthslater肺癌靶位治療的時機PDagain,3monthslater5monthslaterStopIressa肺癌靶位治療的時機Comments/ConclusionIntermittentIressatreatmentdoesstillwork肺癌靶位治療的時機DiscussionandlearningpointsResistancetoIressawillbeamajorproblem?ornot?BecauseofintermittentuseEconomicisstillamajorproblemtomaintaineffectivetreatment肺癌靶位治療的時機ChemotherapyplusGefinitibReasonable?Moreeffective?肺癌靶位治療的時機[7155]Docetaxelandgefitinibinthefirst-linetreatmentofelderlypatients(>70)withadvancednon-smallcelllungcancer(ANSCLC):ResultsofphaseIItrial

G.Bepler(fromASCO2005)Docetaxel75mg/M2d1assessedevery2cyclesGefitinib250mgstartedd1assessedeverytwomoifaloneuntilPDM/F16/14,medianage74,PS0-121evaluablePR38%SD24%CR0%MS12.4mo1yearsurvival60%FavorabletoxicityRepeated21days肺癌靶位治療的時機[7259]AphaseI/IItrialofweeklydocetaxelandgefitinibinelderlypatients(≥70)withstageIIIB/IVnon-smallcelllungcancer