肺癌靶位治療的時(shí)機(jī)課件

IressaasFirstLineTherapyinNSCLC肺癌靶位治療的時(shí)機(jī)PersonaldetailsPersonaldetails

Mrs.Chen-LinFemale62y/oNon-smoker肺癌靶位治療的時(shí)機(jī)PatienthistoryHistoryCough,leftchestpainfortwomonthsBronchoscopicbiopsyandeffusioncytology:adenocarcinoma.PerformancestatusECOGPS3PrevioustreatmentRefusedanychemotherapy肺癌靶位治療的時(shí)機(jī)InvestigationsImageCTscanofchestrevealedevidenceahugemass,measuredgreaterthan5.0cmindiametertoleftuppelobewithpleuraleffusion.EnlargedLNstoAPwindow.Noevidenceofdistalmets.T4N2M0,stageIIIB肺癌靶位治療的時(shí)機(jī)TreatmentRefusedanychemotherapyagainandagainIressa250mgperday肺癌靶位治療的時(shí)機(jī)OutcomeTumorsizeisgettingsmalleraftertwoweeksIressatreatment.Followupimagestudy:PRPatientcanwalkwellnow.Iressaisongoingtillnow.Noseveresideeffectexceptskineruptionbutpatientcantolerateit.肺癌靶位治療的時(shí)機(jī)IRESSA250mgTwoweekslater肺癌靶位治療的時(shí)機(jī)TenweekslaterIressa250/day,Ongoing肺癌靶位治療的時(shí)機(jī)Comments/ConclusionIressaasfirstlinetherapyiseffective.Poorperformancescale:Iressawillimproveitifeffective.FemaleAdenocarcinomaNon-smokerOriental肺癌靶位治療的時(shí)機(jī)DiscussionandlearningpointsIressainfirstlinetherapyofNSCLCpatients?Lesssideeffect.Wellqualityoflife.肺癌靶位治療的時(shí)機(jī)[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(shí)機(jī)IressaasThirdLineTherapy

(apatientwithboneandbrainmetsafterGemzarpluscisplatinandTaxotere)肺癌靶位治療的時(shí)機(jī)PersonaldetailsPersonaldetails

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

Mr.ChenMale42y/oCigarettesmoking,20pack-years肺癌靶位治療的時(shí)機(jī)PatienthistoryHistoryReferredfromotherhospitalbecauseofbronchogeniccarcinoma,RLL,T4N2M1[distalspinalmets]withparaplegia.PerformancestatusECOGPS3-4PrevioustreatmentC/TwithGemzarpluscisplatin肺癌靶位治療的時(shí)機(jī)InvestigationsCTscanofchestTumormass,measured85mmtoRLLwithRLLcollapsePleuraleffusiontorightsideMediastinalLNsmetsBonescanMultipleincreaseduptaketoLumbarandthoracicspine肺癌靶位治療的時(shí)機(jī)TreatmentTaxoterewasgivenafteradmissionSteroidandRadiotherapyforspinalmetsPDafterthreecyclesweeklyscheduletherapywithtaxotere25-30mg/M2Iressa250mgQD,onemonthlaterPleuraleffusiondisappearedTumorsizereducedto3.5cm肺癌靶位治療的時(shí)機(jī)PDafterGemzarpluscisplatinasfirstlineAndTaxotereassecondlineIressa250mg/daysixmonthslater肺癌靶位治療的時(shí)機(jī)OutcomePatientstoppedIressatherapybecauseofeconomicproblemTumorisgettinglarger,measured70mmtwomonthslaterIressa250mgQDagainSD肺癌靶位治療的時(shí)機(jī)StopIressa,sixmonthslaterIressa250mg/dayagain3monthslater肺癌靶位治療的時(shí)機(jī)PDagain,3monthslater5monthslaterStopIressa肺癌靶位治療的時(shí)機(jī)Comments/ConclusionIntermittentIressatreatmentdoesstillwork肺癌靶位治療的時(shí)機(jī)DiscussionandlearningpointsResistancetoIressawillbeamajorproblem?ornot?BecauseofintermittentuseEconomicisstillamajorproblemtomaintaineffectivetreatment肺癌靶位治療的時(shí)機(jī)ChemotherapyplusGefinitibReasonable?Moreeffective?肺癌靶位治療的時(shí)機(jī)[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(shí)機(jī)[7259]AphaseI/IItrialofweeklydocetaxelandgefitinibinelderlypatients(≥70)withstageIIIB/IVnon-smallcelllungcancer