2022年医学专题—常见实体瘤化疗方.ppt

常见实体(shítǐ)瘤化疗方案选择湖南省肿瘤医院罗以第一页，共五十八页。主要(zhǔyào)内容(fèiái)非小细胞肺癌大肠癌乳腺癌恶性淋巴瘤第二页，共五十八页。非小细胞(xìbāo)肺癌第三页，共五十八页。第四页，共五十八页。Lung(Non-SmallCellCarcinomasT1T2T3T4N0IIIAIIBIIIBN1IIAIIBIIIAIIIBN2IIIAIIIAIIIAIIIBN3IIICIIICIIICIIICM1IVIVIVIV第五页，共五十八页。四组化疗(huàliáo)方案对晚期初治NSCLC患者效果的比较Kubota,KarmanosCRC(Abstract7106,2000.10-2002.6)RegimenDrugdosesandRRMedianMedianOneYearOS(%)TC(145n)schedules(%)TTPOS32.4Paclitaxel4.5mo12.351200mg/m2CarboplatinAUC6MOGP(146n)Gemcitabine30.14.0mo14.8601g/m2,d1,8MODDP80mg/m2,d1NP(145n)Vinorelbine33.14.111.44825mg/m2,d1,8DDP80mg/m2,d1IP(145n)Irinotecan60mg/m231.04.714.259,d1,8,15DDP80mg/m2,d1第六页，共五十八页。目前晚期(wǎnqī)非小细胞肺癌治疗选择：二线治疗化学治疗多西他赛(Docetaxel)培美曲塞(Pemetrexed)靶向治疗(zhìliáo)特罗凯(Tarceva)吉非替尼(Iressa)第七页，共五十八页。DOC二线(èrxiàn)治疗NSCLCIII期临床试验RDOC100mg/m²1hq3wksTAX320DOC75mg/m²1hq3wks去甲(qùjiǎ)长春花碱30mg/m²d1,8,15q3wks,orR异环磷酰胺2g/m²d1,2,3q3wksTAX317DOC100,1hq3wks,DOC75mg/m²1hq3wks最好(zuìhǎo)的支持治疗(BSC)ShepherdFJCO2000,FossellaJCO2000第八页，共五十八页。DOC二线(èrxiàn)治疗NSCLCIII期临床试验TAX317TAX320ShepherdFJCO2000,FossellaJCO2000第九页，共五十八页。DOCVsAlimta1.00ALIMTA(n=280)0.75多烯紫杉醇(n=288)生存分布(fēnbù)函数HR0.990.5095%CIofHR(0.82,1.20)0.25中位生存(shēngcún)时间8.3月中位生存时间7.9月一年总体生存率:29.7%一年总体生存率:29.7%0.000.02.55.07.510.012.515.017.520.0HR=风险(fēngxiǎn)比月CI=可信区间ASCO2003,JCOVol22:1589,2004MST=中位生存时间第十页，共五十八页。(zhìliáo)二线治疗中的临床III期试验：患者特征TarcevavsDocetaxelDocetaxelBSC1,2(75mg/m2)vs(75mg/m2)vspemetrexed3,4BSC5TBSCDPDBSC(n=488)(n=243)(n=288)(n=283)(n=55)(n=100)PS(%)6568888975750/122623121125253990000Priorregimens(%)505010010080761250500020241Tarcevaproductinformation;2OSIandRochedataonfile3Pemetrexedproductinformation;4HannaN,etal.JClinOncol2004;22:1589–975Docetaxelproductinformation第十一页，共五十八页。(zhìliáo)二线治疗的生活质量结果药物工具生活质量结果症状结果Tarceva1EORTC:显著改善与BSC相比，显著QLQ-C30global,增加症状恶化时间QLQ-LC13physical,和(咳嗽，呼吸困难，emotionalQoL疼痛)vs.BSCDocetaxel2LCSS–与BSC相比，docetaxel75mg/m2不能显著改善症状PemetrexeLCSS–与docetaxeld75mg/m相比无显31BezjakA,etal.JClinOncol2006;24:3831–7;2DanceyJ,etal.LungCancer2004;43:183–94;3HannaN,et2al.J著差异ClinOncol2004;22:1589–97第十二页，共五十八页。(kǎolǜ)方便性的考虑用药途径预防/同时用药Docetaxel每3周静脉输注Pemetrex每3周静脉输注在用药前后立即口服ed类固醇Tarceva每天口服在用药前后口服类固醇VitaminB12注射口服叶酸无需预防/同时用药第十三页，共五十八页。(liáoxiào)IDEAL1和2的疗效对比IDEAL1IDEAL2(n=210)(n=216)250mg/500mg/250mg/500mg/daydaydayday有效率(%)18.419.01210疾病控制率(%)症状改善率(%)54.451.4NRNR中位生存期(月)40.337.044407.68.07.06.0AssessedusingFACT-LquestionnaireFukuokaM,etal.JClinOncol2003;21:2237–46KrisM,etal.JAMA2003;290:2149–58NR=notreported第十四页，共五十八页。IDEAL1试验(shìyàn)中两种剂量的耐受性250mg/day500mg/day不良事件Grade1/2Grade3/4Grade1/2Grade3/4皮疹(%)腹泻(%)45.61.062.26.6皮肤干燥(%)瘙痒(%)39.8051.06.6恶心(%)27.2029.3030.1034.90.911.71.022.60.9RecommendeddoseforFukuokaM,etal.JClinOncol2003;21:2237–46phaseIII=250mg/day第十五页，共五十八页。...