贝伐单抗联合化疗治疗晚期非小细胞肺癌PPT.pptx

贝伐单抗联合化疗治疗晚期非小细胞肺癌 化疗 晚期NSCLC一线化疗:疗效进入平台期 Schiller JH, et al. N Engl J Med. 2002;346:92-98. 1.0 0.8 0.6 0.4 0.2 0 Proportion of patients Mos 0 5 10 15 20 25 30 Cisplatin/paclitaxelCisplatin/gemcitabineCisplatin/docetaxelCarboplatin/paclitaxel ECOG 1594: OS 贝伐单抗 贝伐单抗联合化疗 晚期NSCLC一线化疗+靶向：ECOG 4599研究 Chemothrapy－naive stage IIIB/IV non-squamous NSCLC (n=878) PC  6 (n=444) Avastin (15mg/kg) every 3 weeks + PC  6 (n=434) PD* PD Avastin every 3 weeks until progression 主要研究终点：OS Sandler A, et al. N Engl J Med 2006;355:2542–50 P=紫杉醇，200mg/m2 C=卡铂，AUC=6 PC方案为q.3.w，最多不超过6周期 进展后无交叉 使用贝伐单抗 ECOG 4599: PFS OS Sandler A, et al. N Engl J Med. 2006;355:2542-2550. Sandler A, et al. ASCO 2005. Abstract 4. Response: 15% carboplatin/paclitaxel vs 35% for chemo + bevacizumab 0 6 12 18 24 30 36 0 20 40 60 80 100 Mos P = .003; HR: 0.79 Median OS: 12.3 vs 10.3 mos 1-yr OS: 51% vs 44% 2-yr OS: 23% vs 15% Patients Surviving (%) OS Patients With PFS (%) P .001; HR: 0.66 Median PFS: 6.2 vs 4.5 mos 6-mo PFS: 55% vs 33% 1-yr PFS: 15% vs 6% PFS Carboplatin/paclitaxel Carboplatin/paclitaxel + bevacizumab Carboplatin/paclitaxel Carboplatin/paclitaxel + bevacizumab 0 6 12 18 24 30 36 0 20 40 60 80 100 Mos 不良反应 研究意义 AVAIL研究 晚期NSCLC一线化疗+贝伐单抗：AVAiL研究 入组患者: 既往未治IIIB/IV期或复发非鳞型NSCLC 非鳞癌 ≥18岁 PS 0-1 足够内脏功能 N=1043 贝伐单抗15 mg/kg+GP N=351 安慰剂+GP N=347 贝伐单抗7.5 mg/kg+GP N=345 G=吉西他滨，1250mg/m2 D1,D8 P=顺铂，80mg/m2 D1 GP方案为q.3.w，最多不超过6周期 Reck M, et al. J Clin Oncol 2009; 27:1227-1234. Martin Reck, et al. Ann Oncol. 2010; 21(9): 1804–1809 R AVAiL研究：PFS Endpoint Cisplatin/Gemcitabine + Placebo Cisplatin/Gemcitabine + Bevacizumab 7.5 mg/kg Cisplatin/Gemcitabine + Bevacizumab 15 mg/kg PFS, HR (95% CI) NA 0.75 (0.64-0.87); P = .0003 0.85 (0.73-1.00); P = .0456 Median PFS, mos 6.2 6.8 6.6 Response rate, % 20 34 (P .0001) 30 (P .0017) Med OS, mos 13.1 13.6 13.4 Manegold. C, et al. ASCO 2007. Abstract LBA7514. PFS 1.0 Possibility of PFS 0.8 0.6 0.4 0.2 Mos 0 6 12 18 3 9 15 GP + bevacizumab 15 mg/