老年肺癌靶向治疗.pptVIP

Palliative chemotherapy for elderly metastatic NSCLC – Non-Platinum based 在紫杉醇/卡铂的基础上联合贝伐单抗未延长老年患者的OS和PFS Grade 3/4 toxicity more common in patients ≥ 70 years of age Grade 4 neutropenia worst toxicity in both arms (P = .06) BPC: 34% PC: 22% FLEX研究试验设计缺陷 在当时有限学术数据和认识的历史条件下（IPASS之前），各项人口学条件在不同种族亚组分配中极端不一致。如腺癌在高加索人和亚洲人中的比为44%比72%；女性为27%比46%；从不吸烟者为17%比52%；KPS 0/1分的为81%比94%；研究后用小分子TKI者比为17%比61%。在亚洲人组中西妥昔和非西妥昔单抗组腺癌的比例也不同，为65%比80%；使用小分子TKI者比为50%比73%。而这些恰恰就是目前所知小分子TKI有效的优势筛选条件。因此，造成了高加索人和亚洲人中位生存期9.6比19.5个月的重大差距！也使得亚洲人群内化疗加西妥昔单抗组比单纯化疗组中位生存期为17.6比20.4个月的费解现象。 TTP by Age Median time to disease progression among the patients more than 65-year and under 65-year was 5.4 months and 3.0 months, respectively Survival by Age Median survival of patients ≥ 65-years exceeds 17.0 months (16 days to 41.1 months) Median survival of patients 65-years was 12.1 months (2 days to 36.1months) BR21与ISEL研究设计相似 ISEL研究结果 BR21与ISEL研究结果解读 * * KEY POINT: Overall survival was significantly prolonged by the addition of bevacizumab to paclitaxel and carboplatin. * * * * * * * Two further independent Phase III trials have compared gefitinib monotherapy with doublet chemotherapy first line in selected populations. The first study discussed here is the NEJ002 study which was a multicentre Phase III trial that compared first-line gefitinib (250 mg/day) vs chemotherapy (carboplatin AUC 6 and paclitaxel 200 mg/m2 ) in selected patients of with EGFR mutation-positive stage IIIB/IV NSCLC conducted in Japan.1 The second study, to be discussed is the First-SIGNAL study which was a randomised Phase III study of first-line gefitinib (250 mg daily) compared with standard chemotherapy (gemcitabine (1250 mg/m2) plus cisplatin (80 mg/m2) in never-smokers with advanced NSCLC conducted in Korea. 2 References 1.Lee et al . WCLC 2009 2. Kobayashi et al. J Clin Oncol 2009; 27:15S: abstract 8016. * Consistently superior efficacy for gefitinib versus doublet chemotherapy in EGFR mutation-positive patien