肺癌靶位治療的時機概要課件

IressaasFirstLineTherapyinNSCLCIressaasFirstLineTherapyiPersonaldetailsPersonaldetails

Mrs.Chen-LinFemale62y/oNon-smokerPersonaldetailsPersonaldetaiPatienthistoryHistoryCough,leftchestpainfortwomonthsBronchoscopicbiopsyandeffusioncytology:adenocarcinoma.PerformancestatusECOGPS3PrevioustreatmentRefusedanychemotherapyPatienthistoryHistoryInvestigationsImageCTscanofchestrevealedevidenceahugemass,measuredgreaterthan5.0cmindiametertoleftuppelobewithpleuraleffusion.EnlargedLNstoAPwindow.Noevidenceofdistalmets.T4N2M0,stageIIIBInvestigationsImageTreatmentRefusedanychemotherapyagainandagainIressa250mgperdayTreatmentRefusedanychemotherOutcomeTumorsizeisgettingsmalleraftertwoweeksIressatreatment.Followupimagestudy:PRPatientcanwalkwellnow.Iressaisongoingtillnow.Noseveresideeffectexceptskineruptionbutpatientcantolerateit.OutcomeTumorsizeisgettingsIRESSA250mgTwoweekslaterIRESSA250mgTwoweekslaterTenweekslaterIressa250/day,OngoingTenweekslaterIressa250/day,Comments/ConclusionIressaasfirstlinetherapyiseffective.Poorperformancescale:Iressawillimproveitifeffective.FemaleAdenocarcinomaNon-smokerOrientalComments/ConclusionIressaasDiscussionandlearningpointsIressainfirstlinetherapyofNSCLCpatients?Lesssideeffect.Wellqualityoflife.Discussionandlearningpoints[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[7256]PhaseIItrialoffirstIressaasThirdLineTherapy

(apatientwithboneandbrainmetsafterGemzarpluscisplatinandTaxotere)IressaasThirdLineTherapy

PersonaldetailsPersonaldetails

Mr.ChenMale43Y/OCigarettesmoking:40pack-yearsPersonaldetailsPersonaldetaiPatienthistoryHistoryCough,hemoptysisDxafterimageandbronchoscopicstudiesBronchogeniccarcinoma,LLL,adeno-typePatienthistoryHistoryInvestigationsCTscanTumorsize5.3cmLNsmets,bilateralPleuraleffusion,leftBonescanMultiplebonemetsISSStagingT4N3M1,bonemets,stageIVPerformancestatusECOGPS0InvestigationsCTscanTreatmentGemzar1000mg/M2plusCisplatin75mg/m2PDafterthreecyclestreatmentTaxotere25-30mg/m2,weeklyscheduleSDofChestimagestudiesUnstablegaitwithrefractorynausea,hiccupafter4cyclestaxoteretreatmentMultiplebrainmetsdiagnosedwithCTscanIressa250mgperdayafteracourseofwholebrainirradiation.TreatmentGemzar1000mg/M2plusGemzarpluscisplatinProgressivedisease3cycles11/JUN/2002TaxotereGemzarpluscisplatinProgressi13/NOV/2003Iressa250mgperdayBrainmetsRadiotherapy13/NOV/2003Iressa250mgperd17/DEC/2003rightnowGefinitib17/DEC/2003rightnowGefinitibOutcomeTumorsizeinlungandpericardial,pleuraleffusionvolumereducedafteronemonthGefitinibtreatmentBrainmets,underwellcontrolCNSconditionisstableandhecanwalkanddosomeeasythingECOGPSaround0-1nowIressa250mgperdayisongoingOutcomeTumorsizeinlungandComments/ConclusionIressaiseffectiveeveninlife-threateningconditionoffar-advancedlungcancerBrainmetsisstilleffective?Comments/ConclusionIressaisDiscussionandlearningpointsIressaandbrainbloodbarrier?IressaasthirdlinetherapyisstandardaftertaxaneandcisplatinfailureDiscussionandlearningpointsIrregulartreatmentofIressainapatientofNSCLCIrregulartreatmentofIressaPersonaldetailsPersonaldetails

Mr.ChenMale42y/oCigarettesmoking,20pack-yearsPersonaldetailsPersonaldetaiPatienthistoryHistoryReferredfromotherhospitalbecauseofbronchogeniccarcinoma,RLL,T4N2M1[distalspinalmets]withparaplegia.PerformancestatusECOGPS3-4PrevioustreatmentC/TwithGemzarpluscisplatinPatienthistoryHistoryInvestigationsCTscanofchestTumormass,measured85mmtoRLLwithRLLcollapsePleuraleffusiontorightsideMediastinalLNsmetsBonescanMultipleincreaseduptaketoLumbarandthoracicspineInvestigationsCTscanofchestTreatmentTaxoterewasgivenafteradmissionSteroidandRadiotherapyforspinalmetsPDafterthreecyclesweeklyscheduletherapywithtaxotere25-30mg/M2Iressa250mgQD,onemonthlaterPleuraleffusiondisappearedTumorsizereducedto3.5cmTreatmentTaxoterewasgivenafPDafterGemzarpluscisplatinasfirstlineAndTaxotereassecondlineIressa250mg/daysixmonthslaterPDafterGemzarpluscisplatinOutcomePatientstoppedIressatherapybecauseofeconomicproblemTumorisgettinglarger,measured70mmtwomonthslaterIressa250mgQDagainSDOutcomePatientstoppedIressaStopIressa,sixmonthslaterIressa250mg/dayagain3monthslaterStopIressa,sixmonthslaterIPDagain,3monthslater5monthslaterStopIressaPDagain,3monthslater5montComments/ConclusionIntermittentIressatreatmentdoesstillworkComments/ConclusionIntermittDiscussionandlearningpointsResistancetoIressawillbeamajorproblem?ornot?BecauseofintermittentuseEconomicisstillamajorproblemtomaintaineffectivetreatmentDiscussionandlearningpointsChemotherapyplusGefinitibReasonable?Moreeffective?ChemotherapyplusGefinitibRea[7155]Docetaxelandgefitinibinthefirst-linetreatmentofelderlypatients(>70)withadvancednon-smallcelllungcancer(ANSCLC):ResultsofphaseIItrial

G.Bepler(fromASCO2005)Docetaxel75mg/M2d1assessedevery2cyclesGefitinib250mgstartedd1assessedeverytwomoifaloneuntilPDM/F16/14,medianage74,PS0-121evaluablePR38%SD24%CR0%MS12.4mo1yearsurvival60%FavorabletoxicityRepeated21days[7155]Docetaxelandgefitinib[7259]AphaseI/IItrialofweeklydocetaxelandgefitinibinelderlypatients(≥70)withstageIIIB/IVnon-smallcelllungcancer(NSCLC)

T.E.StinchcombeGefitinib250mgperdayDocetaxeld1,d8,d15PhaseI30mg/M2PhaseII36mg/M2M/F11/9;MedianAge76.2PS0/1/2:3/13/4IIIB/IV:4/16PR29%SD17%PD39%2non-evaluableRepeatedevery28days,untilPDorunacceptabletoxicity[7259]AphaseI/IItrialofwIressaasFirstLineTherapyinNSCLCIressaasFirstLineTherapyiPersonaldetailsPersonaldetails

Mrs.Chen-LinFemale62y/oNon-smokerPersonaldetailsPersonaldetaiPatienthistoryHistoryCough,leftchestpainfortwomonthsBronchoscopicbiopsyandeffusioncytology:adenocarcinoma.PerformancestatusECOGPS3PrevioustreatmentRefusedanychemotherapyPatienthistoryHistoryInvestigationsImageCTscanofchestrevealedevidenceahugemass,measuredgreaterthan5.0cmindiametertoleftuppelobewithpleuraleffusion.EnlargedLNstoAPwindow.Noevidenceofdistalmets.T4N2M0,stageIIIBInvestigationsImageTreatmentRefusedanychemotherapyagainandagainIressa250mgperdayTreatmentRefusedanychemotherOutcomeTumorsizeisgettingsmalleraftertwoweeksIressatreatment.Followupimagestudy:PRPatientcanwalkwellnow.Iressaisongoingtillnow.Noseveresideeffectexceptskineruptionbutpatientcantolerateit.OutcomeTumorsizeisgettingsIRESSA250mgTwoweekslaterIRESSA250mgTwoweekslaterTenweekslaterIressa250/day,OngoingTenweekslaterIressa250/day,Comments/ConclusionIressaasfirstlinetherapyiseffective.Poorperformancescale:Iressawillimproveitifeffective.FemaleAdenocarcinomaNon-smokerOrientalComments/ConclusionIressaasDiscussionandlearningpointsIressainfirstlinetherapyofNSCLCpatients?Lesssideeffect.Wellqualityoflife.Discussionandlearningpoints[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[7256]PhaseIItrialoffirstIressaasThirdLineTherapy

(apatientwithboneandbrainmetsafterGemzarpluscisplatinandTaxotere)IressaasThirdLineTherapy

PersonaldetailsPersonaldetails

Mr.ChenMale43Y/OCigarettesmoking:40pack-yearsPersonaldetailsPersonaldetaiPatienthistoryHistoryCough,hemoptysisDxafterimageandbronchoscopicstudiesBronchogeniccarcinoma,LLL,adeno-typePatienthistoryHistoryInvestigationsCTscanTumorsize5.3cmLNsmets,bilateralPleuraleffusion,leftBonescanMultiplebonemetsISSStagingT4N3M1,bonemets,stageIVPerformancestatusECOGPS0InvestigationsCTscanTreatmentGemzar1000mg/M2plusCisplatin75mg/m2PDafterthreecyclestreatmentTaxotere25-30mg/m2,weeklyscheduleSDofChestimagestudiesUnstablegaitwithrefractorynausea,hiccupafter4cyclestaxoteretreatmentMultiplebrainmetsdiagnosedwithCTscanIressa250mgperdayafteracourseofwholebrainirradiation.TreatmentGemzar1000mg/M2plusGemzarpluscisplatinProgressivedisease3cycles11/JUN/2002TaxotereGemzarpluscisplatinProgressi13/NOV/2003Iressa250mgperdayBrainmetsRadiotherapy13/NOV/2003Iressa250mgperd17/DEC/2003rightnowGefinitib17/DEC/2003rightnowGefinitibOutcomeTumorsizeinlungandpericardial,pleuraleffusionvolumereducedafteronemonthGefitinibtreatmentBrainmets,underwellcontrolCNSconditionisstableandhecanwalkanddosomeeasythingECOGPSaround0-1nowIressa250mgperdayisongoingOutcomeTumorsizeinlungandComments/ConclusionIressaiseffectiveeveninlife-threateningconditionoffar-advancedlungcancerBrainmetsisstilleffective?Comments/ConclusionIressaisDiscussionandlearningpointsIressaandbrainbloodbarrier?IressaasthirdlinetherapyisstandardaftertaxaneandcisplatinfailureDiscussionandlearningpointsIrregulartreatmentofIressainapatientofNSCLCIrregulartreatmentofIressaPersonaldetailsPersonaldetails

Mr.ChenMale42y/oCigarettesmoking,20pack-yearsPersonaldetailsPersonaldetaiPatienthistoryHistoryReferredfromotherhospitalbecauseofbronchogeniccarcinoma,RLL,T4N2M1[distalspinalmets]withparaplegia.PerformancestatusECOGPS3-4PrevioustreatmentC/TwithGemzarpluscisplatinPatienthistoryHistoryInvestigationsCTscanofchestTumormass,measured85mmtoRLLwithRLLcollapsePleuraleffusiontorightsideMediastinalLNsmetsBonescanMultipleincreaseduptaketoLumbarandthoracicspineInvestigationsCTscanofchestTreatmentTaxoterewasgivenafteradmissionSteroidandRadiotherapyforspinalmetsPDafterthreecyclesweeklyscheduletherapywithtaxotere25-30mg/M2Iressa250mgQD,onemonthlaterPleuraleffusiondisappearedTumorsizereducedto3.5cmTreatmentTaxoterewasgivenafPDafterGemzarpluscisplatinasfirstlineAndTaxotereassecondlineIressa250mg/daysixmonthslaterPDafterGemzarpluscisplatinOutcomePatientstoppedIressatherapybecauseofeconomicproblemTumorisgettinglarger,measured70mmtwomonthslaterIressa250mgQDagainSDOutcomePatientstoppedIressaStopIressa,sixmonthslaterIressa250mg/dayagain3monthslaterStopIressa,sixmonthslaterIPDagain,3monthslater5monthslaterStopIressaPDagain,3monthslater5montC