晚期NSCLC一線化療規(guī)范化課件

晚期NSCLC一線化療的規(guī)范化方勇浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院腫瘤內(nèi)科晚期NSCLC一線化療的規(guī)范化1非小細(xì)胞肺癟診治過(guò)程概述重AM確定病理診斷明確分期選擇治療方案非小細(xì)胞肺癟診治過(guò)程概述2治療選擇正從以組織學(xué)為基礎(chǔ)的模式轉(zhuǎn)變?yōu)橐灾掳?qū)動(dòng)因子為靶點(diǎn)的模式2019-2019組織學(xué)驅(qū)動(dòng)的選掃以致癌驅(qū)動(dòng)基因NSCLC的治療演變非鱗癌EGFR野生型●■EGFRALK■HER2■未知以腺癌中的突變率為例目前NSCLC的標(biāo)準(zhǔn)治療MassachusettsGeneralH治療選擇正從以組織學(xué)為基礎(chǔ)的模式轉(zhuǎn)變?yōu)?“精準(zhǔn)治療”使驅(qū)動(dòng)基因型肺癌逐漸成為臨床可控的疾病二二二二二二二二二二二二二二二二二二二=二二二二二二精準(zhǔn)鵝{噸服耐藥12019臨床選擇10月2019190日傳統(tǒng)化療時(shí)代22總生存時(shí)間“精準(zhǔn)治療”使驅(qū)動(dòng)基因型肺癌4晚期NSCLC一線治療:立即化療Vs“觀察并等待”2019WcLc:加拿大癌癥登記進(jìn)行回顧性分析ReferredtoamediatechemoWatchandwait319{46%n=166(24%)n=209(30%)ReceivedchemoStillonwatchandMissedopportunityosttofollow-upMedianFollow-upIntervecliningECOG(n-36)PatientMoved(n-1)晚期NSCLC一線治療:立即化療Vs“觀察并等待”5晚期NSCLC一線化療規(guī)范化課件6晚期NSCLC一線化療規(guī)范化課件7晚期NSCLC一線化療規(guī)范化課件8晚期NSCLC一線化療規(guī)范化課件9晚期NSCLC一線化療規(guī)范化課件10晚期NSCLC一線化療規(guī)范化課件11晚期NSCLC一線化療規(guī)范化課件12晚期NSCLC一線化療規(guī)范化課件13晚期NSCLC一線化療規(guī)范化課件14晚期NSCLC一線化療規(guī)范化課件15晚期NSCLC一線化療規(guī)范化課件16晚期NSCLC一線化療規(guī)范化課件17晚期NSCLC一線化療規(guī)范化課件18晚期NSCLC一線化療規(guī)范化課件19晚期NSCLC一線化療規(guī)范化課件20晚期NSCLC一線化療規(guī)范化課件21晚期NSCLC一線化療規(guī)范化課件22晚期NSCLC一線化療規(guī)范化課件23晚期NSCLC一線化療規(guī)范化課件24晚期NSCLC一線化療規(guī)范化課件25晚期NSCLC一線化療規(guī)范化課件26晚期NSCLC一線化療規(guī)范化課件27晚期NSCLC一線化療規(guī)范化課件28晚期NSCLC一線化療規(guī)范化課件29晚期NSCLC一線化療規(guī)范化課件30晚期NSCLC一線化療規(guī)范化課件31晚期NSCLC一線化療規(guī)范化課件32晚期NSCLC一線化療規(guī)范化課件33晚期NSCLC一線化療規(guī)范化課件34晚期NSCLC一線化療規(guī)范化課件35晚期NSCLC一線化療規(guī)范化課件36晚期NSCLC一線化療規(guī)范化課件37晚期NSCLC一線化療規(guī)范化課件38晚期NSCLC一線化療規(guī)范化課件39晚期NSCLC一線化療規(guī)范化課件40晚期NSCLC一線化療規(guī)范化課件41晚期NSCLC一線化療規(guī)范化課件42晚期NSCLC一線化療規(guī)范化課件43晚期NSCLC一線化療規(guī)范化課件44晚期NSCLC一線化療規(guī)范化課件45晚期NSCLC一線化療規(guī)范化課件46晚期NSCLC一線化療規(guī)范化課件47晚期NSCLC一線化療規(guī)范化課件48晚期NSCLC一線化療規(guī)范化課件49晚期NSCLC一線化療規(guī)范化課件50晚期NSCLC一線化療規(guī)范化課件51晚期NSCLC一線化療的規(guī)范化方勇浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院腫瘤內(nèi)科晚期NSCLC一線化療的規(guī)范化52非小細(xì)胞肺癟診治過(guò)程概述重AM確定病理診斷明確分期選擇治療方案非小細(xì)胞肺癟診治過(guò)程概述53治療選擇正從以組織學(xué)為基礎(chǔ)的模式轉(zhuǎn)變?yōu)橐灾掳?qū)動(dòng)因子為靶點(diǎn)的模式2019-2019組織學(xué)驅(qū)動(dòng)的選掃以致癌驅(qū)動(dòng)基因NSCLC的治療演變非鱗癌EGFR野生型●■EGFRALK■HER2■未知以腺癌中的突變率為例目前NSCLC的標(biāo)準(zhǔn)治療MassachusettsGeneralH治療選擇正從以組織學(xué)為基礎(chǔ)的模式轉(zhuǎn)變?yōu)?4“精準(zhǔn)治療”使驅(qū)動(dòng)基因型肺癌逐漸成為臨床可控的疾病二二二二二二二二二二二二二二二二二二二=二二二二二二精準(zhǔn)鵝{噸服耐藥12019臨床選擇10月2019190日傳統(tǒng)化療時(shí)代22總生存時(shí)間“精準(zhǔn)治療”使驅(qū)動(dòng)基因型肺癌55晚期NSCLC一線治療:立即化療Vs“觀察并等待”2019WcLc:加拿大癌癥登記進(jìn)行回顧性分析ReferredtoamediatechemoWatchandwait319{46%n=166(24%)n=209(30%)ReceivedchemoStillonwatchandMissedopportunityosttofollow-upMedianFollow-upIntervecliningECOG(n-36)PatientMoved(n-1)晚期NSCLC一線治療:立即化療Vs“觀察并等待”56晚期NSCLC一線化療規(guī)范化課件57晚期NSCLC一線化療規(guī)范化課件58晚期NSCLC一線化療規(guī)范化課件59晚期NSCLC一線化療規(guī)范化課件60晚期NSCLC一線化療規(guī)范化課件61晚期NSCLC一線化療規(guī)范化課件62晚期NSCLC一線化療規(guī)范化課件63晚期NSCLC一線化療規(guī)范化課件64晚期NSCLC一線化療規(guī)范化課件65晚期NSCLC一線化療規(guī)范化課件66晚期NSCLC一線化療規(guī)范化課件67晚期NSCLC一線化療規(guī)范化課件68晚期NSCLC一線化療規(guī)范化課件69晚期NSCLC一線化療規(guī)范化課件70晚期NSCLC一線化療規(guī)范化課件71晚期NSCLC一線化療規(guī)范化課件72晚期NSCLC一線化療規(guī)范化課件73晚期NSCLC一線化療規(guī)范化課件74晚期NSCLC一線化療規(guī)范化課件75晚期NSCLC一線化療規(guī)范化課件76晚期NSCLC一線化療規(guī)范化課件77晚期NSCLC一線化療規(guī)范化課件78晚期NSCLC一線化療規(guī)范化課件79晚期NSCLC一線化療規(guī)范化課件80晚期NSCLC一線化療規(guī)范化課件81晚期NSCLC一線化療規(guī)范化課件82晚期NSCLC一線化療規(guī)范化課件83晚期NSCLC一線化療規(guī)范化課件84晚期NSCLC一線化療規(guī)范化課件85晚期NSCLC一線化療規(guī)范化課件86晚期NSCLC一線化療規(guī)范化課件87晚期NSCLC一線化療規(guī)范化課件88晚期NSCLC一線化療規(guī)范化課件89晚期NSCLC一線化療規(guī)范化課件90晚期NSCLC一線化療規(guī)范化課件91晚期NSCLC一線化療規(guī)范化課件92晚期NSCLC一線化療規(guī)范化課件93晚期NSCLC一線化療規(guī)范化課件94晚期