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系统性大肠癌治疗PPT课件.ppt

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系统性大肠癌治疗AdenomatoCarcinomaPathwayStageSystems:Terminologyvs.Contents(概念与内涵);Populationsvs.Individuals(群体与个体)SEERColonCancer1973-2005(USA)N=28,491HistoryofTherapeuticRegimensfortheTreatmentofMCRCAdvancesintheTreatmentofColorectalCancerManagementofMCRC:AnEvolvingTreatmentAlgorithmChemotherapy0.0FOLFIRIOverallSurvivalCPT-11180mg/m2+simplifiedLV5FUProbabilityOPTIMOX-1OPTIMOXStudiesPhaseIIOPTIMOX2Trial:StudyDesignPhaseIIITrialBevacizumabinFirst-LineMCRC(AVF2107g)PhaseIIITrialofBevacizumabinFirst-LineMCRC:EfficacyPhaseIIITrialofBevacizumabinFirst-LineMCRC:SurvivalE3200:High-doseBEV+FOLFOX4:StudyDesignE3200(FOLFOX+Bevacizumab):OverallSurvivalBevacizumabwith5-FU/LV:PFSBevacizumabwith5-FU/LV:OverallSurvivalXELOX+placebon=350EffectofBevacizumabonPFSPRIME:studydesignPRIME(first-lineFOLFOX±panitumumab):K-rasWTPFSPRIME(first-lineFOLFOX±panitumumab):K-rasWTOS(interimanalysis)PRIME(first-lineFOLFOX±panitumumab):responseratesLivermetastaticdiseaseDefiningTherapeuticSettingsLiverMetastasesinCRCLiverMetSurveyRegistry:PrognosticImportanceofIntrahepaticTumorBurden66patientsLiveronlymetswithCRonCTscanafterChemotherapyTreatmentOptions&HowLongAdjuvantX-ACTtrialinadjuvanttreatmentofDukes’CcoloncancerConfirmedbyperprotocolanalysis,HR0.89(95%CI0.76-1.04)PhaseIIIMOSAICMOSAIC4-yrDFS:ASCO2005Disease-freeSurvivalinStageIIIPatients:N1&N2NSABPC-07p<0.004HR:0.79[0.67–0.93]NSABPC-07:toxicityandmortalityChemo/radiotherapy-naivestageIIIcolon≤8weekssinceresectionN=1886BaselinetumourcharacteristicsDoseintensity/treatmentmodifications5-yearDFS:benefitwithXELOXmaintainedandincreasedovertimeNO16968subgroupanalysisofDFSbyageNO16968subgroupanalysisofOSbyage1.Saltzetal.JCO20072.VanCutsemetal.JCO2009;3.Ychouetal.AnnOncol200924weeksEv3yDFSmFF6+B29177.4mFF631275.5BO17920(AVANT)PhaseIIITrialAVANT:patientrecruitmenttimelineAVANT:patientdemographicsAVANT:mortalityAVANT:adverseeventsofspecialinterestforAvastin*AdjuvantTherapy:CetuximabQUASAR:Adjuvantvs.ObservationinStageIICRC1.00.80.60.40.20.0E5202:stageIIcoloncance