晚期NSCLC一线治疗新进展-PPT

*,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,晚,期,NSCLC,一线,治,疗进,展,陆军军医大学新桥医院,徐 瑜,The power of teamwork,选择少：,放,疗，化疗,肺癌：,培美曲塞,治疗,非鳞非小细胞肺癌,靶向驱动基因变异,以病理为指导的治疗,以疾病为指导的治疗,以分子检测为指导的治疗,临床肿瘤学,分,子肿瘤学,病理肿瘤学,肿瘤免疫学,精准医学,重建免疫监视,晚期,NSCLC,一线治疗模式演变过程,以肿瘤免疫微环境指导的治疗,Evading growth,suppressor,can-thanos,Sustaining proliferative signal,Avoiding immune,Destruction,Inducing angiogenesis,EGFR,ALK,ROS-1,Captain TKI,Chemo-hulk,Destroy,everything,Checkpoint thor,Angio-man,Avengers III,Part1,驱动基因阳性,NSCLC,治疗进展,驱动基因检测成为晚期,NSCLC,一线治疗前的关键步骤,NCCN Clinical Practice Guidelines in Oncology(NCCN Guidelines,)Non-Small Cell Lung Cancer version1.2018.,研究,患者,人群,TKI,病例数,PFS(,月,),OS(,月,),TKI,化疗,HR(95%CI),TKI,化疗,HR(95%CI),III,期临床中,EGFR,突变亚组人群,IPASS,亚裔、,不吸烟,G,261,9.5,6.3,0.48,(0.36-0.64),21.6,21.9,0.78,(0.50-1.20),First Signal,韩裔、,不吸烟,G,42,8.0,6.3,0.61,(0.31-1.22),27.2,25.6,0.82,(0.352-1.922),EGFR,突变人群中进行的,III,期临床,NEJ002,日本,G,228,10.8,5.4,0.322,(0.236-0.438),27.7,26.6,0.88,(0.634-1.241),WJTOG3405,日本,G,172,9.6,6.6,0.52,(0.378-0.715),35.5,38.8,1.185,(0.767-1.829),OPTIMAL,中国,E,154,13.1,4.6,0.16,(0.10-0.26),32.1,37.5,1.065,ENSURE,亚裔,E,217,11.0,5.5,0.34,(0.22-0.51),26.3,25.5,0.91,（,0.63-1.31,）,EURTAC,高加索裔,E,173,9.7,5.2,0.37,(0.25-0.54),19.3,19.5,0.80,(0.47-1.37),Lux-lung 3,高加索裔、亚裔,A,345,11.1,6.9,0.58,(0.43-0.78),28.2,28.2,0.88,（,0.66-1.17,）,Lux-lung 6,亚裔,A,364,11.0,5.6,0.29,(0.20-0.33),23.1,23.5,0.93,（,0.72-1.22,）,EGFR,突变型晚期非鳞患者一线,TKI,治疗,PFS,更长,1.Mok,et al.NEJM 2009;2.Han et al.JCO 2012.30(10).3,Maemondo,et al.NEJM 2010;4.Mitsudomi,et al.Lancet Oncol 2010;5.Zhou,et al.Lancet Oncol 2011;6.Wu YL,et al.Ann Oncol.2015.7.Rosell et al.Lancet Oncol 2012.8.CH Yang,et al.Lancet Oncol.2015.9.Wu YL,et al.Lancet Oncol 2014,15.10.BJ.Solomon,et al.NEJM 2014,驱动基因的,发,现推,进了晚期,NSCLC OS,的延长,0,1,2,3,4,5,0,0.2,0.4,0.6,0.8,1.0,Log-rank p 1 gen,e,3,%,M,ET,1%,NRA,S,1%,M,E,K1,1%,Keynote,407,Prombro+CP,（,nab,）,vs placebo+CP,（,nab,）,鳞癌,any,Keynote 189,Prombro+pem+,铂,vs palcebo+,pem+,铂,腺癌,any,Nivolumab,BMS,checkmate227,Nivo+ipilimu,and Nivo+chemo vs chemo,NSCLC,any,（,50%,1,50%,1,50%,total,PD-L1,HR=0.81,NA,HR=1.07 (NS),HR=0.69,HR=0.92,HR=0.81,Keynote,407,HR=0.56,58.4%vs 35%,HR=0.64,PD-L1,Keynote 189,HR=0.52,47.6%vs 18.9%,HR=0.49,PD-L1,CM227,PD-L11%,A,vs B,TMB high HR=0.48,NA,immature,TMB,，,PD-L1,TMB low HR=1.17,C vs B,HR=0.74,36.7%vs 23.1%,immature,IP150,A,NA,40%vs,41%,HR=0.88(NS),Teff,，,PD-L1,B vs C,HR=0.59,56%vs 41%,HR=0.78,IMpower131,HR=0.71,49%vs 41%,immature,(HR=,0.96,),PD-L1,PD-L1,50%,PD-L1,1%,50%,PD-L1 1%,pembrolizumab,IO+chemo,IO+chemo+bev,pembrolizumab,IO+chemo+bev,IO+chemo,IO+chemo+bev,IO+chemo,TMB,10,非鳞,NSCLC,一线免疫治疗选择方案,鳞癌一,线免疫,治,疗选择方案,pembrolizumab,IO+chemo,pembrolizumab,IO+chemo,IO+chemo,TMB,10,驱动基因突变型晚期,NSCLC,一线治疗,驱动基因野生型晚期,NSCLC,一线治疗,T update,A+T,T+C,IO,IO+IO,IO+C,IO+C+A,总结,To be continued.,IV,