常见实体瘤化疗方

T1 T2 T3 T4N0N1N2N3M1Lung (Non-Small Cell Carcinomas四组化疗方案对晚期初治四组化疗方案对晚期初治NSCLC患者效果的比较患者效果的比较Kubota, Karmanos CRC(Abstract7106,2000.10-2002.6) DOC 100, 1 h q 3 wks , DOC 75 mg/m 1 h q 3 wks最好的支持治疗(BSC)DOC 100 mg/m 1 h q 3 wksDOC 75 mg/m 1 h q 3 wks去甲长春花碱 30 mg/m d1, 8, 15 q 3 wks, or 异环磷酰胺2 g/m d1, 2, 3 q 3 wksRTAX320RTAX317DOC二线治疗二线治疗NSCLCIII期临床试验期临床试验Shepherd F JCO 2000, Fossella JCO 2000Shepherd F JCO 2000, Fossella JCO 2000DOC二线治疗二线治疗NSCLCIII期临床试验期临床试验生存分布函数生存分布函数月月HR = HR = 风险比风险比CI = CI = 可信区间可信区间MST = MST = 中位生存时间中位生存时间0.000.250.500.751.000.02.55.07.510.012.515.017.520.0中位生存时间中位生存时间8.3月月一年总体生存率一年总体生存率: 29.7% HR 0.99 95% CI of HR (0.82, 1.20)中位生存时间中位生存时间 7.9 月月一年总体生存率一年总体生存率: 29.7%ALIMTA (n=280)多烯紫杉醇多烯紫杉醇 (n=288)ASCO 2003, JCO Vol 22:1589, 20041Tarceva product information; 2OSI and Roche data on file3Pemetrexed product information; 4Hanna N, et al. J Clin Oncol 2004;22:1589975Docetaxel product information1 Bezjak A, et al. J Clin Oncol 2006;24:38317; 2Dancey J, et al. Lung Cancer 2004;43:18394; 3Hanna N, et al. J Clin Oncol 2004;22:158997Fukuoka M, et al. J Clin Oncol 2003;21:223746Kris M, et al. JAMA 2003;290:214958*Assessed using FACT-L questionnaire NR = not reportedFukuoka M, et al. J Clin Oncol 2003;21:223746Recommended dose for phase III = 250mg/dayThatcher N, et al. Lancet 2005;366:152737*No significant difference versus BSC for docetaxel 75mg/m2Comparable symptom control data to docetaxel 75mg/m2 Significant for cough, pain, dyspnoea, global QoL, physical function, emotional function药物药物 生存期生存期改善改善 症状控制症状控制/生活质量生活质量 毒性毒性 Docetaxel + Pemetrexed + Tarceva * + CRCResectability AssessmentPrimarilyResectablePrimarilyUnresectableNeoadjuvantSurgery ChemotherapyAdjuvant CTLocalAdjuvantMetastasesOther MeasurementsRT+CT0,50,60,70,80,9101020304050ProbabilityDFS (months)24% risk reduction for stage III patients in the FOLFOX arm FOLFOX (n=672) 71.8%LV5FU2 (n=675) 65.5% 3-year5-FU bolus400 mg/m2 over 2-4 min5-FU bolus400 mg/m2 over 2-4 min5-FU infusion600 mg/m2LV 200 mg/m2Oxaliplatin 85 mg/m25-FU infusion600 mg/m2LV 200 mg/m22 h22 h2 h22 hFOLFOX4q2w5-FU bolus400 mg/m2 over 2-4 min5-FU infusion1200 mg/m2/day x 2 daysLV 400 mg/m2Oxaliplatin 100 mg/m22 h46-48 hFOLFOX6q2w5-FU infusion1200 mg/m2/day x 2 daysLV 400 mg/m2Oxaliplatin 130 mg/m22 h46-48 hFOLFOX7q2wChemo-nave Dukes C,resection 8 weeks Xeloda1 250mg/m2 twice daily, d114, q21d n = 1 004Bolus 5-FU/LV5-FU 425mg/m2 plus LV 20mg/m2, d15, q28dn = 983Recruitment1998200124 weeksEstimated probabilityAbsolute difference at 3 years: 3.6%1.00.80.60.40123456YearsHR = 0.86 (95% CI: 0.740.99)p=0.0407 3-yearXeloda (n=1 004) 65.5%5-FU/LV (n=983) 61.9%Cassidy J et al. Proc Am Soc Clin Oncol Late-breaking Abstract Book 2004;23:14 (Abst 3509)Estimated probability0123456YearsAbsolute difference at 3 years: 3.7%1.00.80.60.4 3-yearXeloda (n=1 004) 81.3%5-FU/LV (n=983) 77.6%HR = 0.84 (95% CI: 0.691.01)p=0.0706 Cassidy J et al. Proc Am Soc Clin Oncol Late-breaking Abstract Book 2004;23:14 (Abst 3509)