肺癌靶向治疗的策略及临床实践__培训课件.pptx

肺癌靶向治疗的策略及临床实践南京军区总医院 宋勇神奇药片开启了肺癌靶向治疗的时代吉非替尼 治疗6周IPASS研究正式开启了肺癌的靶向治疗吉非替尼 EGFR M+ (n=132)吉非替尼 EGFR M- (n=91)卡铂紫杉醇 EGFR M+ (n=129)卡铂紫杉醇 EGFR M- (n=85)Probabilityof PFS1.00.8EGFR M+ HR (95% CI) 0.48 (0.36, 0.64), p0.0001EGFR M- HR (95% CI) 2.85 (2.05, 3.98), p0.00010.6Treatment by subgroup interaction test, p0.00010.40.20.004812162024Time from randomisation (months)Tony Mok et al N Engl J Med 2009八项随机III期临床研究验证了TKI的卓越疗效研究分组N (EGFR m+)ORR(%)中位PFS (月)IPASS易瑞沙卡铂/紫杉醇26171.2 vs. 47.39.5 vs. 6.3First-SIGNAL易瑞沙顺铂/吉西他滨4284.6 vs. 37.58.0 vs. 6.3W3405易瑞沙顺铂/多西他赛17262.1 vs. 32.19.6 vs. 6.6NEJ002易瑞沙卡铂/紫杉醇22873.7 vs. 30.710.8 vs. 5.4OPTIMAL厄洛替尼卡铂/吉西他滨15483 vs. 3613.1 vs. 4.6EURTAC厄洛替尼含铂两药17358 vs. 159.7vs. 5.2LUX-Lung 3阿法替尼顺铂/培美曲塞34556.1 vs. 22.611.1 vs. 6.9LUX-Lung 6阿法替尼顺铂/吉西他滨36466.9 vs. 23.011 vs. 5.6Rossi A, et al. Cancer Treatment Reviews 2013; 39:489-497.Wu YL, et al. 2013 ASCO Abstract 8016.Han JY, et al. J Clin Oncol 2012; 30:1122-1128. 肺癌靶向治疗发展到今天，该如何定位？未经选择人群选择性人群突变人群ECOG1594含铂两药化疗(N=1207)18.0JMDB顺铂/培美曲塞(N=618)211.8非鳞癌患者IPASS卡铂/紫杉醇(N=608)317.4腺癌、不吸烟患者NEJ002易瑞沙EGFR基因敏感突变患者(N=114)427.7WJTOG3405易瑞沙EGFR基因敏感突变患者(N=86)5 35.5 05101520253035中位生存期 (月)1. Schiller JH, et al. N Engl J Med 2002; 346:92-98. 2. Scagliotti GV, et al. J Clin Oncol 2008; 26:3543-3551.3. Yang CH, et al. Presented at 2010 ESMO. 4. Inoue A, et al. 2011 ASCO Abstract 7519.5. Mitsudomi T, et al. Lancet Oncol 2009; DOI:10.1016/s1470-2045(09)70364-X.随着靶点选择的精确，靶向治疗带来的生存获益越来越显著对于特定人群，靶向治疗的生存贡献要高于传统化疗OPTIMAL研究OS分析nEventsn (%)Median(months)95% CI单用化疗组2117 (81)11.707.29–22.87单用TKI组3322 (67)20.6716.62–28.32化疗联合TKI组9450 (53)30.3925.99–NR1.00.80.6OS probability0.4Patients receiving EGFR TKI and chemo vs patients receiving chemo only p=0.0001Patients receiving EGFR TKI only vs patients receiving chemo only p=0.057Log-rank p value 0.00010.200510152025303540对于EGFR突变阳性患者，TKI治疗带来更大的生存贡献Time (months)*Chemo only, no EGFR TKI: patients from the GC arm who had no further treatment (n=16) or further chemotherapy (n=5)?EGFR TKI o