肝癌靶向治疗用药时机和疗效评估.pptVIP

* * * * * * 内容 实体瘤疗效评估标准的演变 靶向药物治疗肝细胞癌（HCC）的疗效评估 靶向药物索拉非尼治疗HCC的时机探讨 患者的选择 疗效的评估 疾病进展后的治疗选择 索拉非尼治疗进展后的治疗选择 停药＋最佳支持治疗？ 除索拉非尼外尚无其他药物获批治疗晚期HCC 可耐受情况下继续索拉非尼治疗？ 独特的作用机制可能延缓疾病进展速度 可能在进展基础上再次出现疾病稳定 多吉美慈善赠药标准的相应修改 SFDA 2008年7月批准多吉美治疗肝癌，临床用药经验显示患者在疾病进展后继续治疗可能持续获益 中华慈善总会多吉美患者援助项目通过专家讨论于2008年12月修改肝癌患者停止赠药的医学标准 从开始服药起，连续两次判定为进展（PD）的患者(评估以最近一次影像学评价为对照)须终止多吉美治疗； 如果医生根据经验判断患者仍有可能临床获益,可在患者签署知情同意书后可推荐患者继续服药 总结 肿瘤是慢性疾病，带瘤生存的理念已广为接受 总生存时间是评估靶向药物治疗肿瘤疗效的金标准 通过RECIST修订标准评估TTP可判断短期疗效 CR＋PR＋SD均为有效 选择肝功能良好的晚期HCC患者及早应用索拉非尼可能获益更佳 * * * * * Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92(3 ): 205-16 . Llovet JM, et al.; Panel of Experts in HCC-Design Clinical Trials: Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma. J Natl Cancer Inst. 2008 May 21;100(10):698-711 Llovet JM, et al.; Panel of Experts in HCC-Design Clinical Trials: Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma. J Natl Cancer Inst. 2008 May 21;100(10):698-711 * * * * * * * * Bisphosphonates Overview * * * * * * Abou-Alfa GK, Amadori D, Santoro A et al. Is sorafenib (S) safe and effective in patients (pts) with hepatocellular carcinoma (HCC) and Child-Pugh B (CPB) cirrhosis? Presented at the 2008 Gastrointestinal Cancers Symposium, Orlando, Florida, January 25–27, 2008. 2. Abou-Alfa GK, Schwartz L, Ricci S et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006;24:4293–4300. 3. Junji Furuse, Hiroshi Ishii, Kohei Nakachi,et al. Blackwell Publishing Asia Phase I study of sorafenib in Japanese patients with hepatocellular carcinoma. Cancer Sci 2008; 99: 159–165 4. Thomas Yau, Pierre Chan, Kelvin K. Ng, et al. Phase 2 Open-label Study of Singleagent Sorafenib in Treating Adv