NSCLC辅助及晚期化疗.pptVIP

NSCLC的化疗 复旦大学肿瘤医院化疗科   Standard of care for early-stage disease depends upon whether the patient is a candidate for surgery. With surgical resection, the 5-year survival rate for patients with stage IB NSCLC is 57% and less than 50% for patients with stage II disease. While local disease recurs in approximately one third of patients following surgical resection, distant disease is the primary cause of death for patients with early-stage NSCLC. Author and Year Published # Pts Treatment Groups 5-Year Survival% P Value Arriagada et al[6] (IALT) 2004 1867 Cisplatin and either:EtoposideVinorelbineVindesineVinblastine 44.5 .03 OBS 40.4 Winton et al[7](JBR.10) 2004 482 Cisplatin-Vinorelbine 69 .03 OBS 54 Strauss et al[8](CALGB 9633) 2004 344 Carboplatin-Paclitaxel 71 (4 years) .028 OBS 59 (4 years) Rosell et al[9](ANITA) 2005 840 Cisplatin-Vinorelbine 51 .0131 OBS 43 IALT Trial Results  Chemotherapy No chemotherapy N 935 932 Stage I and II disease 61% 61% Stage III disease 39% 39% 5-year OS 44.5% 40.4% P 0.03 5-year DFS 39.4% 34.4% Median survival (months) 50.8 44.4 Median DFS (months) 40.2 30.5 44.5%vs40.4% Adjuvant chemotherapy with a cisplatin-based regimen should be considered in patients who maintain a good performance status after surgical resection. 总例数：344例 5-y生存：59%：57% P=0.375 ANITA: phase III adjuvant vinorelbine (N) and cisplatin (P) versus observation in completely resected (stage I-III) non-small cell lung cancerRosell R 2005  840 patients IB (T2N0), II, IIIA R A N D O M I Z E cisplatin 100 mg/m2 day 1 vinorelbine 30 mg/m2/week every 4 weeks observation end point: 2-year survival secondary end point:relapse-free survival ANITA: Rosell R 2005  stage adjuvant therapy arm OBS I 62% 63% II 52% 39% III 42% 26% Five-year survival 70 months follow-up : median survival : 65.8 months vs 43.7 months ANITA: Rosell R 2005  Grade 3/4 toxicities in the experimental arm : neutropenia 86%,