食管癌最新化疗精选PPT.ppt

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1、关于食管癌最新化疗关于食管癌最新化疗现在学习的是第1页，共15页化疗原则化疗原则n nT1aN0的食管癌不需术后辅助化疗n nT1b（侵及粘膜下层）尤其分化差的鳞癌术后应作适当辅助化疗n nII、III期最好行新辅助放化疗或放疗或化疗n nIV期：放化疗n n转移：化疗n n颈段环咽肌5cm以内的食管癌：放化疗现在学习的是第2页，共15页化疗有效药物及方案化疗有效药物及方案现在学习的是第3页，共15页Preoperative chemotherapy n nRTOG8911RTOG8911 FP+surgery VS surgery alone FP+surgery VS surgery al

2、one R0 R0切除率提高（切除率提高（64 vs 59%64 vs 59%）但但 OSOS无差异无差异n nMRCOEO2MRCOEO2 2 2周期周期FP+surgery VS surgery aloneFP+surgery VS surgery alone总生存提高总生存提高3.53.5月（月（16.8 VS 13.316.8 VS 13.3）n nMetaMeta分析分析 5 5年生存及年生存及DFSDFS提高提高4%4%（small but significantsmall but significant）现在学习的是第4页，共15页Preoperative chemotherap

3、yn nAbstract 180Abstract 180：Outcomes associated with T4 Outcomes associated with T4 esophageal canceresophageal cancern n3(7.9%)pCR,17(44.7%)pPR,18(47.4%)NR 3(7.9%)pCR,17(44.7%)pPR,18(47.4%)NR n nR0 resections were accomplished in 37(R0 resections were accomplished in 37(94.9%)94.9%)n n14 14 例术后复发：

4、例术后复发：pCR 1(7.1%),pPR 6(42.9%),NR 7 pCR 1(7.1%),pPR 6(42.9%),NR 7(50%)(50%)n nmedian time to recurrence of median time to recurrence of 19.519.5(4-71)months(4-71)monthsn nPatients achieving aPatients achieving a pCR pCR had a 5-year overall and disease had a 5-year overall and disease free survival

5、of free survival of(43%and 47%),(43%and 47%),compared to pPR compared to pPR(30%and 21%)while there were(30%and 21%)while there were no 5-year survivors in no 5-year survivors in the NR cohort the NR cohort we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increase

6、d R0 resections and improvements in overall and disease free survival 现在学习的是第5页，共15页Preoperative chemotherapyn nAbstract 4060Abstract 4060 ：Final results of feasibility study of Final results of feasibility study of neoadjuvant chemotherapy with neoadjuvant chemotherapy with DCFDCF for clinical stag

7、e II/III for clinical stage II/III esophageal squamous cell carcinoma esophageal squamous cell carcinoma（JapanJapan）RR 60%RR 60%，pCR 22%pCR 22%most common grade 3 or 4 toxicities were most common grade 3 or 4 toxicities were neutropenia(83%),febrile neutropenia(2%),neutropenia(83%),febrile neutropen

8、ia(2%),anorexia(7%),and stomatitis(5%).anorexia(7%),and stomatitis(5%).现在学习的是第6页，共15页chemoradiationn nRTOG85-01 trial(randomized)RTOG85-01 trial(randomized)5-Fu+DDP RT 5-Fu+DDP RT +RT +RT（50Gy50Gy）（60Gy60Gy）中位生存中位生存 1414月月 9 9月月 5 5年生存率年生存率 27%027%0n nINT0123 trialINT0123 trial 不同放疗剂量联合相同化疗方案，中位生存、不

9、同放疗剂量联合相同化疗方案，中位生存、2 2年年生存率及局部复发率无统计学差异生存率及局部复发率无统计学差异VS现在学习的是第7页，共15页chemoradiationAbstract 4034 Abstract 4034（2011 ASCO2011 ASCO）Phase II trial Phase II trial （JapanJapan）RTRT 30Gy/3wks+30Gy/3wks+S1 S1 80mg/m2/d d1-14 80mg/m2/d d1-14 DDPDDP 70mg/m2 d8 70mg/m2 d8 S1S1 80mg/m2/d d1-14 80mg/m2/d d1-1

10、4 DDPDDP 70mg/m2 d8 70mg/m2 d82wks later现在学习的是第8页，共15页chemoradiationn nAbstract 4034 Abstract 4034（2011 ASCO2011 ASCO）Phase II trialPhase II trial（JapanJapan）stage II III IVstage II III IV patient 12 61 29 patient 12 61 29 CR(%)92 64 24 CR(%)92 64 24 PR(%)100 85 66 PR(%)100 85 66 OS 100%795d 369d OS

11、 100%795d 369d 主要不良反应：主要不良反应：3/43/4度骨髓抑制（度骨髓抑制（36/14%36/14%）2 2度恶心呕吐，口腔黏膜炎等度恶心呕吐，口腔黏膜炎等现在学习的是第9页，共15页chemoradiationn nAbstract 4072 Abstract 4072（2011 ASCO2011 ASCO）（FranceFrance）Chemoradiation with FOLFOX plus cetuximab Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophag

12、eal in locally advanced cardia or esophageal cancer:Final results of a GERCOR phase II cancer:Final results of a GERCOR phase II trial(ERaFOX).trial(ERaFOX).（Stage IIIStage III）FOLFOX6+C225 2FOLFOX6+C225 2周期周期 FOLFOX6+C225+RTFOLFOX6+C225+RT（50.4Gy50.4Gy）（5-Fu 1800mg/m2/d1-25-Fu 1800mg/m2/d1-2）现在学习的是

13、第10页，共15页chemoradiationn nAbstract 4072 Abstract 4072（2011 ASCO2011 ASCO）Phase II trialPhase II trial（FranceFrance）male/female 60/19male/female 60/19 median age 63(23-79)median age 63(23-79)PS 0/1/ND 47/31/1 PS 0/1/ND 47/31/1 SCC/adeno/undifferentiated 53/25/1 SCC/adeno/undifferentiated 53/25/1 esop

14、hagus/cardia 74/5 esophagus/cardia 74/5 ORR(ITT)was achieved in 61 pts(77.2%ORR(ITT)was achieved in 61 pts(77.2%）median PFS/OS were 13.8/21.6 months.median PFS/OS were 13.8/21.6 months.Most frequent grade 3-4 toxicities were:neutropenia Most frequent grade 3-4 toxicities were:neutropenia(28.4%),dysp

15、hagia-esophagitis(13.5%),rash(10.8%)(28.4%),dysphagia-esophagitis(13.5%),rash(10.8%)and allergy(8.9%).and allergy(8.9%).现在学习的是第11页，共15页Chemotherapy for metastatic diseasen nFluoropyrimidine/platinum-based first-line chemotherapy in Fluoropyrimidine/platinum-based first-line chemotherapy in metastati

16、c esophageal squamous cell carcinoma:metastatic esophageal squamous cell carcinoma:Prognostic factor analysis in 239 patientsPrognostic factor analysis in 239 patients（Abstract 4088Abstract 4088，韩国韩国）n nXPXP与与FPFP方案方案 ORRORR，PFS,OS PFS,OS 无统计学差异无统计学差异n nECOG2,albumin level 3.5g/dL and weight lossECO

17、G2,albumin level 3.5g/dL and weight loss (10%of the weight loss for 3 months)at the(10%of the weight loss for 3 months)at the time of chemotherapy were significantly time of chemotherapy were significantly associated with both associated with both worse PFS(P0.05)and worse PFS(P0.05)and OS(P0.05).OS

18、(P0.05).现在学习的是第12页，共15页Target therapyn nToGA studyToGA study 曲妥珠单抗曲妥珠单抗+化疗化疗 VS VS 化疗在化疗在Her-2Her-2过表达的胃过表达的胃-食管交界腺癌，食管交界腺癌，OS OS 提高（提高（13.5 VS 11.1 13.5 VS 11.1 月）月）n nC225C225、特罗凯、贝伐单抗、特罗凯、贝伐单抗n nPhase II trial of Phase II trial of sorafenibsorafenib in esophageal(E)and in esophageal(E)and gastroe

19、sophageal junction(GEJ)cancer:gastroesophageal junction(GEJ)cancer:Response and protracted stable disease Response and protracted stable disease observed in adenocarcinoma observed in adenocarcinoma（abstract abstract 41004100）现在学习的是第13页，共15页研究方向n n不同的化疗方案与放化疗的合理应用n n新的靶向药物在食管癌的疗效n n食管鳞癌与腺癌的区别n n食管癌的预后及预测因子现在学习的是第14页，共15页感谢大家观看现在学习的是第15页，共15页