文档介绍：伊立替康+顺铂治疗小细胞肺癌
多中心随机对照临床研究
解放军总医院肿瘤内科
研究背景
·WHo2000年:全球死于肺癌人数占恶性肿瘤死
亡的19%,居恶性肿瘤死因的首位
我国近20年肺癌发病率以每年11%速度递增
ScLC约占肺癌20~25%
SCLc对化疗和放疗都非常敏感
·多种治疗方案未能使患者长期生存
研究背景
局限期小细胞肺癌( LD-SCLC)占30-40%
中位生存期:10~16个月
5年生存率:18%
广泛期小细胞肺癌( ED-SCLC占60-70%
中位生存期:6~12个月
5年存活率:<2%
预后好的因素:一般状况好、女性、70岁以下、
白种人、LDH正常、足量联合化疗、单发转移灶
研究背景
手术:非常规首选,严格适应征
纵隔镜、PET-CT:精确分期
TNM-IAIBⅡA:LD期
≥Ig:ED期
放疗:LD期:RCT优于单纯cT
(2007AScO:3年绝对获益+5%)
同步优于序贯:MS272mVs197m
美国同步,欧洲序贯
预防性脑放疗:LD期:3年绝对获益+54%
%
研究背景
一线化疗:
A:EP优于cAV2Y:25%Vs8%
5Y:10%Vs3%
B:P优于EP
RR:84%Vs64%
MS: vs 9. 4m
PFS: vs
C:PEM+CBP优于PEM+DDP
MS: vs
1Y:43%%
研究背景
·二线化疗:
70~80%LD、100%ED进展或复发
拓扑替康+铂类
培美曲塞+铂类
紫杉醇+铂类?
靶向治疗:小样本,无确切疗效
NCCN in aonecl gy l a Small Cell Lung Cancer
TESTING RESULT
INITIAL TREATNENTI
preferred) and
Chemothera例y
mediastinal lymph<
negative
node dissection
mediastinal RTK
Clinical stag T1-2, NO
Good performance
Chemotherapy concurrent
s status(PS 0-2
thoracic RT"(categary 1)
medi aspinal stain
due to sCLc
Chemotherapy±RTk
ed treatment
or PS (3-4
due to SCL
cluding s upportive care
regimens
Chemotherapy
Limited disea
Poor Ps阝4
excess ofT
due to SCLC
→ chemotherapy±Rrk
Poor PS(3-4)not
Individualized treatment
incuding supportive care
NCCN Pn achico gy deli. o8 Small Cell Lung Cancer
SCLC Abad Corlan
Stagno, M. RFdemEnmAs
TAGE
ADDITIONAL WORKUP
INITIAL TREATMENT
Combination che mothe rapy m ineluding
supportive care regimens
localized
See NccN Palliative Care Guidelines
matic site:
Poor Ps(3-4)
Individualized the rapy including
Severely
supportive care regimens
debilitated
See NCCN Palliative Care Guidelines.
Lobar al
I Plain-film x-rays
→Bcne
structural impairment
Extensive
of bone s can
xtensive stace
SeaNCCN Bone cancers Guidelines
localized
weight- bearing
ymptomatic sites
Spinal cord-+ soe NCCN CNS Tumors
Chemotherapy symptomatic field rt
mptomatic-, May adminis