文档介绍：胃癌内科治疗
内科治疗的几个问题
晚期胃癌的最佳化疗方案;
化疗获益后如何安排后续治疗;
Alimita, Bortezomib, Cetuximab和bevacizumab的定位;
Study
Regimen
N
RR (%)
p-value
MST
p-value
EORTC
1991
FAM
FAMTX
103
105
9
41
<.0001
29 w
42 w
.004
1992
FAMTX
EAP
30
30
33
20
NS
m
m
NS
NCCTG
1994
FAP
FAMe
FAMe+TZT
51
53
79
m
m
m
NS
MRC
1997
FAMTX
ECF
108
111
21
45
.002
m
m
.009
EORTC
2000
FAMTX
ELF
FP
92
93
98
12
9
20
NS
m
m
m
NS
哪个方案更好?
90年代的III 期临床试验结果
化疗相对敏感;
临床疗效一般,主要起姑息作用,但比 BSC好;
ECF、FAMTX、EAP 方案的PR 30-50%; CR 罕见,
缓解期短,OS 6-10 个月,毒性大;
没有标准方案:
5-FU/ PDD 为基础的方案如:
ECF、5FU/LV/PDD 或 5FU/ PDD 为“参考”方案。
90年代的化疗状况
Agent No RR(%) 95% CI
Paclitaxel 212 24 20-28%
Docetaxel 157 22 18-26%
Irinotecan 135 17 12-24%
Capecitabine 69 29 20-38%
S1 94 44 34-54%
单药一线治疗
LV5FU2
n= 45
LV5FU2-cisplatin
n=44
LV5FU2-irinotecan
n=45
CR
0%
0%
0%
PR.
13%
27%
40%
Overall resp.
CI 95%
13%
[-]
27%
[-]
40%
[-]
SD
36%
39%
20%
PD
40%
20%
17%
Response rate as per independent review (eligible population & WHO criteria)
Gastric Cancer Study
months
0
10
20
30
40
50
60
70
80
90
100
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
%
LV5FU2 (n=45) mo.
95% CI (-)
LV5FU2-P (n=44) mo.
95% CI (-)
LV5FU2-I (n=45) mo.
95% CI (-)
Progression-free survival
Gastric Cancer Study
Capecitabine and Cisplatin for AGC
Capecitabine 1250 mg/m2 po bid Day 1-14 Cisplatin 60 mg/m2 iv Day 1
q 3 weeks
No. of patients 42 Response 55 % Time to progression m Median survival time m
Asian Medical Center Trial, Korea
Paclitaxel 80 mg/m2 iv (1h) weekly x 6 Cisplatin 50 mg/m2 iv Day 8, 29 5-FU 2000 mg/m2 iv (civ) weekly x 6 Lv 500 mg/m2 iv (2h) weekly x 6 q 7 weeks No. of patients 29 Response 48 % (4CR) Time to progression 8 m Median survival time 11 m
Paclitaxel, CIFU and Cisplatin (TCF)
Honecker, Ant