方健 — 肺腺癌的综合治疗.pptx

方健

北京大学肿瘤医院

肺腺癌的内科治疗

靶向治疗的出现使突变人群临床获益延长：

从ECOG1594（中位7.4-8.1月）到LCMC（3.5年）

Patients

N

mOS(y)

Pvalue

Targetedtherapy

260

3.5

P<.001

Notargetedtherapy

318

2.4

Patientswithnodriver

360

2.1

J-H.SCHILLER,etal.NEJM2002Krisetal.JAMA2014

EGFRTKIs研究进展回顾：III期数据

（3代目前仅为II期数据）

Costa,etal.ClinCancerRes2014;Wu,etal.WCLC2013;Chen,etal.AnnOncol2013;GefitinibSmPC2010;Han,etal.JClinOncol2012Mitsudomi,etal.LancetOncol2010;Maemondo,etal.NEnglJMed2010;Sequist,etal.JClinOncol2013;Wu,etal.LancetOncol2014Yang,etal.ESMO2014;Ramalingam,etal.ASCO2015;Sequist,etal.ASCO2015

T790Mmostcommonresistancemechanism

20002005201020152020

Effectiveagainstexon19delandL858R

EGFRTKIs

Platinumchemotherapy

14

12

10

8

6

EffectiveagainstT790M

2ndGen

Afatinib

EffectiveagainstEGFRWT

PFS,月

Cx

3rdGen

BR.211

III

2/3L

EGFRunselected

Erlotinib(N=488)vs.Placebo(N=243)

2.2vs1.8

HR=0.61,p<0.001

6.7vs4.7

HR=0.70,P<0.001

TITAN2

III

2L

EGFRunselectedrapidprogress

Erlotinib(n=203)vs.Chemo§(n=221)

6.3wvs8.6w

HR=1.19,p=0.089

5.3vs5.5

HR=0.96,P=0.730

HORG3

III

2/3L

EGFRunselected

Erlotinib(n=166)vs.Pem(n=166)*

3.6vs2.9

P=0.136

8.2vs10.1

P=0.986

ISEL4

III

2/3L

EGFRunselected

Gefitinib(n=1129)vs.Placebo(n=563)

3.0vs.2.6(TTP)p=0.0006

5.6vs.5.1

HR=0.89p=0.087;(0.77-1.02)

INTER

EST5

III

2/3L

EGFRunselected

Gefitinib(n=723)vs.Placebo(n=710)

2.2vs2.7

HR=1.04,p=0.47

7.6vs8.0

HR(96%CI)=

1.020(0.905,1.150)

在非选择经治人群中，EGFRTKI的疗效优于安慰剂，与单药化疗相似

§PemorDoc

*36squamouscarcinomareceivedpemtrexedtreatment

1.FrancesA,etal.NEJM2005;2.Ciuleanu,etal.LancetOncol2012;

3.Karampeazis,etal.Cancer2013;4.ThatcherN,etal.Lancet2005;366:1527-37;5.Edwardetal.Lancet2008;372:1809-18

EGFRTKIs在非选择人群中的疗效

TrialPhLinePopulation