《ASCO 2011结直肠癌更新课件》由会员分享，可在线阅读，更多相关《ASCO 2011结直肠癌更新课件（69页珍藏版）》请在金锄头文库上搜索。
1、ASCO 2011- Updates in Colorectal Cancer -,Axel GrotheyProfessor of OncologyMayo Clinic Rochester,Noteworthy at ASCO for CRC?,No practice-changing information, but confirmation of standards of careEarly rectal cancer:Capecitabine can be used as radiosensitizer in neoadjuvant therapyAddition of oxalip
2、latin more toxic, no increase in pCR rateIs there a role for TNT (Total Neoadjuvant Therapy)?,Noteworthy at ASCO for CRC?,Early colon cancer:Value of oxaliplatin as adjuvant therapy in stage II cancers debatable Palliative therapy of CRC:IGF-R1 inhibitors conclusively ineffectiveNot all KRAS mutatio
3、ns are created equalAflibercept (VEGF-TRAP) is active and improves OS in 2nd line added to FOLFIRI(to be presented in Barcelona),The Impact of Capecitabine and Oxaliplatin in the Preoperative Multimodality Treatment of Patients with Carcinoma of the Rectum: NSABP R-04,MS Roh, GA Yothers, MJ OConnell
4、, RW Beart, HC Pitot, AF Shields, DS Parda, S Sharif, CJ Allegra, NJ Petrelli, JC Landry, DP Ryan, A Arora, TL Evans, GS Soori,L Chu, RV Landes, M Mohiuddin, S Lopa, N Wolmark1400 Patients,Compare the rate of local-regional relapse in patients receiving preoperative capecitabine with RT to patients
5、receiving preoperative CVI 5-FU with RTCompare the rate of local-regional relapse in patients receiving preoperative oxaliplatin with those not receiving preoperative oxaliplatin,NSABP R-04,Primary Aims,Roh et al. ASCO 2011,Group 4Capecitabine 825 mg/m2 PO BID + Oxaliplatin 50 mg/m2/week X 5+4600cGy
6、 + 540-1080cGy,Adenocarcinoma of rectum amenable to surgical resection located 12 cm from anal verge,STRATIFICATIONGenderClinical Tumor Stage II or IIIIntent for Type of Surgery (sphincter saving; non-sphincter saving),RANDOMIZATION,Group 3Capecitabine 825 mg/m2 PO BID +4600cGy + 540-1080cGy,Group 2
7、5FU (CVI 225mg/m2 5d/week) + Oxaliplatin 50 mg/m2/week X 5 +4600cGy + 540-1080cGy,Group 15FU (CVI 225mg/m2 5d/week)+4600cGy + 540-1080cGy,SURGERY,Roh et al. ASCO 2011,Gastrointestinal Toxicity5-Fu or CAPE vs addition of Oxaliplatin,Oxali,No Oxali,0.04,0.08,0.12,0.16,0.2,*CTCAE Version 3.0,Roh et al.
8、 ASCO 2011,Surgical Downstaging (SD) by Treatment5-FU vs Capecitabine,*Restricted to patients without pre-trial intent for SSS,Roh et al. ASCO 2011,Surgical Downstaging (SD) by TreatmentOxaliplatin vs None,*Restricted to patients without pre-trial intent for SSS,Roh et al. ASCO 2011,Pathologic Compl
9、ete Response by Treatment5-FU vs Capecitabine,Roh et al. ASCO 2011,Pathologic Complete Response by TreatmentOxaliplatin vs None,Roh et al. ASCO 2011,NSABP R-04Conclusions,Administration of capecitabine with preoperative RT achieved rates similar to continuous infusion 5-FU forSurgical downstagingSph
10、incter saving surgeryPathologic complete responseAddition of oxaliplatin did not improve outcomes and added significant toxicityLonger follow up will be needed to assess local-regional tumor relapse, DFS and OS,Roh et al. ASCO 2011,Capecitabine versus 5-fluorouracil-based (neo-)adjuvant chemo-radiot
11、herapy for locally advanced rectal cancer:Long term results of a randomized phase III trial,R. Hofheinz, F. Wenz, S. Post, A. Matzdorff, S. Laechelt, J. Hartmann, L. Mller, H. Link, M. H. Moehler, E. Kettner, E. Fritz, U. Hieber, H. W. Lindemann, M. Grunewald, S. Kremers, C. Constantin, M. Hipp, D.
12、Gencer, I. Burkholder, A. Hochhaus,on behalf of the German MARGIT study group,Treatment regimen,Arm AChemoradiotherapy50.4 Gy + Cape 1,650 mg/m days 1 38 N=197plus 5 cycles of Cape 2,500 mg/m d 1 14, rep. d 22 S I: 2 x Cape CRT 3 x Cape S II: CRT TME surgery (4 6 weeks after CRT) Cape x 5 Arm BChemo
13、radiotherapy50.4 Gy + 5-FU 225 mg/m c.i. daily S I or N=1955-FU 1,000 mg/m c.i. d 1 5 and 29 33 S II plus 4 cycles of bolus 5-FU 500mg/m d 1 5, rep. d 29 S I: 2 x 5-FU CRT 2 x 5-FU S II: CRT TME surgery (4 6 weeks after CRT) 5-FU x 4,Cape: capecitabine; CRT: chemoradiotherapy; TME: total mesorectal
14、excision; 5-FU: 5-fluorouracil,Hofheinz et al. ASCO 2011,Treatment regimen Adjuvant stratum S I,Arm A,Arm B,1,5,9,13,17,21,Radiotherapy 50.4 Gy,Capecitabine 2,500mg/m/day (during radiotherapy 1,650mg/m/day),Week,5-FU 500mg/m day 1 5 (during radiotherapy 225 mg/m/day),Radiotherapy 50.4 Gy,Hofheinz et
15、 al. ASCO 2011,Treatment regimen Neodjuvant stratum S I,Arm A,Arm B,Hofheinz et al. ASCO 2011,Neoadjuvant stratumComparison Arm A & Arm B,pCR: pathological complete remission,Hofheinz et al. ASCO 2011,Neoadjuvant stratumComparison Arm A & Arm B,Hofheinz et al. ASCO 2011,Neoadjuvant stratum Trend of
16、improved downstaging with Capecitabine,Patients receiving capecitabine exhibited less ypN-positive tumors (p = 0.09) improved T-downstaging (i.e. ypT0 2) (p = 0.07) more pCR (ypT0 ypN0): 13.2 % vs. 5.4% (p = 0.16),Hofheinz et al. ASCO 2011,Disease free survival (DFS)Secondary endpoint (Median Follow-up 52 mon.),
