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1、胃癌治疗现状及 2008ASCO进展,Rui-hua Xu (徐瑞华） Sun Yat-sen University Cancer Center Tel: 020-8734 3468,胃癌治疗有效的化疗药物,Old Drugs Fluoropyrimidines 5-FU Platinum Cisplatin Anthracyclines Doxorubicin Epirubicin Etoposide Methotrexate,New Drugs Fluoropyrimidines Capecitabine S-1 Platinum Oxaliplatin Taxanes Paclitax
2、el Docetaxel Irinotecan,FP vs FAM vs UFTM: JCOG 9912 trial,Ohtsu et al 2003,FP 5-FU UFTM p value,No. Patients 105 105 70,Response (%) 34.8 11.4 8.6 0.0001,PFS (weeks) 3.9 1.9 2.4 0.001,MS (weeks) 7.1 7.3 6.0 NS,UFTM, tegafur uracil / mitomycin,Waters et al 1999,ECF vs FAMTX: UK Trial,Chemotherapy fo
3、r gastric cancer in the past,FP regimen has been the standard or reference regimen in Asia ECF is recommended mostly in Europe,Where we have been in AGC 我们所知道的胃癌化疗,Eloxatin: REAL-2, phase III Xeloda: ML17032, phase III Taxotere: TAX 325, phase III CPT-11 V306, phase III Eloxatin: FLO vs FLP, phase I
4、II S1: JCOG 9912, phase III S1: SPIRITS, phase III 2008 ASCO DC vs FLP phase III Phase II clinical trials,E Epirubicin 50 mg/m2 iv C Cisplatin 60 mg/m2 iv F PVI 5-FU 200 mg/m2/day q3w,REAL-2: 研究设计,2 x 2 randomisation Planned treatment duration 24 weeks,E Epirubicin 50 mg/m2 iv C Cisplatin 60 mg/m2 i
5、v X Capecitabine 625 mg/m2/bid q3w,E Epirubicin 50 mg/m2 iv O Oxaliplatin 130 mg/m2 iv F PVI 5-FU 200 mg/m2/day q3w,E Epirubicin 50 mg/m2 iv O Oxaliplatin 130 mg/m2 iv X Capecitabine 625 mg/m2/bid q3w,PVI, portal vein infusion,Cunningham D, et al. ASCO 2006 (Abstract LBA4017).,Hazard ratio (95% CI):
6、 0.86 (0.800.99),Time (years),Probability (%),0,1,2,3,4,5,6,0,20,40,60,80,100,8,206,178,37,52,12,No. at risk,484,480,28,3,1,5-FU,Capecitabine,5-FU,Capecita-bine,Cunningham D, et al. ASCO 2006 (Abstract LBA4017).,REAL-2: overall survival for fluoropyrimidine comparison (per protocol),REAL-2: overall
7、survival for platinum comparison (per protocol),Hazard ratio (95% CI): 0.92 (0.801.10),Probability (%),0,1,2,3,4,5,6,0,20,40,60,80,100,10,198,187,41,48,10,490,474,1,4,1,Cisplatin,Oxaliplatin,Cisplatin,Oxaliplatin,Time (years),No. at risk,Cunningham D, et al. ASCO 2006 (Abstract LBA4017).,ECF EOX,Pro
8、bability (%),Time (years),Cunningham D, et al. ASCO 2006 (Abstract LBA4017).,REAL-2: overall survival for ECF and EOX (ITT),*p0.05 vs ECF; *p70 Adequate hematologic/ biochemical parameters No prior palliative chemotherapy,RANDOM I S A T I ON,Treatment until PD, consent withdrawn or unacceptable toxi
9、city; tumor assessments q8w,Docetaxel-based chemotherapy in advanced gastric cancer: Phase III trial (TAX 325),Van Cutsem E, et al. J Clin Oncol (accepted for publication).,Log-rank p=0.0004 Hazard ratio: 1.47 (95% CI: 1.191.83) Risk reduction: 32.1%,0,0,10,20,30,40,50,60,70,80,90,100,DCF,CF,3,6,9,12,15,18,21,24,Probability (%),TAX 325: time to progression (primary endpoint),Time (months),
