3. T1 T2 T3 T4 N0 N1 N2 N3 M1 Lung (Non-Small Cell Carcinomas IV IV IV IV IIIB IIIB IIIB IIIB IIIB IIIA IIIA IIIA IIIB IIIA IIA IIA IIIB IIB IB * IA
4. Relative survival rates for patients with NSCLC diagnosed in the United States in 1992 and 1993.Data from the National Cancer Data Base (commission on Cancer of the American College of Surgeons and the American Cancer Society) Lung (Non-Small Cell Carcinomas
41. 四组化疗方案对晚期初治 NSCLC 患者效果的比较 Kubota, Karmanos CRC(Abstract7106,2000.10-2002.6) 60 14.8 MO 4.0 mo 30.1 Gemcitabine 1g/m2 ,d1,8 DDP 80 mg/m2 ,d1 Repeat every 21 days GP(146n) 48 11.4 4.1 33.1 Vinorelbine 25mg/m2 ,d1,8 DDP 80 mg/m2 ,d1 Repeat every 21 days NP(145n) 59 14.2 4.7 31.0 Irinotecan 60mg/m2 ,d1,8,15 DDP 80 mg/m2 ,d1 Repeat every 28 days IP(145n) 51 12.3 MO 4.5 mo 32.4 Paclitaxel 200mg/m2 Carboplatin AUC 6 Repeat every 21 days TC(145n) One Year OS(%) Median OS Median TTP RR (%) Drug doses and schedules Regimen
43. Non-Small-Cell Lung Cancer—Frontline Therapy Myelosuppression, Thtombocytopenia, Anemia,Nausea or vomiting, Neurotoxicity, Nephrotoxicity ,Constipation, or diarrhea, Dyspnea,Asthenia,Rash,Cardiotoxicity N Engl J Med 346:92,2002 J Clin Oncol 18:122,2002 J Clin Oncol 21:3025,2003 8—9.5mo 4.2—5.7mo 22—30% Cisplatin 60---100 mg/m2 IV over 2 hours day 1 Gemcitabine 1,000 mg/m2 IV over 30 minutes days 1and 8 Repeat every 21 days for 6 cycles. Cisplatin + Gemcitabine Myelosuppression ,Anemia,Thrombocytopenia, infection ,Nausea or vomiting,Neurotoxicity , Nephrotoxicity,Asthenia,Hypersensitivity, Cardiotoxicity ,Diarrhea,Anorexia J Clin Oncol 21:3016,2003 N Engl J Med 346:92,2002 7.4—11.3 mo 3.7—5.5 mo 17-31% Docetaxel 75 mg/m2 IV over 1 hour Followed by Cisplatin 75 mg/m2 IV over 2 hours Repeat every 21 days for 6 cycles. Docetaxel + Cisplatin Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen
44. Non-Small-Cell Lung Cancer—Frontline Therapy Neutropenia,Anemia,Thrombocytopenia,Nausea,or vomiting, Diarrhea,Hypomagnesemia,Melosuppression,Cardiotoxicity,Pulmonary, Constipation,Fatigue J Clin Oncol 21:3025,2003 J Natl Cancer Inst 95:362,2003 7.5—8 mo 4.25—4.75 mo 21—25% Gemcitabine 800-1200mg/m2 IV over 30 minutes days 1 and 8 Vinorelbine 25-30 mg/m2 IV over 10 minutes days 1 and 8 Repeat every 21 days Gemcitabine + Vinorelbine Myelosuppression,Thrombocytopenia,Anemia, Nausea or vomiting ,Alopecia, Bleeding , Liver function, test elevation, Neurotoxicity , infection Lung Cancer 41:321,2003 8 mo 4.75 mo 29.2% Carboplatin AUC 6 IV over 30—60minutes day 1 Gemcitabine 1,000-1,200mg/m2 IV over 30 minutes days 1 and 8 Repeat every 21days for 6cycles Carboplatin + Gemcitabine Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen
45. Non-Small-Cell Lung Cancer—Frontline Therapy Key point : The carboplatin dose is determined on the basis of the Calvert formula: (glomerylar filtration rate + 25) *AUC. Myelosuppression, Anemia, Thrombocytopnia Infection ,Nausea or vomiting Asthenia ,Pulmonary ,pain , Diarrhea,Anorexia J Clin Oncol 21:3016,2003 9.4 MO 5 mo 24% Docetaxel 75 mg/m2 IV over 1 hour Followed by Carboplatin AUC 6 IV over 30—60 minutes Repeat every 21 days for 6 cycles Docetaxel + Carboplatin Neutropnia , Thrombocytopenia, Anemia,Nausea or Vomiting, Neurotoxicity (sensory and motor), Fatigue ,Alopecia, ,Dehydration,Diarrhea,Myalgia or arthralgia J Clin oncol 19:3210,2001 Ann Oncol 11:799,2000 8.6-11.4 MO 4-6.5 mo 25—32% Paclitaxel 175-225 mg/m2 IV over 3 hours Followed by Carboplatin AUC 6 IV over 30—60 minutes Repeat every 21 days for 6 cycles. Paclitaxel + Carboplatin Grade 3 and 4 Side Effects ; Reference(s) Median OS Median TTP RR Drug doses and schedules Regimen
46. Small-Cell Lung Cancer—Frontline Therapy Neutropenia,Thrombocytopenia,Anemia,Leukopenia,Nausea or vomiting , Astheniam, Fever , AST or ALT elevation ,infection N Engl J Med 340:265,1999 J Clin Oncol 10:282,1992 J Natl Cancer Inst 83:855,1991 8.6-9.9 mo 4.3 mo 61-78% Cisplatin 60-100 mg/m2 IV over 2 hours day 1 Etoposide 80 -120 mg/m2 IV over 4 hours days 1-3 Repeat every 21 days. Cisplatin + Etoposide Neutropenia,Leukopenia,Anemia,Thrombocytopenia,Liver function test elevations(1-2%),Hyponatremia,infection,Arterial oxygen pressure J Clin Oncol 17:3540,1999 8.6-10.8mo 4.3-6.4 mo 61-75% Carboplatin AUC 6 IV over 30-60minutes day 1 Etoposide 100mg/m2 IV over 4hours days1-3 Repeat every 21 days Date from phase 11 trial . Carboplatin + Etoposide Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen
47. Small-Cell Lung Cancer—Frontline Therapy Neutropenia,Leukopenia,Anemia, Throbocytopenia,Diarrhea,Nausea or vomiting ,infection ,ALT elevation ,Fever ,Arterial oxygen pressure N Engl j Med 346:85,2002 12.8 mo 6.9 mo 84.4% Cisplatin 60 mg/m2 IV over 2 hours day 1 Irinotecan 60 mg/m2 IV over 90 minutes days 1 and 8 Repeat every 21 days Cisplatin + Irinotecan Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen
48. Non-Small-Cell Lung Cancer—Frontline Therapy Neutropenia,Anemia,Thrombocytopenia,Nausea,or vomiting, Diarrhea,Hypomagnesemia,Melosuppression,Cardiotoxicity,Pulmonary, Constipation,Fatigue J Clin Oncol 21:3025,2003 J Natl Cancer Inst 95:362,2003 7.5—8 mo 4.25—4.75 mo 21—25% Gemcitabine 800-1200mg/m2 IV over 30 minutes days 1 and 8 Vinorelbine 25-30 mg/m2 IV over 10 minutes days 1 and 8 Repeat every 21 days Gemcitabine + Vinorelbine Myelosuppression,Thrombocytopenia,Anemia, Nausea or vomiting ,Alopecia, Bleeding , Liver function, test elevation, Neurotoxicity , infection Lung Cancer 41:321,2003 8 mo 4.75 mo 29.2% Carboplatin AUC 6 IV over 30—60minutes day 1 Gemcitabine 1,000-1,200mg/m2 IV over 30 minutes days 1 and 8 Repeat every 21days for 6cycles Carboplatin + Gemcitabine Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen
62. Non-Small-Cell Lung Cancer—Salvage Therapy Leukopenia,Throbocytopenia,Fatigue,Nausea or vomiting ,Pulmonary,infection , Alopcia,Cutaneous Lung Cancer 29:67,2000 J Clin Oncol 17:2081,1999 4 mo Not available 6-19% Gemcitabine 1,000 mg/m2 IV over 30 minutes days 1 ,8,and15 Repeat every 28 days . Date from phase 11 trial. Gemcitabine* Neutropenia, Anemia , Nausea or vomiting, Asthenia, Diarrhea,Cardiotoxicity,Fluid retention, Neurotoxicity,(sensory and motor), Pulmonary,Stomatitis,infection J Clin Oncol 18:2059,2000 J Clin Oncol 18:2354,2000 5.7-7 mo 2.1-2.6 mo 6.7-7.1% Docetaxel 75 mg/m2 IV over 1 hour Repeat every 21 days Docetaxel Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Doses and Schedules Drug
63. Non-Small-Cell Lung Cancer—Salvage Therapy Leukopenia,Anemia,Thrombocytopenia, Neutropenia,Fever , Fatigue , Septic death Lung Cancer 29:91,2000 3.2 mo Not available 0—20% Vinorelbine 25-30mg/m2 IV over 10 minutes days 1,8,and 15 Repeat every 21-18 days Date from phase 11 trial Vinorelbine Leukopenia,Anemia,Myelosuppression , Diarrhdea, Nausea or vomiting ,Pulmonary toxicity J Clin Oncol 10:12,1992 10.5 mo 3.75 mo 31% Irinotecan 80-100 mg/m2 IV over 90 minutes days 1,8,and 15 Repeat every 21-18 days *Date from phase 11 trial in chemonaive patients Irinotecan Diarrhea,1% Rash,1% ALT elevation, 1% J clin Oncol 21:136,2003 JAMA 290:2149,2003 7-7.6 mo 2.7-7 mo 12-18.4% Gefitinib 250 mg PO daily continuously *Date from phase 11 trial Gefitinib Grade 3 and 4 Side Effects; Reference(s) Median OS Median TTP RR Drug Doses and Schedules Regimen