爱必妥联合放化or化疗食道癌ASCO.ppt

概述 食道癌占全球癌症死因第6位 亚洲国家常见病理类型：鳞状细胞癌 西方国家常见病理类型：腺癌 50-80％的食道癌有EGFR表达 C-225联合同步放化疗治疗胃食道癌 治疗方案： C-225：400mg/m2（第1周），250mg/m2（第2-6周） 紫杉醇：50mg/m2/w + 卡铂 AUC＝2/w（第1-6周） 同步放疗：DT 50.4Gy/28F Safran H,et al. Int.J.Radiat Oncol Biol Phys. 2007.10 爱必妥治疗食管癌 治疗模式有同步放化疗、新辅助爱必妥+化疗、新辅助爱必妥+放化疗 小样本初步结果令人鼓舞 最合适的治疗模式有待进一步研究 安全性有待进一步观察 结论 C-225联合紫杉醇、卡铂的同步放化疗治疗胃食道癌患者是安全的 C-225会增加皮肤毒性和过敏反应的发生率 C-225最突出的皮肤毒性反应表现为：颜面部疼痛、掻痒的痤疮样皮疹，其他常见的部位包括胸部和腹部 放疗区域皮肤的皮疹并没有加重 皮疹在治疗的第1-3周最为严重 口服强力霉素、头孢氨苄可用于治疗皮疹 Methods: Main inclusion criteria were: stage III squamous cell or adenocarcinoma of the esophagus or gastroesophageal junction; WHO PS 0-1; age 18-80 years; weight loss 15% in the last 6 months. Patients (pts) received 2 cycles of induction FOLFOX plus cetuximab therapy, then 50.4Gy of radiation with FOLFOX plus cetuximab. Tumor evaluation was performed at the end of CRT. Primary end-point was the overall response rate (ORR, RECIST). Results: male/female 24/12, median age 63 years (23-79), PS 0/1/ND 22/13/1, squamous/adenocarcinoma/undifferentiated 20/15/1; esophagus/cardia 32/4; median daily caloric intake 1720 Kcal (1115-2551). 35 pts were treated by CRT (one pt experienced G4 allergy during the first cetuximab infusion). ORR was achieved in 28 pts (CR/PR: 14/14; 10 confirmed response), 5 pts had stable disease, and 1 pt had disease progression (2 pts were not evaluable). Among 18 patients with unconfirmed tumor response, 14 had no PD ≥ 1 month after evaluation; ITT ORR of 66.6% (24/36). Grade 3/4 toxicities induction therapy/CRT (%): neutropenia: 0/17.1; febrile neutropenia: 0/2.9; vomiting: 2.8/0; mucitis: 2.8/2.9; diarrhea: 5.6/2.9; dysphagia-esophagitis: 2.9/2.9; rash: 8.3/5.7; allergy 2.8/0. Conclusions: Preliminary analysis suggests that CRT with FOLFOX-cetuximab is safe and active in cardia or esophagus cancer, supporting continuation of the study until the planned accrual of 80 pts. Concurrent chemoradiotherapy with ce