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  • 1.
    • M.V. Lomonosov Moscow State University Faculty of Basic Medicine
    • Supervisor:
    • M.D. A.F.Marenich
    • 2010,Moscow
  • 2.
    • Lung cancer is the commonest malignancy and leading cause of cancer deaths.
    • At the moment , the development of Non Small Cell Lung Cancer (NSCLC) in 25 – 30% of cases is diagnosed the local-extended process and in 40 – 50% distant metastasis are revealed.
    • The conservative methods of treatment occupy key place.
  • 3.
    • The 5-year relative survival rate varies markedly depending on the stage at diagnosis, from 49% to 16% to 2% for patients with local, regional, and distant stage disease respectively.
    • According to stages
    • I - > 60%
    • II - 30 - 60%
    • III - 5 - 30%
    • IV - < 5%
    • If high mitotic rate and tumor necrosis associated with poor prognosis.
  • 4. Published Chemotherapy Regimens Schedule 1 Cisplaitn 50 mg/m 2 days 1 and 8 Vinorelbine 25 mg/m 2 days 1, 8, 15, 22 Every 28 days for 4 cycles 2 Cisplaitn 100 mg/m 2 on day 1 Vinorelbine 30 mg/m 2 days 1, 8, 15, 22 Every 28 days for 4 cycles 3 Cisplaitn 75-80 mg/m 2 on day 1 Vinorelbine 25-30 mg/m 2 days 1, 8 Every 28 days for 4 cycles 4 Cisplaitn 100 mg/m 2 on day 1 Etoposide 100 mg/m 2 day 1-3 Every 28 days for 4 cycles 5 Cisplaitn 80 mg/m 2 day 1 Vinblastine 4 mg/m 2 days 1, 8, 15, 22 Every 28 days for 4 cycles Acceptable Cisplaitn-base Regimens 1 Cisplatin 80 mg/m 2 on day 1 Gemcitabine 1000 mg/m 2 on days 1, 8 Every 21 days 2 Cisplatin 80 mg/m 2 Docetaxel 75 mg/m 2 Every 21 days Chemotherapy Regimens for patients with comorbidities or patients not able to tolerate cisplatin 1 Paclitaxel 200 mg/m 2 on day 1 Carboplatin AUC 6 on day 1 Every 21 days
  • 5.
    • EGFR is expressed in 40 - 80% of lung cancers.
    • Gefitinib (Iressa 250 mg) and erlotinib (Tarseva 150 mg) were the first two agents to target the tyrosine kinase of the EGFR. Both of these agents have activity in NSCLC.
    • On the 1 st July 2009 the European Commission granted marketing authorisation for IRESSA for the treatment of adults with locally advanced or metastatic NSCLC.
    • The National Institute for Clinical Excellence (NICE) has approved Tarceva® as an alternative treatment to the chemotherapy drug docetaxel for people with non-small cell lung cancer.
    • Bevacizumab, to improve survival when combined with chemotherapy in the first-line setting.
    • In currently aflibercept with the combination of other drugs is in phase III cliinical trails.
  • 6.
    • To determine the significant effects of different chemotherpy regimes
  • 7.
    • To identify which one is more effective than other chemotherapy regimes
    • To determine the toxicities of the drugs
  • 8.
    • Patients and method
    • Retrospective study
    • Patients
    • - 95 patients with nom small cell lung cancer stage III – IV (Blokhin’s Russian Cancer Research Center from 2007 to march 2008) ECOG performance status <2.
    • Treatment program
    • - combination therapy for first line
    • - single drug for second line
    • Follow up
    • - every two courses , patients were followed up annually
    • - According to the patient’s status , response to treatment and progression, further therapy are given.
  • 9.
    • First line combination drugs
    Regimens Patients % 1 Gemcetabine + Cisplatin 29 30.53 2 Gemcetabine + Carboplatin 8 8.42 3 Gemcetabine + Platinum base + Radiotherapy 14 14.74 4 Gemcetabine + Platinum base + Avastin 4 4.21 5 Etoposite + Platinum base 15 15.79 6 Etoposite + Platinum base + Radiotherapy 2 2.10 7 Taxane base + Platinum base 14 14.74 8 Taxane base + Platinum base + Radiotherapy 6 6.31 9 Taxane base + Platinum base + Avastin 3 3.16
  • 10.
    • Second line single drug
    Regimens patients 1 Docetaxel 75-80 mg/ m 2 7 2 Irinotecan 200 mg/ m 2 3 3 Tarceva 150 mg/ m 2 5 4 Iressa 250 mg/ m 2 5
  • 11.  
  • 12.  
  • 13.  
  • 14.
    • No clinical response for second line drug
  • 15. Regimes GC GCar GPR GPA Total No. 29 8 14 4 No. % No. % No. % No. % Anaemia 4 13.79 1 12.50 4 28.57 - - Leucopenia 16 55.17 5 62.50 9 64.28 3 75 Lymphopenia 3 10.34 1 12.50 2 14.29 2 50 Thrombopenia 6 20.69 3 37.50 5 35.71 - - N & V 12 41.38 2 25.00 9 64.28 2 50 Increase Cr 4 13.79 1 12.50 3 21.43 - - Diarrhoea 2 6.90 - - 2 14.29 - - Hepatotoxicity 1 3.45 2 25.00 - - - - Fever 4 13.79 2 25.00 3 21.43 - - Nephrotoxicity 1 3.45 - - - - - - Fatigue 10 34.48 4 50.00 8 57.14 - -
  • 16.  
  • 17. Regimes EP TP TPR Total No. 15 14 6 No. % No. % No. % Anaemia - - - - 1 16.67 Leucopenia - - 6 42.86 3 50 Thrombopenia - - - - 1 16.67 N & V 4 26.67 3 21.43 2 33.33 Diarrhoea - - - - 1 16.67 Fever 1 6.67 1 7.14 1 16.67 Nephrotoxicity 1 6.67 - - - - Neuropathy - - 3 21.43 - - Fatigue - - 3 21.43 1 16.67 Myalgia - - 3 21.43 - -
  • 18.  
  • 19.
    • Diarrhoea is common toxicity for second line drugs.
    • About 30-40% of patients.
    • Oesophagitis is common complication of radiothearpy.
  • 20.
    • Most common and most lethal malignancies worldwide
    • 5 years survival rate for stage IIIA, IIIB, and IV were 10-30%, <10%, and <5% respectively
    • The aim is to relieve the symptoms and for longer duration of life.
    • According to the sample size and limitation of the study, there is no significant result
    • Overall response was only 9 patients (9.47%)
    • The most effective regimes was GPR (gemcitabine + Platinum based + Radiotherapy) regime
    • Clinical response (21.43%)
    • The effectiveness of regime than other regimes is 65.43%
    • The relative response rate than other regimes is nearly 3 times
    • 95% confidence interval of relative response is 0.82-10.27
  • 21.
    • For first line drugs
    • Blood toxicities is more than others and leucopenia is the most (average 50%)
    • GI toxicities is the second and fatigue stand third position
    • For second line drugs
    • Diarrhoea is common toxicity
    • All toxicities not more than grade III (CTCAE)
    • For radiotherapy
    • Oesophagitis is the most common radio toxicities
  • 22.
    • This study showed the efficacy and toxicities of different combined chemotherapy
    • No statistically significant for each regime
    • GPR (gemcitabine + platinum based + radiotherapy) regime was more effective than other regimes
    • Blood toxicities is more than others
    • Use the treatment program for the cancer patient is depend on the patient and risk and benefit of the chemo regime effect on the patient.
  • 23.