Aung thiha soe

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Aung thiha soe

  1. 1. <ul><li>M.V. Lomonosov Moscow State University Faculty of Basic Medicine </li></ul><ul><li>Supervisor: </li></ul><ul><li>M.D. A.F.Marenich </li></ul><ul><li>2010,Moscow </li></ul>
  2. 2. <ul><li>Lung cancer is the commonest malignancy and leading cause of cancer deaths. </li></ul><ul><li>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. </li></ul><ul><li>The conservative methods of treatment occupy key place. </li></ul>
  3. 3. <ul><li>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. </li></ul><ul><li>According to stages </li></ul><ul><li>I - > 60% </li></ul><ul><li>II - 30 - 60% </li></ul><ul><li>III - 5 - 30% </li></ul><ul><li>IV - < 5% </li></ul><ul><li>If high mitotic rate and tumor necrosis associated with poor prognosis. </li></ul>
  4. 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. 5. <ul><li>EGFR is expressed in 40 - 80% of lung cancers. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Bevacizumab, to improve survival when combined with chemotherapy in the first-line setting. </li></ul><ul><li>In currently aflibercept with the combination of other drugs is in phase III cliinical trails. </li></ul>
  6. 6. <ul><li>To determine the significant effects of different chemotherpy regimes </li></ul>
  7. 7. <ul><li>To identify which one is more effective than other chemotherapy regimes </li></ul><ul><li>To determine the toxicities of the drugs </li></ul>
  8. 8. <ul><li>Patients and method </li></ul><ul><li>Retrospective study </li></ul><ul><li>Patients </li></ul><ul><li>- 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. </li></ul><ul><li>Treatment program </li></ul><ul><li>- combination therapy for first line </li></ul><ul><li>- single drug for second line </li></ul><ul><li>Follow up </li></ul><ul><li>- every two courses , patients were followed up annually </li></ul><ul><li>- According to the patient’s status , response to treatment and progression, further therapy are given. </li></ul>
  9. 9. <ul><li>First line combination drugs </li></ul>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. 10. <ul><li>Second line single drug </li></ul>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. 14. <ul><li>No clinical response for second line drug </li></ul>
  12. 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 - -
  13. 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 - -
  14. 19. <ul><li>Diarrhoea is common toxicity for second line drugs. </li></ul><ul><li>About 30-40% of patients. </li></ul><ul><li>Oesophagitis is common complication of radiothearpy. </li></ul>
  15. 20. <ul><li>Most common and most lethal malignancies worldwide </li></ul><ul><li>5 years survival rate for stage IIIA, IIIB, and IV were 10-30%, <10%, and <5% respectively </li></ul><ul><li>The aim is to relieve the symptoms and for longer duration of life. </li></ul><ul><li>According to the sample size and limitation of the study, there is no significant result </li></ul><ul><li>Overall response was only 9 patients (9.47%) </li></ul><ul><li>The most effective regimes was GPR (gemcitabine + Platinum based + Radiotherapy) regime </li></ul><ul><li>Clinical response (21.43%) </li></ul><ul><li>The effectiveness of regime than other regimes is 65.43% </li></ul><ul><li>The relative response rate than other regimes is nearly 3 times </li></ul><ul><li>95% confidence interval of relative response is 0.82-10.27 </li></ul>
  16. 21. <ul><li>For first line drugs </li></ul><ul><li>Blood toxicities is more than others and leucopenia is the most (average 50%) </li></ul><ul><li>GI toxicities is the second and fatigue stand third position </li></ul><ul><li>For second line drugs </li></ul><ul><li>Diarrhoea is common toxicity </li></ul><ul><li>All toxicities not more than grade III (CTCAE) </li></ul><ul><li>For radiotherapy </li></ul><ul><li>Oesophagitis is the most common radio toxicities </li></ul>
  17. 22. <ul><li>This study showed the efficacy and toxicities of different combined chemotherapy </li></ul><ul><li>No statistically significant for each regime </li></ul><ul><li>GPR (gemcitabine + platinum based + radiotherapy) regime was more effective than other regimes </li></ul><ul><li>Blood toxicities is more than others </li></ul><ul><li>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. </li></ul>

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