最新治疗方案--化疗靶向交叉治疗(2星期化疗，2星期靶向)显著延长无进展生存时间

jimmy112199

根据目前在美国芝加哥正在召开的国际肺癌研究协会会议(2008年11月13-11月15) http://www.iaslc.org/报道：
:健择+顺铂/卡铂与特罗凯交叉治疗(2星期化疗，2星期靶向)显著延长无进展生存时间， 这是与会医生介绍：

  – In an interesting Asian trial called FASTACT that compared chemo (cisplatin or carboplatin on day 1, and gemcitabine on days 1 and 8 every 28 days) with “intercalated” tarceva (erlotinib) or placebo on days 15-28 (following the practice of pharmacodynamic separation) of each cycle, the patients who received chemo and intercalated tarceva showed a significant improvement in progression free survival.  Interestingly, this benefit was seen pretty much across all patient subgroups, including smokers as well as never-smokers, men as well as women, and non-adenocarcinomas as well as adenocarcinomas.  There was also a better response rate in the patients who received chemo/erlotinib vs. chemo/placebo, though this didn’t reach statistical significance (the trial only included 154 patients).  These results are very interesting, but there was a consensus that these results with Asian patients can’t be generalized to a North American population.  It’s also important to bear in mind that the chemo didn’t overlap with tarceva: the treatments alternated, with two weeks of chemo followed by two weeks of tarceva, every 28 days.

在一个有趣亚洲试药中(称为FASTACT)，试药比较了化疗（第1天用顺铂或卡铂，第1和8天，用健择，每2 8天一个疗程）交叉特罗凯或安慰剂(疗程的第1 5-28天)，而且每个周期完全遵照药效学分离做法。病人得到化疗交叉特罗凯治疗的，显示了显着改善无进展生存率。有趣的是，这种临床受益表现在所有分组，包括吸烟者以及从未吸烟者，男人和妇女，非腺癌以及腺癌。同时，接受化疗/特罗凯组比化疗/安慰剂组，还有更好的反应率，虽然由于人数关系（试药只包括154例），这并没有达到统计学意义。这些结果是非常有趣的。但有一个共识，即这些亚洲患者的结果不能推广到北美人口。有一点是重要的，是要牢记的，化疗与特罗凯没有重叠，是治疗交替，两个星期的化疗之后两个星期的特罗凯，每28天一疗程。

---如有进一步得文献，将会随后转来

后知先觉

又是一个好消息！谢谢jjmmy112199!

共创奇迹

谢谢jimmy送来的好消息，请问有没有人用易做过类似的试验的呢？

我是小猫

是个好消息。

ljzp98

是个好消息，妈妈前些天开始用易瑞沙，身体状况改善明显，挺高兴，但是同时又担心的很，不知道什么时候就耐药了，耐药后又该怎么办呢？

yujianmin2

谢谢楼主的好消息 我本来也是这样想的  先吃易  再化疗  然后再吃易

amei

之前，我们的主治提过类似的方法，泰素蒂联合特罗凯，10天泰素蒂，10天特罗凯，但是这样的做法，不知道身体是否可以耐受，另外如果特罗凯耐药，或者特罗凯无效，这样做可能会使特罗凯重新起效么？

jimmy112199

这是文摘：时间从23。7星期增至31。3星期

Sequential Scheduling of Erlotinib with Chemotherapy as 1stlineTherapy for Advanced NSCLC: Subgroup Analyses of a
Randomized Double-Blind Placebo-Controlled Phase II Trial(FASTACT)
M. L. Liao1, Y. Wu2, V. Srimuninnimit3, J. Lee4, J. Ignacio5, M. Boyer6, C.Yu7, A. Gintings8, P. McCloud9, T. Mok10, Shanghai Chest HospiAffiliated to Jiaotong University, Shanghai, China, 2Guangdong ProvincialPeople’s Hospital, Guangzhou, China, 3Siriraj Hospital, Bangkok, Thailand,4National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea,5Philippine General Hospital, Manila, Philippines, 6Sydney Cancer Centre,Sydney, Australia, 7National Taiwan University Hospital, Taipei, Taiwan,8Central Army Hospital RSPAD, Jakarta, Indonesia, 9Roche Products Pty
Ltd, Sydney, Australia, 10Prince of Wales Hospital, Hong Kong, Hong Kong
Purpose: To determine whether sequential use of erlotinib with chemotherapy improves outcomes as 1st-line therapy for advanced NSCLC.
Methods: Eligible patients (pts) had stage IIIB/IV NSCLC and performance status 0/1. Erlotinib (E) 150mg/day or placebo (P) was given on d15–28 of 4-weekly chemotherapy cycles (up to 6 cycles) comprising gemcitabine (G) 1250mg/m2 (d1, 8) and either cisplatin (C) 75mg/m2 or carboplatin (C)AUC5 (d1). E or P were continued after chemotherapy, until disease
progression or unacceptable toxicity. Clinical subgroups were pre-defined bydisease stage, smoking history, histology, gender, age and performance status.
Results: 154 pts (median age 57 years) were enrolled from 7 Asia Pacific countries (n76 GC-E; n78 GC-P). Baseline characteristics were balanced between the two arms. There was a significant improvement in PFS (31.3 wks in GC-E vs 23.7 wks in GC-P, log-rank p0.0175; hazard ratio [HR] 0.57, 95% CI 0.38–0.84), with a 43% reduction in the risk of progression or death in favor of the GC-E arm. In pre-defined analyses, the PFS benefit for
GC-E over GC-P was apparent in all pt subgroups, such as current smokers
(HR  0.68); former smokers (HR  0.56); never smokers (HR  0.47);
adenocarcinoma (HR  0.55); non-adenocarcinoma (HR  0.79); female
(HR  0.60) and male (HR  0.63) although the sample sizes were
insufficient to detect significant differences in all cases. A difference of
12.4% in ORR (36.8% in GC-E vs 24.4% in GC-P; odds ratio  1.85) was
observed with a trend to significance (p0.0888). Median OS has not been
reached. Biomarker data are not yet available. The addition of E to GC was
generally well tolerated. Treatment-related grade 3/4 toxicities occurred in
38% of GC-E pts vs 35% of GC-P pts. Treatment-related skin toxicity was
more common in the GC-E arm (64% vs 33%), but was mostly grade 1–2 and
did not lead to discontinuation.
Conclusion: The sequential GC-E regimen significantly prolonged PFS;
benefit was observed in all clinical subgroups, including males, smokers, and
those with non-adenocarcinoma histology. Further investigation of this novel
approach in phase III is planned.
Author Disclosure Block:
M.L. Liao, None; Y. Wu, AstraZeneca, Roche, C. Consulting Fees/Honoraria;
V. Srimuninnimit, Roche, H. Research grants; J. Lee, Roche, Astra-
Zeneca, Lilly, BI, H. Research grants; J. Ignacio, None; M. Boyer, Roche,
C. Consulting Fees/Honoraria; C. Yu, AstraZeneca, Roche, Sanofi-Aventis,
C. Consulting Fees/Honoraria; A. Gintings, None; P. McCloud, Hoffmann-
La Roche, A. Financial Interest/Stock Options; Roche Products Pty
Ltd, F. Employment; T. Mok, Roche, AstraZeneca, Pfizer, Eli Lilly MSD, C.
Consulting Fees/Honoraria.
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