非小细胞肺癌NCCN解读

Chemotherapy—Adjuvant therapy
Chemotherapy—Adjuvant therapy
Chemotherapy—Adjuvant therapy
Chemotherapy—Concurrent therapy
Chemotherapy—Concurrent therapy
Prognostic factors
• Stage(early)
• PS(≤2) • Weight loss(<5%)
• Gender(female)
Immunohistochemical staining
• Differentiate primary pulmonary adenocarcinoma from metastatic adenocarcinoma to the lung:TTF1,CK-7,CK20,CDX-2
Targeted therapy—Cetuximab
Follow-up
THANKS
• Complete mediastinal lymphadenectomy removes one or more lymph nodes from all mediastinal stations • Adequate mediastinal lymphadenectomy should include stations 2R, 4R, 7, 8, and 9 for right sided cancers and stations 4L, 5, 6, 7, 8 and 9 for left sided cancers. Six or more nodes were resected in 99% of patients in this study
Staging
Staging
Staging
Treatment approaches
• • • •
Surgery Radiation therapy Chemotherapy Targeted therapy
Surgery
Surgery—Lymph node dissection
Surgery—Lymph node dissection
Chemotherapy—Palliative therapy
Chemotherapy—Palliative therapy
Chemotherapy—Drugs
Targeted therapy
• Bevacizumab:a recombinant monoclonal antibody
that blocks VEGF
K-ras mutations
• K-ras mutational status is prognostic of survival.Patients with K-ras mutation have shorter survival than patients with wild-type K-ras • K-ras mutational status is also predictive of therapeutic efficacy from EGFT-TKIs. Patients without K-ras mutation have better response than patients with it
ERCC1 level of expression
• In patients with completely resected NSCLC who did not receive perioperative chemontherapy or radiation,ERCC1 mRNA levels were prognostic of survival.Patients whose tumors had high levels lived signficicantly longer than patients whose tumors had low levels • ERCC1 levels can predict the efficacy of platinum-based chemotherapies in NSCLC:high levels are associated with resistance,while low levels are associated with sensitivity
Radiation therapy
Radiation therapy—N2 disease
Radiation therapy—N2 disease
Radiation therapy
Radiation therapy—Preoperation radiotherapy
Radiation therapy—Preoperation radiotherapy
EML4-ALK mutations
• The patients who have EML4-ALK mutations are resistant to EGFR TKIs but are otherwise similar to those with EGFR mutations (ie.adenocarcinoma,nonsmokers,female)
Radiation therapy
Radiation therapy
Radiation therapy—SBRT
Radiation therapy—SBRT
Radiation therapy—PCI
Radiation therapy
Radiation therapy
Chemotherapy—Adjuvant therapy
RRM1 level of expression
• In patients with completely resected NSCLC who did not receive perioperative chemontherapy or radiation, RRM1 mRNA levels were prognostic of survival.Patients whose tumors had high levels lived signficicantly longer than patients whose tumors had low levels • RRM1 protein levels were significantly and inversely correlated with disease response to gemcitabine or carboplatin,that is,response was better in patients with low levels of RRM1 expression
Non-Small Cell Lung Cancer
NCCN Guidelines
Overview
• Lung cancer is the leading cause of cancer death in United States.And only 15.8% of all lung cancer patients are alive 5 years or more after diagnosis • The primary risk factor for lung cancer is smoking, which accounts for more than 85~90% of all lung cancer-related deaths • The routine use of screening CT is not recommended as standard clinical practice.But high risk individuals (those who are 55~74 years old and either current or former smokers with a 30-pack year smoking history )are recommended to participate in a clincal trail evaluating CT screening
• Distinguish adenocarcinoma from malignant mesothelioma:CEA,B72.3,Ber-EP4,MOC31,WT1,calretinin,D2-40,cytokeratiredictive biomarkers
• • • • • EGFR mutations K-ras mutations EML4-ALK mutations ERCC1 level of expression RRM1 level of expression
EGFR mutations
• The presence of the EGFR exon 19 deletion or exon 21 L858R mutation is predictive of treatment benefit from EGFR-TKI therapy
• Erlotinib:a small molecule inhibitor of EGFR
• Cetuximab:a monoclonal antibody that targets
EGFR
Targeted therapy—Bevacizumab
Targeted therapy—Erlotinib