肺癌基因突变于化疗疗效分析培训课件

Clinical question: Could vinorelbine and cisplatinum have adjuvant benefits for survival in stage IB and II NSCLC patients?
Molecular pathology question: Could we identify molecular markers in the tumor tissue of these patients that can predict improvement in survival with or without adjuvant chemotherapy?
I
36 %
~ 40%
II
8%
5-year survival rate 60 %
39 %
IIIA
10 %
23 %
IIIB
20 %
5%
IV
2/1/2021
27 %
肺癌基因突变于化疗疗效分析
<1 %
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National Cancer Institute of Canada (NCIC-CTG BR.10 Trial)
100
100
Cumulative Proportion Surviving Cumulative Proportion Surviving
80
80
60 S ta g e I
40
S ta g e II
20
S ta g e IIIb S ta g e IIIa
S ta g e IV
0
12
24 36
48 60
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肺癌基因突变于化疗疗效分析
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NCIC-CTG BR.10 Trial
Patients’ tumor and normal lung tissue collected in a paraffin block and frozen tumor bank and analysed for presence or absence of ras gene mutation
with companion tumor marker evaluation
Principal Investigator: Dr. Tim Winton
Started in 1994 Completed in 2001
Results presented at ASCO 2004
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肺癌基因突变于化疗疗效分析
2/1/2021
肺癌基因突变于化疗疗效分析
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NCIC-CTG BR.10 Trial
Patients: Primary Tx:
T1N0, T1-2N1 Complete Surgical Resection
RANDOMIZATION
Ras Analysis
Stratification:
Stage: N0 vs N1
Main message:
Molecular Pathology will soon be an important component of pathological diagnosis in lung cancer
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肺癌基因突变于化疗疗效分析
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World’s cancer incidence and cancer deaths
M o n th s A fte r T re a tm e n t
60 S ta g e I
40 S ta g e II
20 S ta g e IIIa
S ta g e IV
S ta g e IIIb
0
12
24
36
48
60
M o n th s A fte r T re a tm e n t
Adenocarcinoma
Stomach
973 (9.5%)
835 (11.9%)
Liver
2/1/2021626 Βιβλιοθήκη 6.1%)611 (8.7%)
肺癌基因突变于化疗疗效分析
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1999 WHO Pathological Classification of Lung Cancer
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肺癌基因突变于化疗疗效分析
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Non-small Cell Lung Cancer
Squamous cell carcinoma
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肺癌基因突变于化疗疗效分析
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NSCLC - Survival Rate and Proportion at Presentation vs. Clinical stage
Clinical Stage
Percentage of Patients
Incidence in thousands Deaths in thousands
(% total)
(% total)
Lung
1,305 (12.7%)
1,211 (17.2%)
Colon & rectum
Breast
1,045 (10.2%) 1,032 (10%)
608 (6.7%) 430 (6.1%)
A phase III prospective randomized study of adjuvant chemotherapy with
vinorelbine(长春瑞滨) and cisplatin(顺铂) in completely resected non-small cell lung cancer
ONTARIO CANCER INSTITUTE (OCI) PRINCESS MARGARET HOSPITAL
2/1/2021
肺癌基因突变于化疗疗效分析
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Objective:
To report the results of 2 important clinical trials reported at 2004 American Society of Clinical Oncologist
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NCIC-CTG BR.10 Trial
Early stage I and II NSCLC patients have an overall 5-year survival rate of 50%.
Phase II results suggested that in advanced NSCLC, vinorelbine plus cis-platinum yielded a 25-40% response rate.