asco结直肠癌热点荟萃北京.pptx

2016 ASCO 的CRC丏场 口头报告丏场Oral session 临床科学论坛Clinical Science Symposium(CSS)壁报讨论Poster Discussion(PD)教育丏场Educational session(ED)潜在可切除mCRC：MDT病例讨论 ASCO/ECCO联合论坛：医疗的价值 辩论：mCRC内科治疗中的争议 RAS WT一线：抗VEGF vs 抗EGFR？维持治疗 vs 化疗假期；局部进展期直肠癌治疗中的问题 去手术化？去新辅助治疗化？辅助化疗模式？教授有约Meet The Professor(MTP)直肠癌的影像学 2016 ASCO 的CRC丏场 口头报告丏场Oral session 临床科学论坛Clinical Science Symposium(CSS)壁报讨论Poster Discussion(PD)教育丏场Educational session(ED)潜在可切除mCRC：MDT病例讨论 辩论：mCRC内科治疗中的争议 RAS WT一线：抗VEGF vs 抗EGFR？维持治疗 vs 化疗假期；局部进展期直肠癌治疗中的问题 去手术化？去新辅助治疗化？辅助化疗模式？2016 ASCO 的CRC丏场 口头报告丏场Oral session 临床科学论坛Clinical Science Symposium(CSS)壁报讨论Poster Discussion(PD)教育丏场Educational session(ED)潜在可切除mCRC：MDT病例讨论 辩论：mCRC内科治疗中的争议 RAS WT一线：抗VEGF vs 抗EGFR？维持治疗 vs 化疗假期；局部进展期直肠癌治疗中的问题 去手术化？去新辅助治疗化？辅助化疗模式？口头报告丏场 PART 1：Immunotherapy beyond“MSI后MSI时代的免疫治疗”4个研究#3500#3503 免疫丏场：1个研究#PART 2：Side Matters“肿瘤部位很重要”3个研究#3504#3506 PART 3：Is Less More?“更少的治疗更好？”2个研究#3507-#3508 口头报告丏场 PART 1：Immunotherapy beyond“MSI后MSI时代的免疫治疗”PART 2：Side Matters“肿瘤部位很重要”#3504：CALGB/SWOG 80405“左右半”生存数据更新#3505：美国SEER“部位与生存数据分析”#3506：原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3：Is Less More?“更少的治疗更好？”#3507：CREST-梗阻性左半结肠癌支架植入变急诊手术为择期手术#3508：JCOG 0212 II/III期中低位直肠癌，LLND是否必要？口头报告丏场 PART 2：Side Matters“肿瘤部位很重要”#3504：CALGB/SWOG 80405“左右半”生存数据更新#3505：美国SEER“部位与生存数据分析”#3506：原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3：Is Less More?“更少的治疗更好？”#3507：CREST-梗阻性左半结肠癌支架植入变急诊手术为择期手术#3508：JCOG 0212 II/III期低位直肠癌，LLND是否必要？#3507 Hill et al CREST-梗阻性结肠癌支架植入变急诊手术为择期手术#3508 Fujita et al JCOG 0212:II/III期低位直肠癌LLND的必要性 我的解读 CREST：证实了支架植入可以安全桥接，把急诊手术变为择期手术，减少造口率，不影响肿瘤学效果 JCOG 0212 低位LARC，如果单纯直接手术，建议LLND 未来应该对比：TME+术后CRT vs TME+LLND CRT+TME vs TME+LLND 口头报告丏场 PART 2：Side Matters“肿瘤部位很重要”#3504：CALGB/SWOG 80405“左右半”生存数据更新#3505：美国SEER“部位与生存数据分析”#3506：原发灶部位、分子特征与EGFR单抗疗效的关系 PART 3：Is Less More?“更少的治疗更好？”#3507：CREST-梗阻性左半结肠癌支架植入变急诊手术为择期手术#3508：JCOG 0212 II/III期低位直肠癌，LLND是否必要？#3504 Venook et al CALGB/SWOG 80405“左右半”生存数据更新#3504，Venook et al Impact of primary tumor location on Overall Survival and Progression Free Survival in patients with metastatic colorectal cancer:Analysis of CALGB/SWOG 80405(Alliance)A Venook,D Niedzwiecki,F Innocenti,B Fruth,C Greene,BH ONeil,J Shaw,J Atkins,LE Horvath,B Polite,JA Meyerhardt,EM OReilly,R Goldberg,HS Hochster,CD Blanke,R Schilsky,RJ Mayer,M Bertagnolli,HJ Lenz for SWOG and the ALLIANCE CALGB/SWOG 80405 Chemo +Cetuximab Chemo+Bevacizumab 1ST LINE MET/ADVANCED COLORECTAL KRAS wt Codons 12&13 FOLFIRI or FOLFOX MD choice ASCO,JUNE,2014 Chemo+Chemo+CetuximabCetuximab OS=29.9 OS=29.9 mosmos PFS=10.4 PFS=10.4 mosmos Chemo+Chemo+BevacizumabBevacizumab OS=29.0 OS=29.0 mosmos PFS=10.8 PFS=10.8 mosmos N=1137 CONCLUSION:NO DIFFERENCE OS better than anticipated in both arms:Treatment effect and/or Patient selection All All RASRAS wtwt OS=32.0 OS=32.0 mosmos PFS=11.4 PFS=11.4 mosmos OS=31.2 OS=31.2 mosmos PFS=11.3 PFS=11.3 mosmos ESMO,SEP,2014ESMO,SEP,2014 N=526N=526 Patient Characteristics by Tumor Side,80405(KRAS wt)RIGHTRIGHT-SIDEDSIDED (N=293)(N=293)LEFTLEFT-SIDEDSIDED (N=732)(N=732)TOTAL*TOTAL*(N=1137)(N=1137)P P Age (mean)61.2 57.3 58.4 0.0001 Gender(M%)54.9%65.0%62.1%0.002 Synchronous Stage IV 86.9%76.0%79.3%0.0009 Prior Adjuvant 10.6%15.7%14.2%0.03 FOLFOX/FOLFIRI 74.4/25.6 72.4/27.6 73.4/26.6 0.51 Primary in place 19.2%29.6%26.6%0.0007 Pattern mets:liver only liver mets extra-hepatic 27.5%40.5%32.0%32.1%43.2%24.7%30.9%42.8%28.5%0.02*Transverse colon 66(excluded from analysis);unknown-46*Test of any liver metastases versus extrahepatic 80405:Overall Survival by Sidedness SideSide N N(Events)Events)Median Median (95%CI)95%CI)HRHR (95%CI)95%CI)p p LeftLeft 732(732(550)550)33.333.3 (31.4(31.4-35.735.7)1.551.55 (1.321.32-1.82)1.82)0.0001 0.0001 RightRight 293(293(242)242)19.419.4 (16.716.7-23.6)23.6)Right Left 80405:OS by Sidedness(Bevacizumab)Presented by:SideSide N(N(Events)Events)Median Median (95%CI)95%CI)HR(95%CI)HR(95%CI)p p LeftLeft 356(356(280)280)31.431.4 (28.328.3-33.6)33.6)1.321.32 (1.05(1.05-1.65)1.65)0.010.01 RightRight 150(150(121)121)24.224.2 (17.917.9-30.3)30.3)Left Right 80405:OS by Sidedness(Cetuximab)Presented by:SideSide N(N(Events)Events)Median Median (95%CI)95%CI)HRHR (95%CI)95%CI)p p LeftLeft 376(376(270)270)36.036.0 (32.632.6-40.3)40.3)1.871.87 (1.48(1.48-2.32)2.32)0.00010.0001 RightRight 143(143(121)121)16.716.7 (13.113.1-19.4)19.4)Left Right 80405:Sidedness is Prognostic Progression Free Survival(PFS)Presented by:KRASKRAS wtwt N=1025N=1025 Right Right 1 1 Median PFS(Median PFS(mosmos)Left Left 1 1 Median PFS(Median PFS(mosmos)Hazard RatioHazard Ratio 95%CI95%CI P(adjusted*)P(adjusted*)AllAll ptspts 8.98.9 11.711.7 1.03(1.11,1.50)1.03(1.11,1.50)P=0.0006P=0.0006 CetCet 7.8 7.8 12.412.4 1.56(1.26,1.94)1.56(1.26,1.94)P 0.0001P 0.0001 BV BV 9.69.6 11.2 11.2 1.06(0.86,1.31)1.06(0.86,1.31)P=0.55P=0.55 *Adjusted for biologic,protocol chemotherapy,prior adjuvant therapy,prior RT,age,sex,synchronous disease,in place primary,liver metastases 80405:Sidedness is Prognostic Overall Survival(OS)Presented by:KRASKRAS wtwt N=1025N=