Post on 04-Jul-2020
Tratamento Sistêmico Câncer Gástrico
Dr. Pedro Luiz S. Usón Jr
Hospital Israelita Albert Einstein
Tópicos de discussão
• Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante • Doença avançada
Tópicos de discussão
• Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante • Doença avançada
Quimioterapia perioperatória
Cunningham, David, et al. "Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer." New England Journal of Medicine355.1 (2006): 11-20.
Quimioterapia perioperatória
Cunningham, David, et al. "Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer." New England Journal of Medicine355.1 (2006): 11-20.
Quimioterapia perioperatória
Cunningham, David, et al. "Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer." New England Journal of Medicine355.1 (2006): 11-20.
5 year survival rate : 36% versus 23%
Quimioterapia perioperatória
Pauligk, Claudia, et al. "Pathological response to neoadjuvant 5-FU, oxaliplatin, and docetaxel (FLOT) versus epirubicin, cisplatin, and 5-FU (ECF) in patients with locally advanced, resectable gastric/esophagogastric junction (EGJ) cancer: Data from the phase II part of the FLOT4 phase III study of the AIO." ASCO Annual Meeting Proceedings. Vol. 33. No. 15_suppl. 2015.
Tópicos de discussão
• Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante • Doença avançada
Taxa de sobrevida em 3 anos 80.1% no grupo S-1 e 70.1% no grupo de cirurgia apenas
Quimioterapia Adjuvante
Noh, Sung Hoon, et al. "Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial." The Lancet Oncology 15.12 (2014): 1389-1396.
Quimioterapia Adjuvante
Noh, Sung Hoon, et al. "Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial." The Lancet Oncology 15.12 (2014): 1389-1396.
Quimioterapia Adjuvante
Noh, Sung Hoon, et al. "Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial." The Lancet Oncology 15.12 (2014): 1389-1396.
3 year disease-free survival: 74 % versus 59%
Quimioterapia Adjuvante
Tópicos de discussão
• Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante • Doença avançada
Quimiorradioterapia adjuvante
Smalley, Stephen R., et al. "Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection." Journal of Clinical Oncology 30.19 (2012): 2327-2333.
Quimiorradioterapia adjuvante
Quimiorradioterapia adjuvante
Fuchs, C. S., et al. "Postoperative adjuvant chemoradiation for gastric or gastroesophageal junction (GEJ) adenocarcinoma using epirubicin, cisplatin, and infusional (CI) 5-FU (ECF) before and after CI 5-FU and radiotherapy (CRT) compared with bolus 5-FU/LV before and after CRT: Intergroup trial CALGB 80101." ASCO Annual Meeting Proceedings. Vol. 29. No. 15_suppl. 2011.
Quimiorradioterapia adjuvante
Fuchs, C. S., et al. "Postoperative adjuvant chemoradiation for gastric or gastroesophageal junction (GEJ) adenocarcinoma using epirubicin, cisplatin, and infusional (CI) 5-FU (ECF) before and after CI 5-FU and radiotherapy (CRT) compared with bolus 5-FU/LV before and after CRT: Intergroup trial CALGB 80101." ASCO Annual Meeting Proceedings. Vol. 29. No. 15_suppl. 2011.
Quimiorradioterapia adjuvante
Lee, Jeeyun, et al. "Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial." Journal of clinical oncology 30.3 (2012): 268-273.
Quimiorradioterapia adjuvante
Quimiorradioterapia adjuvante
Quimiorradioterapia adjuvante
Park, Se Hoon, et al. "Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses." Journal of Clinical Oncology 33.28 (2015): 3130-3136.
Quimiorradioterapia
Quimiorradioterapia adjuvante
Marcel Verheij , “A multicenter randomized phase III trial of neo-adjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy in resectable gastric cancer: First results from the CRITICS study”. ASCO Annual Meeting Proceedings. Vol. 34. No. 4_suppl. 2016
Quimiorradioterapia
Quimiorradioterapia adjuvante
• 788 pacientes randomizados (393 CT; 395 CRT).
• No braço da CT 46% e no braço da CRT 55% completaram o tratamento de acordo com o protocolo.
• Após follow up de 50 meses. 5-year survival foi 41.3% para CT e 40.9% para CRT (p=0.99).
• Conclusão: Sem diferenças em OS.
Quimiorradioterapia adjuvante
Artist II
Park, Se Hoon, et al. "Multicenter phase III trial of adjuvant chemoradiotherapy in stomach tumors 2 (ARTIST 2)." ASCO Annual Meeting Proceedings. Vol. 33. No. 3_suppl. 2015.
Conclusão
• Evidência:
• Quimiorradioterapia para pacientes operados com linfadenectomia <D2.
• Quimioterapia perioperatória.
• Quimioterapia adjuvante.
Tópicos de discussão
• Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante • Doença avançada
Pacientes HER-2 positivo
Bang, Yung-Jue, et al. "Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial." The Lancet 376.9742 (2010): 687-697.
9.6 x 7.4 m
5.2 x 3.8m
Resumindo
• Tratamento padrão em cenário avançado é baseado em platina e/ou fluorpirimidina, se HER-2 positivo, associar trastuzumabe.
• Segunda linha baseada em ramucirumabe e/ou taxano, ou drogas de 1° linha não utilizadas.
• Imunoterapia com resultados promissores.
Obrigado!
pedroluiz_uson@hotmail.com