Tratamento Sistêmico Câncer Gástrico › wp-content › uploads › 2017 › 01 ›...

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

Quimioterapia perioperatória

Cunningham, David, et al. "Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer." New England Journal of Medicine355.1 (2006): 11-20.


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%


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.

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.


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%

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.


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.


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.


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


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

• 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.


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.

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!

[email protected]

Tratamento Sistêmico Câncer Gástrico › wp-content › uploads › 2017 › 01 ›...

Documents

Transcript of Tratamento Sistêmico Câncer Gástrico › wp-content › uploads › 2017 › 01 ›...