卵巣癌の治療
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- あきお ねごろ
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9 (FIGO) a
10 (FIGO) b
11 (FIGO) c
12 (FIGO) a
13 (FIGO) b
14 (FIGO) c
15 (FIGO)
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17 (FIGO)
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21 Risk factors Preventive factors Risk factors 35 PCO, Preventive factors?
22 Relative risk Lanct, Beral V, 2008
23 (<10%): BRCA1, BRCA2 MLH1, MLH2 (DNA HNPCC) BRCA BRCA p53, p %)(15%) HER-2/NEU, k-ras, AKT2, c-myc (20-30%) (5%) (10%) (20-30%)
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26 a,b G1 G2,3 3-6 c 3-6 optimal (<1cm) 6 suboptimal (>=1cm) CR PR IDS SD,PD IDS: interval debulking surgery 2007
27 Staging laparotomy + Debulking surgery
28 TC TJ mg/m2 iv(3h) AUC 5 6 iv(1h)
29 GOG GOG CAP CPA+ADM+CDDP CP CPA+CDDP GOG111 OV ,1998 GOG158 AGO Danish-Dutch 1999,1997,1996 TP PTX+CDDP TC PTX+CBDCA
30 5 25th Annual Report. IJGO, 2007
31 ( ) CJ 41 TJ 34 CR 5(33%) 4(21.1%) PR 8(53.3%) 12(63.2%) SD 1(6.7%) 2(10.5%) PD 1(6.7%) 1(5.3%) RR 86.6% 84.3% CJ cyclophosphamide,carboplatin TJ paclitaxel, carboplatin
32 % month
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34 ( ) CR 6(24%) 2(28.5%) 0 1(100%) 1(50%) PR 18(72%) (50%) SD 4(57.1%) PD 1(4%) 1(14.2%) RR 96% 28.5% 100% 100% 100%
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37 3017 Paclitaxel:175mg/m2 iv, day1 Carboplatin:AUC6, iv,day1 3 6 irinotecan:60mg/m2 iv, day1,8,15 Cisplatin:60mg/m2, iv,day1 4 6
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39 / Jacob(1991) MST optimal(<2cm) (18) 18m 39% NAC (22) 16m(NS) 77% (p=0.02) Omnis(1996) 3year OS 5year OS optimal(<2cm) (284) 31% 21% 29% NAC (88) 27%(NS) 19%(NS) 42% Vergote(1998) 3year OS NAC (112) 26% NAC (173) 42%(p=0.0001) Kayikcioglu(2001) 5year OS MST optimal(=0) (158) 24% 38m 14% NAC (45) 30%(NS) 34m(NS) 49%(p<0.001) Kuhn(2001) MST optimal(<2cm) NAC 23m 42m(p<0.007) 63% 84%(p<0.04)
40 EORTC Histologically proven stage c or ovarian epithelial carcinoma, peritoneal carcinoma, or fallopian tube carcinoma Randomize Primary debulking surgery Platinum(+taxane) X3 courses NAC Platinum(+taxane) X3 courses Interval debulking surgery Platinum(+taxane) X3 courses Interval debulking surgery Platinum(+taxane) X3 courses OS, PFS, QOL, complication
41 JGOG-0602 cytologically proven stage c or ovarian epithelial carcinoma, peritoneal carcinoma, or fallopian tube carcinoma Randomize Primary debulking surgery PTX CBDCA X4courses Interval debulking surgery NAC PTX CBDCA X4courses Interval debulking surgery PTX CBDCA X4courses PTX CBDCA X4courses OS, PFS,AE
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44 SWOG9701,GOG178 CR PTX PFS OS 3 cycle 12 cycle(every 4 weeks) 14m 22m 46m 53m (NS) GOG212 PTX, polyglutamate PTX(12
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46 catheter port port catheter
47 RCT
48 RCT IP 2006 NCI announcement
49 ip OS GOG104 GOG114 GOG NCI 3 optimal
50 / AUC FU Markman et al. Semin Oncol 1991;18:248 Markman et al. J Clin Oncol 1992;10:1485
51 (TC ) carboplatin IP GOG RCT?? TC (control arm) vs ip carboplatin or ip cisplatin or ip paclitaxel iv paclitaxel bevacizmab
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53 GOG0182-ICON5 I Carboplatin AUC 6 (d1) Paclitaxel 175 mg/m 2 (d1) x8 R A N D O M I Z E II III IV V Carboplatin AUC 5 (d1) Paclitaxel 175 mg/m 2 (d1) Gemcitabine 800 mg/m 2 (d1,8) Carboplatin AUC 5 (d1) Paclitaxel 175 mg/m 2 (d1) Doxil 30 mg/m 2 (d1) Carboplatin AUC 5 (d3) Topotecan 1.25 mg/m 2 (d1-3) Carboplatin AUC 6 (d8) Gemcitabine 1 g/m 2 (d1,8) x4 x4 x8 x8 Carboplatin AUC 6 (d1) Paclitaxel 175 mg/m 2 (d1) x ASCO
54 GOG0182-ICON5: 2006 ASCO
55 GOG0182-ICON5: 2006 ASCO
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57 JGOG3016 Ovarian epithelial,primary FIGO Stage randomization Dose-intensity dose-escalation dose-dense Conventional TC Paclitaxel 180mg/m2 day1 Carboplatin AUC 6.0 day1 Every 21 days for 6-9 cycles Dose-dense weekly TC Paclitaxel 80mg/m2 day1,8,15 Carboplatin AUC 6.0 day1 Every 21 days for 6-9 cycles
58 JGOG3016 n=312 n=312 n=319 n=319 n M PFS P HR C-TC mos dd-tc mos n 2 P HR C-TC % dd-tc % ASCO
59 GOG3016 PFS 2008 ASCO
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62 GOG170D Bevacizumab( VEGF ) (15 mg/kg IV q 3weeks) CR 3/62 5% PR 8/62 13% SD 34/62 55%
63 Bevacizumab
64 Bevacizumab study GI perforation(%) Burger(GOG-170D) 0/62(0) Garcia(ASCO 2005) 2/29(6.9) Cannistra(ASCO 2006) 5/44(11.4) Wright(ASCO 2006) 4/62(6.5) Friberg(ASCO 2006) 2/13(15.4) Monk(Gyn Oncol 2006) 1/32(3.1) Wright(Cancer 2006) 2/23(8.7) Bidus(Gyn Oncol 2006) 0/3(0) Penson(ASCO 2006) 0/30(0) Total 16/298 (5.4%)
65 / suboptimal GOG218 PTX 175mg/m2 CBDCA AUC=6 q 3weeks x6 Placebo day1x5 Start cycle2 PTX 175mg/m2 CBDCA AUC=6 q 3weeks x6 Bevacizmab day1x5 Start cycle2 Placebo Day1, q3weeksx15 cycles Placebo Day1, q3weeksx15 cycles PTX 175mg/m2 CBDCA AUC=6 q 3weeks x6 Bevacizmab day1x5 Start cycle2 Bevacizmab Day1, q3weeksx15 cycles
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67 GOG GOG CAP CPA+ADM+CDDP CP CPA+CDDP GOG111 OV ,1998 GOG158 AGO Danish-Dutch 1999,1997,1996 TP PTX+CDDP TC PTX+CBDCA * ( VEGF) *? Weekly PTX?
スライド 1
QOL 1 Goldberg, JCO 22:23-30, 2004 N9741: Oxaliplatin in First Line (US) IR 200 mg/m 2 OX 85 mg/m 2 every 3 weeks Efficacy IFL FOLFOX4 > IFL IROX FOLFOX4 IROX OS TTP RR 15.0 mo 6.9 mo 31 % P=0.0001 P=0.0014
E3200 BV FOLFOX4 FOLFOX4 PFS % 0.42, 0.65 p< log-rank % FOLFOX4 8.6% FOLFOX % FOLFOX4 259/ % FOL
E3200 BV FOLFOX4 FOLFOX4 PFS 4.5 7.5 0.518 95% 0.42, 0.65 p
スライド 1
第 4 回 福岡大学病院と院外薬局との がん治療連携勉強会 タキサン 福岡大学メディカルホール 2011 年 7 月 20 日福岡大学呼吸器内科内野順治 本日の内容 タキサンが適応となる癌種について 肺癌 乳癌 卵巣癌に治療の考え方とエビデンス 治療レジメンの紹介 疾患別で投与用量 投与方法が異なる事がある 一般名ドセタキセル水和物パクリタキセル 商品名タキソテール注タキソール注 効能 効果 乳癌
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食道がん化学放射線療法後のsalvage手術
2006 2 17 52 Daly JM, et al. J Am Coll Surg 2000;190:562-573 Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573
PowerPoint Presentation
Eriko Aotani Patient-Caregiver Symposium TREATMENT OF OVARIAN CANCER 卵巣癌の治療 Mansoor Raza Mirza NSGO: Nordic Society of Gynaecological Oncology & Rigshospitalet: Copenhagen University Hospital, Denmark
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第 5 回福岡大学病院と院外薬局とのがん治療連携勉強会 ベバシズマブ併用 FOLFOX/FOLFIRI 療法 福岡大学病院腫瘍 血液 感染症内科 田中俊裕 本日の講演内容 大腸がんの治療方法について概説 アバスチン併用 FOLFOX/FOLFIRI 療法の治 療成績について 2005 年にがんで死亡した人は 325,941 例 ( 男性 196,603 例 女性 129,338 例 ) 2 位 4
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