Tratamento Sistêmico Câncer Gástrico

Transcrição

1 Tratamento Sistêmico Câncer Gástrico Hospital Israelita Albert Einstein Dr. Pedro Luiz S. Usón Jr

2 Tópicos de discussão Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante Doença avançada

3 Tópicos de discussão Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante Doença avançada

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

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

6 Quimioterapia perioperatória 5 year survival rate : 36% versus 23% Cunningham, David, et al. "Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer." New England Journal of Medicine355.1 (2006):

7 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

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9 Tópicos de discussão Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante Doença avançada

10 Taxa de sobrevida em 3 anos 80.1% no grupo S-1 e 70.1% no grupo de cirurgia apenas

11 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 (2014):

12 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 (2014):

13 Quimioterapia Adjuvante 3 year disease-free survival: 74 % versus 59% 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 (2014):

14 Quimioterapia Adjuvante

15 Tópicos de discussão Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante Doença avançada

16 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 (2012):

17 Quimiorradioterapia adjuvante

18 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 " ASCO Annual Meeting Proceedings. Vol. 29. No. 15_suppl

19 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 " ASCO Annual Meeting Proceedings. Vol. 29. No. 15_suppl

20 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):

21 Quimiorradioterapia adjuvante

22 Quimiorradioterapia adjuvante

23 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 (2015):

24 Quimiorradioterapia

25 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

26 Quimiorradioterapia

27 Quimiorradioterapia adjuvante

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30 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.

31 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

32 Conclusão Evidência: Quimiorradioterapia para pacientes operados com linfadenectomia <D2. Quimioterapia perioperatória. Quimioterapia adjuvante.

33 Tópicos de discussão Câncer Gástrico operável - Quimioterapia perioperatória - Quimioterapia adjuvante - Quimiorradioterapia adjuvante Doença avançada

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38 Pacientes HER-2 positivo

39 Bang, Yung-Jue, et al. "Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastrooesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial." The Lancet (2010):

40 9.6 x 7.4 m

41 5.2 x 3.8m

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43 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.

44 Obrigado!