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精准医学时代的肿瘤疗效评价标准PPT课件

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精准 医学 时代 肿瘤 疗效 评价 标准 PPT 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 精准医学时代的肿瘤疗效评价标准 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 传统疗效评估以肿瘤大小变化为标准 uu2020世纪世纪7070年代 通常以影像检查或体检等肿瘤评估方法测年代 通常以影像检查或体检等肿瘤评估方法测 得的客观缓解率为依据批准抗肿瘤药物上市得的客观缓解率为依据批准抗肿瘤药物上市 1 1 uu19801980年 年 WHOWHO评估传统细胞毒性的化疗药物 是以肿瘤大评估传统细胞毒性的化疗药物 是以肿瘤大 小为标准小为标准 2 2 uu随后 实体瘤疗效评估小组制定用肿瘤大小评估抗肿瘤药随后 实体瘤疗效评估小组制定用肿瘤大小评估抗肿瘤药 物疗效的指导原则物疗效的指导原则 RECIST RECIST 3 3 1 Guidance for Industry Clinical Trial Endpoints for the Approval of Cancer Drugs and Biologics 2 Miller AB et al Cancer 1981 Jan 1 47 1 207 14 3 Therasse P et al J Natl Cancer Inst 2000 Feb 2 92 3 205 16 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Twombly R J Natl Cancer Inst 2006 98 4 232 4 Mark Ratain 芝加哥大学肿瘤学家 if tumor change is the only criterion used in phase II testing then effective agents such as Herceptin trastuzumab Tarceva erlotinib and Avastin bevacizumab would never have been approved because of their fairly low response rate of about 10 如果肿瘤大小是唯一的标准 那么仅有10 反 应率的靶向抗肿瘤药物根本无法获批准 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 内 容 传统的疗效评估标准 传统的疗效评估标准 WHO RECISTWHO RECIST 基于解剖影像学 基于解剖影像学 CT MRICT MRI 间质瘤的间质瘤的ChoiChoi标准标准 肾癌的肾癌的MASSMASS标准标准 肝癌的肝癌的EASLEASL和和mRECISTmRECIST标准标准 非小细胞肺癌的空洞样改变测量标准非小细胞肺癌的空洞样改变测量标准 基于代谢核医学 基于代谢核医学 PET CTPET CT 结合结合PETPET的的PERCISTPERCIST标准标准 淋巴瘤的淋巴瘤的ChesonCheson标准标准 免疫相关疗效评估标准 免疫相关疗效评估标准 immune related Response Criteria irRCimmune related Response Criteria irRC Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial WHO和RECIST的比较 Miller AB et al Cancer 1981 Jan 1 47 1 207 14 Therasse P et al J Natl Cancer Inst 2000 Feb 2 92 3 205 16 RECIST Response Evaluation Criteria In Solid Tumors Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 持续的VEGF高表达导致新生血管生成 Folkman In DeVita Hellman Rosenberg eds Cancer Principles 6 734 745 抗细胞增殖 肿瘤直径缩小 抗血管生成 除直径变化还有密度减低 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分子靶向治疗后的肿瘤变化 A A 病灶尺寸缩小病灶尺寸缩小 B B 病灶血供降低 无论尺寸有无显著病灶血供降低 无论尺寸有无显著 性变化性变化 C C 病灶稳定或缩小 但伴有空洞病灶稳定或缩小 但伴有空洞 D D 无论病灶是否缩小 出现囊性变无论病灶是否缩小 出现囊性变 E E 无论尺寸是否改变 出现瘤内出血无论尺寸是否改变 出现瘤内出血 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 基于解剖影像学 CT MRI Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 伊马替尼治疗后的间质瘤变化 Choi H et al J Clin Oncol 2007 25 1753 9 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Choi标准 Choi H et al J Clin Oncol 2007 25 1753 9 疗效 CHOI 评价指标CT评价Hu值 肿瘤密度 的变化 CR所有可测量病灶和不可测量病灶全部消失 无新病灶 PR 肿瘤最长径之和缩小10 或肿瘤密度下降 Hu 15 无新病灶 SD非CR PR PD 肿瘤相关症状无加重 PD 肿瘤最长径之和增加10 或肿瘤密度 Hu 改变不符合PR标准 出现新病灶 瘤内新生结节或原瘤内新生结节体积增 加 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial PET的价值 Choi H Oncologist 2008 13 4 7 CT上肿瘤尺寸的变化 cm CT上肿瘤密度的变化 HU 18FDG PET上平均糖代谢 最大标准摄取值变化 SUVmax Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 舒尼替尼治疗后的肾癌肝转移变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial MASS标准 Smith AD et al AJR 2010 194 1470 1478 疗效 MASS标准 良好缓解 Favorable Response 未出现新病灶 并包括下列任何一项 1 肿瘤大小缩小 20 2 一个或多个实质性肿瘤病灶发生中心坏死或密度降 低 40 中等缓解 Intermediate Response 不符合良好缓解或缓解不良的标准 缓解不良 Unfavorable Response 符合以下任一标准 1 肿瘤大小增大 20 且不伴有肿瘤中心坏死或密 度降低 2 新发转移灶 肿瘤中心变实 或治疗前密度较低无 增强的病灶出现密度升高 MASS Morphology 形态 Attenuation 衰减 Size 尺寸 Structure 结构 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial MASS标准和RECIST标准的比较 Smith AD et al AJR 2010 194 1470 1478 PFS RECIST标准下 PR与SD患者无差异 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial MASS标准和RECIST标准的比较 Smith AD et al AJR 2010 194 1470 1478 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 索拉非尼治疗后的肝癌变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝癌经抗血管生成治疗后的变化 基线 治疗后 BFBV大小及密度 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial EASL标准 EASL European Association for the Study of the Liver Bruix J et al J Hepatol 2001 35 421 30 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial mRECIST标准 AASLD JNCI指南推荐 AASLD 美国肝脏疾病研究协会 JNCI 美国国立癌症研究所杂志 mRECIST标准以 存活肿瘤 作为评估对象 动态CT或MRI时动脉期显示造 影剂摄取的病灶 RECISTmRECIST CR所有目标病灶消失 所有目标病灶动脉期增强显 影均消失 PR基线病灶长径总和缩小 30 目标病灶 动脉期增强显影 的直径总和缩小 30 SD缩小未达PR或增加未到PD缩小未达PR或增加未到PD PD 病灶长径总和增加 20 或出 现新病灶 目标病灶 动脉期增强显影 的直径总和增加 20 或 出现新病灶 Lencioni R et al Semin Liver Dis 2010 30 1 52 60 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 不同测量方式的区别 Lencioni R et al Semin Liver Dis 2010 30 1 52 60 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 平扫期 动脉期 门静脉期 该病灶不应选为靶病灶 The lesion does not show typical vascular pattern it does not appear as a clear cut hypervascular mass in the arterial phase mRECIST 肝内靶病灶选择 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial RECIST标准 vs mRECIST标准 治疗前治疗后 RECIST SD mRECIST CR Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial RECIST标准 vs mRECIST标准 治疗前治疗后 RECIST PD mRECIST CR Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial RECIST标准 vs mRECIST标准 治疗前治疗后 RECIST SD mRECIST PR Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 采用mRECIST标准评估TACE疗效 RECIST mRECIST 比较RECIST mRECIST在 TACE治疗中晚期HCC疗效评估 中的作用 N 83 Gillmore R et al J Hepatol 2011 55 6 1309 16 更能准确评估ORR Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial mRECIST标准评价靶向药物疗效 2012 Gastrointestinal Cancers Symposium 比较RECIST mRECIST在索拉非尼治疗晚期HCC疗效评估中的作用 更能准确评估ORR Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial mRECIST疗效评估与靶向药物治疗后的生存预后 Julien Edeline et al Cancer 2012 118 147 56 n以mREICST标准评估为 ORR的患者预后明显好 于SD PD病人 n中位OS为 18 2个月vs 7 7个月 N 53 n以REICST标准评估为SD的42名 n以mRECIST标准评估为ORR 11名 SD 29名 PD 2名 n中位OS分别为 17 1个月 9 7个月以及3 7个月 OS mREICST标准 OS REICST标准 For patients with HCC mRECIST should be used for the standard assessment of treatment efficacy particularly in patients who are receiving antiangiogenic drugs Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2012 EASL EORTC 临床实践指南 J Hepatol 2012 Apr 56 4 908 43 专家推荐mRECIST评价肿瘤缓解 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 贝伐珠单抗治疗后的NSCLC变化 Crabb SJ et al J Clin Oncol 2009 27 3 404 10 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Crabb SJ et al J Clin Oncol 2009 27 3 404 10 空洞样改变的测量标准 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Crabb SJ et al J Clin Oncol 2009 27 3 404 10 疗效转变 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 基于代谢核医学 PET CT Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial mTOR抑制剂治疗后的胰腺癌变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 伊马替尼治疗后的间质瘤肝转移变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial PERCIST标准 Wahl RL et al J Nucl Med 2009 50 suppl 1 122S 150S Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 利妥昔单抗治疗后的淋巴瘤变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Cheson标准 2007版 Cheson BD et al J Clin Oncol 2007 25 579 86 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5分类 five point scale 5 PS Barrington SF et al J Clin Oncol 2014 32 3048 58 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Cheson标准 2014版 Cheson BD et al J Clin Oncol 2014 32 3059 67 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 免疫相关疗效评价标准 immune related Response Criteria irRC Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Ipilimumab治疗后的恶黑转移变化 基线 3个月 4个月 2年 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Ipilimumab治疗后的肿瘤负荷变化类型 起始肿肿瘤体积积增大后发发生缓缓解 出现现新的病灶后 肿肿瘤体积缩积缩 小 25 100 50 时间时间 天 时间时间 天 肿肿瘤体积积自基线线的变变化 肿肿瘤体积积自基线线的变变化 治疗疗开始 治疗疗开始 50 0 25 75 125 6321105189273357441525 125 63 212163105 147189 231273315 357 100 75 50 25 0 25 50 虚线为进线为进 展性疾病 的疗疗效阈值阈值 RECIST 时间时间 天 肿肿瘤体积积自基线线的变变化 治疗疗开始 150 125 100 75 50 25 0 25 50 100 63 212163105 147189 231273315 357 时间时间 天 肿肿瘤体积积自基线线的变变化 治疗疗开始 总总体 基线线 新病灶 63 212163105 147189 231273315 357 125 100 75 50 25 0 25 50 基线线病灶的反应应疾病稳稳定伴肿肿瘤体积缓积缓 慢下降 Wolchok JD et al Clin Cancer Res 2009 15 23 7412 20 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 假性进展 pseudoprogression Agarwala S Semin Oncol 2015 Suppl 3 S20 S27 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 假性进展 pseudoprogression West HJ JAMA Oncol 2015 1 1 115 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial irRC标准 Wolchok JD et al Clin Cancer Res 2009 15 23 7412 20 评价WHO标准irRC标准 新可测量病灶 5 5 mm PD算入肿瘤负荷 新不可测量病灶 5 5 mm PD非PD 但不能纳入irCR CR 连续两次观察 间隔 4周 所有病灶消失 连续两次观察 间隔 4周 所有 病灶消失 PR 连续两次观察 间隔 4周 所有病灶直径减少50 连续两次观察 间隔 4周 肿瘤 负荷减少50 SD 病灶直径较基线下降不足 50 或增大不足25 肿瘤负荷较基线下降不足50 或增大不足25 PD 病灶直径较基线增加至少 25 和 或 出现新发病 灶 连续两次观察 间隔 4周 肿瘤 负荷较基线增加至少25 肿瘤负荷 靶病灶 新可测量病灶 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial irRC标准的理念和发展 irRCirRC标准的理念标准的理念 通过一个后期的扫描来确认疾病进展 并检测可能的延迟肿瘤缓解通过一个后期的扫描来确认疾病进展 并检测可能的延迟肿瘤缓解 在所有肿瘤负荷中纳入针对新病灶的测量在所有肿瘤负荷中纳入针对新病灶的测量 有利于确定有益的持续疾病稳定有利于确定有益的持续疾病稳定 如果临床状况允许 可以在传统的疾病进展定义后继续治疗如果临床状况允许 可以在传统的疾病进展定义后继续治疗 irRCirRC标准标准的发展的发展 在在WHOWHO 二维 和 二维 和RECISTRECIST 单维 标准之间 单维 标准之间 irRCirRC的标准的理念得到转化的标准的理念得到转化 运用运用irRCirRC标准在恶性黑色素瘤以外的疾病标准在恶性黑色素瘤以外的疾病 在在FDAFDA和和EMAEMA的指南性文件中纳入的指南性文件中纳入irRCirRC的理念的理念 在在irRCirRC标准的初步实施后进一步扩展这一理念标准的初步实施后进一步扩展这一理念 在在各种免疫治疗领域显现各种免疫治疗领域显现irRCirRC标准可适用的经典价值标准可适用的经典价值 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 小 结 RECISTRECIST标准仍然是实体瘤疗效评估的金标准标准仍然是实体瘤疗效评估的金标准 分子靶向治疗和免疫治疗后的肿瘤变化与传统细胞毒药物存在很分子靶向治疗和免疫治疗后的肿瘤变化与传统细胞毒药物存在很 大的区别大的区别 对于某些具有特异性分子靶向药物治疗的特殊瘤种 有必要采用对于某些具有特异性分子靶向药物治疗的特殊瘤种 有必要采用 特异性的疗效评估标准特异性的疗效评估标准 除了淋巴瘤以外 基于肿瘤代谢的疗效评估标准有待于前瞻性研除了淋巴瘤以外 基于肿瘤代谢的疗效评估标准有待于前瞻性研 究的验证究的验证 irRCirRC标准有望成为今后免疫治疗疗效评估的金标准标准有望成为今后免疫治疗疗效评估的金标准 在精准医学的时代 疗效评估的个体化也需要与时俱进在精准医学的时代 疗效评估的个体化也需要与时俱进 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 感谢聆听 感谢聆听
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本文标题:精准医学时代的肿瘤疗效评价标准PPT课件
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