非小细胞肺癌脑转移的综合治疗__培训课件.ppt

病情介绍 患者张某某，男，61岁； 2011年7月因咳嗽伴胸背部疼痛，CT提示右下肺占位，MRI提示胸腰椎多发骨破坏； 行右下肺肿块穿刺术，病理示腺癌，因组织较少，EGFR未检测； 诊断：右下肺腺癌伴多发性骨转移Ⅳ期。 治疗经过： 2011年8月3日起 PEM 500mg/m2 D1 DDP 75mg/m2 D1 3周后重复 2个周期后评价PR 4个周期后评价PR 2011年11月2日起维持治疗 PEM 500mg/m2 D1 3周后重复 维持6个周期后因CEA升高，2012年4月9日查头颅MR示右枕叶脑转移（单发） 2012年4月9日口服TKI PFS 8个月 治疗前（2011-08-01） 二个周期后（2011-09-14） 六个周期维持治疗后（2012-04-09） 维持治疗后出现脑转移（2012-04-11） 口服TKI 24天（2012-05-03） 口服TKI 24天（2012-05-03） 2013年8月复查CT，疗效仍然PR。 PFS长达16个月。 三例合并脑转移病例均未先行WBRT 1例有症状EGFR突变的病例--TKI 1例无症状EGFR未突变的病例—化疗 1例维持治疗后PD，无症状且EGFR不明的病例--TKI NSCLC合并脑转移治疗路径（江苏省肿瘤医院内科2012V1版） 合并脑转移患者 有神经系统症状 无神经系统症状 靶向 EGFR或ALK 突变 EGFR或ALK 未突变或未检测 WBRT+ 化疗 EGFR或ALK 突变 EGFR或ALK 未突变或未检测 靶向 或化疗 化疗 脑部病灶有进展可加或加量TKI或加WBRT 脑部病灶有进展可尝试TKI。 脑部病灶有进展可加量TKI或加WBRT。 脑部病灶有进展尝试TKI或加WBRT。 二线 一线 谢谢！ Mt, mutation; NSCLC, non-small-cell lung cancer. ? The question that we just posed and what is shown on this slide emphasizes the first point of differentiation between patients with non-small-cell lung cancer, and that is recognition of great interpatient heterogeneity in the molecular characteristics. These are the differences between one patient and the next. In this cartoon, all the figures appear to be the same, but if we look at 3 patients individually, you will see this first patient is a 65-year-old male smoker, who has squamous cell carcinoma. His cancer is characterized by a KRAS mutation. * Mt, mutation; NSCLC, non-small-cell lung cancer. ? The question that we just posed and what is shown on this slide emphasizes the first point of differentiation between patients with non-small-cell lung cancer, and that is recognition of great interpatient heterogeneity in the molecular characteristics. These are the differences between one patient and the next. In this cartoon, all the figures appear to be the same, but if we look at 3 patients individually, you will see this first patient is a 65-year-old male smoker, who has squamous cell carcinoma. His cancer is characterized