晚期胃癌化疗策略晚期胃癌治疗现状胃癌化疗晚期胃癌化疗临床问题药物、方案的选择RandomizedPhaseIIIStudy:1990-2000欧洲实践标准亚洲实践标准晚期胃癌化疗现状新世纪初的选择…Docetaxel,5-FUandCisplatin:V325PhaseIII胃癌III期临床----TAX325随访结果TAX325:increasedfebrileneutropeniawithTCFTAX325研究结果CPT-11forAGC——Ⅱ期多中心临床研究（2003ASCO）FFCD9803法国CPT-11联合5-FU治疗AGC----III期临床试验（2005ASCO）新世纪初的选择：问题！…新的探索和循证医学证据REAL2randomisedmulticentrephaseIIIstudycomparingcapecitabinewith5-FUandoxaliplatinwithcisplatininpatientswithadvancedoesophagogastriccancerREAL-2:randomized,phaseIIItrialingastricandGEJcancerREAL2:研究目标REAL2interimanalysis:goodresponsewithoxali-vs.cisplatinUpdatedresultsforfourregimensREAL2:conclusionsOxaliplatin联合EPI、5-FU/CF治疗晚期胃癌的临床多中心研究——chinafirst-linechemotherapywithfluorouracil,leucovorinandoxaliplatin(FLO)versusfluorouracil,leucovorinandcisplatin(FLP)SuperiorPerformancewithFLOvs.FLP奥沙利铂＋5FU作为一线治疗Oxaliplatin/CF/5-FUvspaclitaxel/CF/5-FUinpatswithadvancedgastriccancerAphaseIIclinicaltrialPhaseIImulticentertrialofdocetaxel+oxaliplatininstageIVgastroesophagealand/orstomachcancerResults:efficacyML17032:CAPEvs5-FUtrialdesignSuperiorresponseratewithXPvs.FPML17032:XPvsFPprogression-freesurvivalHR0.81Similarall-gradeshematologicadverseevents:XPvs.FPAPhaseIITrialofCapecitabineandDDPinAGC－－ChinaSummaryofCombinationChemotherapywithCAPEinAGCCAPEvs5-FUindoubletregimensforAGC新的探索和循证医学证据伊立替康联合5-FU/LV、CDDP治疗胃癌伊立替康联合奥沙利铂治疗胃癌irinotecanpluscapecitabineinpatientswithAGCS-180mgm2d1-14q28dCPT-1170-100mgm2d1,8q4weeks,phaseI:MTD:CPT-1190mg/m2RD80mg/m2.phaseII:42patsThemediantreatmentcoursewas5(range:1–13).RR62%(95%confidenceinterval:47.2–76.6%),Themediansurvivaltimewas444days.grade3–4haematological19%;nonhaematologicaltoxicities10%,N=45/48irinotecan150mg/m2d1oxaliplatin85mg/m2d1lv100mg/m2/d5-FU2000mg/m248-hcid1,Q2wRR73.3%（2CRsand31PR）.SD9%PD18%estimatedmOS14.0mestimatedmTTP8.9mgrade3/4toxicitieswereneutropenia(11%ofallcycles)andemesis(12%)AphaseIstudyofS-1plusweeklydocetaxelinpatientswithmGCCapecitabineanddocetaxelforadvancedgastriccancerTaxanes+5-FU或CDDP二联治疗