n ational s urgical a djuvant b reast and b owel p roject n.
Download
Skip this Video
Download Presentation
N ational S urgical A djuvant B reast and B owel P roject

Loading in 2 Seconds...

play fullscreen
1 / 23

N ational S urgical A djuvant B reast and B owel P roject - PowerPoint PPT Presentation


  • 128 Views
  • Uploaded on

N ational S urgical A djuvant B reast and B owel P roject. Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'N ational S urgical A djuvant B reast and B owel P roject' - luboslaw


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

Oxaliplatin, Fluorouracil, and Leucovorin

as Adjuvant Treatment for Colon Cancer

Thierry André, M.D., Corrado Boni, M.D., Lamia Mounedji-Boudiaf, M.D.,Matilde Navarro, M.D., Josep Tabernero, M.D., Tamas Hickish, M.D.,Clare Topham, M.D., Marta Zaninelli, M.D., Philip Clingan, M.D., John Bridgewater, M.D., Isabelle Tabah-Fisch, M.D.,and Aimery de Gramont, M.D., for the Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment

of Colon Cancer (MOSAIC) Investigators

slide3

1993-2003: A Decade of Decadence

Mayo v. RPMI

Bolus v. Infusion of 5FU

Efficacy of levamisole

High v. Low dose levamisole, LV

Dukes’ B v C

American v. European

Advocacy neglect

Consensus statement abstinence

Paucity of trials

slide4

EDITORIAL

New England Journal of Medicine

Two Steps Forward in the Treatment of

Colorectal Cancer

slide5

Curative Options for Colorectal Cancer:

Folklore, fables, and mythes

slide7

On November 4, 2004, the FDA

approved oxaliplatin in combination with infusionalFULV for adjuvant stage III

colon cancer.

slide8

The Global test for interaction

between treatment and tumor stage (II+III)

was not significant (p=0.71)

slide9

INT 0035

’85-’87

DukesBDukesC

Control Control

FU+LEV FU+LEV

LEV

n=318n=929

nsabp
NSABP

Pooled analysis of NSABP C-01 through C-04

Death

Recurrence

DFS event

All patients

Stage II

Stage III

0.5

1

2.0

0.5

1

2.0

0.5

1

2.0

int 0035 dukes b rfs
INT 0035 Dukes BRFS

78

70

%

Cont

FuLev

159

159

45

32

P = 0.10

Yrs.

31% reduction in recurrence

Source: Moertel CG et al. J Clin Oncol 1995;13(12):2936-43.

combined analysis 11 77 12 90
COMBINED ANALYSIS 11.77-12.90

Treatment 1

Treatment 2

MOF

PVI

FU+LV

FU+LV

C-01

C-02

C-03

C-04

0.05

0.02

<0.001

0.03

OP

OP

MOF

FU+LEV

Vs

Vs

Vs

Vs

N = 1924

N = 1896

JCO 1999;17:1349

patient population
PATIENT POPULATION
  • DUKES’ B 1567
  • DUKES’ C 2254

JCO 1999;17:1349

slide14

American Society of Clinical Oncology

Recommendations on Adjuvant Chemotherapy for

Stage II Colon Cancer

Al B. Benson III, Deborah Schrag, Mark R. Somerfield, Alfred M. Cohen, Alvaro T. Figueredo, Patrick J. Flynn, Monika K. Krzyzanowska, Jean Maroun, Pamela McAllister, Eric Van Cutsem, Melissa Brouwers, Manya Charette, and Daniel G. Haller

slide15

Quick & Simple & Reliable

'Uncertain indication'

for chemotherapy

(3239 patients ’94 -’03 MTS 4.6 yrs)

Randomize

Observation

(n=1617)

FULV ± Lev

(n=1622)

92% Dukes B

Richard G. Gray MS

slide16

Quasar Survival

n dths 5yS p

Chemo 1622 281 80.3 0.02

None 1617 328 77.4

Source: With permission. Gray RG et al. Presentation. ASCO 2004. Abstract 3501.

slide17

Quasar Dukes B Survival

dths p

Chemo 224 0.04

None 262

Source: With permission. Gray RG et al. Presentation. ASCO 2004. Abstract 3501.

slide18

Stage II:

Putative Prognostic Discriminates

MSI

Allelic instability (18q del)

Venous invasion

T differentiation

Number N examined (ignored or absent)

High Risk Stage II

Mayo algorithm

gene identification c 01 c 02
Gene Identification: C-01/C-02
  • Univariate analysis
  • 142 of 757 genes were associated with RFS (p<0.05)
gene identification c 01 c 021
Gene Identification: C-01/C-02
  • Multivariate analysis
  • Individual Genes
  • # Pos Nodes
  • Tumor Grade
  • Tumor Location
  • 66 of the 142 genes retained independent significance (p<0.05)
slide21

Survey: N=150 pt with CRC

Cum % rec treatment

% risk reduction

Love N. Asco GI 2006

survey n 150 pt with crc

None 1%

None 1%

FFox

68%

FU

10%

FFox

87%

6%

6%

Cape

21%

Stage II

Stage III

Survey: N=150 pt with CRC

Love N. Asco GI 2006 # 373

slide23

Survey: N=100 Medical Oncologists

Breast

CRC

% likely to treat

% risk reduction

Love N. Asco GI 2006

ad