1. Recent Advances in NSCLC Treatment
Aug 10, 2016
魏裕峰
義大醫院胸腔內科

2. Management of Lung Cancer
Surgery
Chemotherapy
Radiotherapy
Target therapy
Immumotherapy
Multidisciplinary
treatment of
lung cancer

3. Mechanisms of chemotherapy and target therapy
Target rapidly dividing cells
Target therapy
Interfere with key molecular events in tumor cells that drive tumor growth and invasion (signal transduction)

4. Historical milestones in the treatment for NSCLC

5. Basic Formula of Chemotherapy in Lung Cancer
Platinum Partner +/- Biologic
Pemetrexed
Gemcitabine
Docetaxel
Paclitaxel
Vinorelbine
Etoposide
Cisplatin
Carboplatin
Bevacizumab
(Cetuximab)

6. Nature Clinical Practice Oncology (2007) 4, 86-100

7. First line chemotherapy in advanced NSCLC
ECOG1594, N Engl J Med 2002;346:92-8

8. J Clin Oncol 2008;26:3543–51

9. J Thorac Oncol. 2010;5: 688–695

14. Target Therapy

15. In this open-label, randomised, multicentre, phase 2 study, patients from 30 centres across Japan with stage
IIIB/IV or recurrent non-squamous NSCLC with activating EGFR mutations, Eastern Cooperative Oncology Group
performance status 0 or 1, and no previous chemotherapy for advanced disease received erlotinib 150 mg/day plus
bevacizumab 15 mg/kg every 3 weeks or erlotinib 150 mg/day monotherapy as a fi rst-line therapy until disease
progression or unacceptable toxicity.
Between Feb 21, 2011, and March 5, 2012, 154 patients were enrolled. 77 were randomly assigned to receive
erlotinib and bevacizumab and 77 to erlotinib alone, of whom 75 patients in the erlotinib plus bevacizumab group
and 77 in the erlotinib alone group were included in the effi cacy analyses.
Primary end point: PFS

16. Progression Free Survival

17. Overall Survival

18. Adverse Events
Erlotinib plus bevacizumab combination could be a new first-line regimen in EGFR mutation-positive NSCLC.

19. Antiangiogenic TKIs for NSCLC

20. Nintedanib (formerly BIBF 1120; Boehringer Ingelheim, Ingelheim, Germany) is a potent, oral angiokinase inhibitor that targets the pro-angiogenic pathways mediated by VEGFR1–3, fi broblast growth factor receptors (FGFR) 1–3, and platelet-derived growth factor receptors (PDGFR) α and β.
Between Dec 23, 2008, and Feb 9, 2011, 655 patients were randomly assigned to receive docetaxel plus
nintedanib and 659 to receive docetaxel plus placebo.

21. Including Taiwan
Background Ramucirumab is a human IgG1 monoclonal antibody that targets the extracellular domain of VEGFR-2.
Between Dec 3, 2010, and Jan 24, 2013, we screened 1825 patients, of whom 1253 patients were randomly
allocated to treatment.

22. Immunotherapy Checkpoint inhibitor
Relieve inhibition of the immune system that allows tolerance of tumor growth
Aid in the recognition of cancer
as foreign by immune system
Stimulate immune response

23. Immunotherapy (Immune) checkpoint inhibitor
Cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody
Programmed death receptor 1 (PD1) antibody
Programmed death ligand 1
(PDL1) antibody

27. (Immune) checkpoint inhibitor
CTLA-4 antibody (Anti-CTLA-4)
Ipilimumab
Tremelimumab
PD1 antibody (Anti-PD-1)
Nivolumab (CheckMate series)
Pembrolizumab (KeyNote series)
PDL1 antibody (Anti-PDL-1)
Atezolizumab (MPDL3280A)
Durvalumab (MEDI4736)

28. Questions in Second and Subsequent Lines of Therapy
Presented By Martin Edelman at 2015 ASCO Annual Meeting

30. Presented By Grace Dy at 2015 ASCO Annual Meeting
SUMMARY
Personalized Treatment Era…
Presented By Grace Dy at 2015 ASCO Annual Meeting