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Cirug a de las Met stasis Hep ticas

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Cirug a de las Met stasis Hep ticas

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    1.

    2. Cirugía de las Metástasis Hepáticas La única opción curativa en la enfermedad metástasica es la cirugía y hay que ir a por ella, como primer objetivo terapéutico

    3. Supervivencia en pacientes con metástasis hepáticas por CCR

    4. Tratamiento Neoadyuvante de metástasis hepáticas de CCR

    5. Equipos Multidisciplinarios para Cirugía de Metástasis Hepáticas

    6. Objetivos QT Neoadyuvante en Metástasis Hepáticas de CCR Incremetar la resecabilidad

    7. Quimioterapia Neoadyuvante (EORTC Intergroup randomized phase III study 40983 EPOC) Se ha demostrado la eficacia de la quimioterapia Neoadyuvante al incrementar de forma significativa la supervivencia libre de progresión en metástasis operables

    8. Estudio de Neoadyuvancia en pacientes con enfermedad potencialmente resecable: EORTC 40983

    9. Cirugía inicial vs post-QT neoadyuvante

    13. Tratamiento Neoadyuvante

    14. Estudios Prospectivos en metástasis hepáticas no resecables: pacientes seleccionados

    15. Estudios Prospectivos en metástasis hepáticas no resecables: pacientes no selecionados

    16. Importancia de la Respuesta a la Quimioterapia

    17. Resection rate of metastases and tumor response 35% mets al DG 80% irresecables Superv <5% Seleccionados: R0 i R1 del 33 al 54% No seleccionados: R0 i R1 del 1 al 26%35% mets al DG 80% irresecables Superv <5% Seleccionados: R0 i R1 del 33 al 54% No seleccionados: R0 i R1 del 1 al 26%

    19. Tratamiento Neoadyuvante ¿Podemos mejorarlo con la integración de agentes antidiana?

    20. ERBITUX 1ª línea – Tasa de resectabilidad ERBITUX aumenta la tasa de resección ? potencial de curación

    21. No retrasa la cirugía Es bien tolerado y con un perfil de toxicidad predecible y manejable No presenta problemas en la cicatrización de las heridas Erbitux – en el contexto de la cirugía

    22. Bevacizumab en Neoadyuvancia de Metástasis Hepáticas

    23. Bevacizumab en el tratamiento Neoadyuvante La incorporación de bevacizumab a la quimioterapia neoadyuvante mejora la tasa y la calidad de la respuesta Es seguro (No incrementa las complicaciones quirúrgicas) No interfiere en la regeneración hepática

    24. Avastin mas Xelox Neoadyuvante en metástasis Hepáticas de CCR (ensayo de un solo centro)

    25. Avastin in patients undergoing hepatic metastasectomy: Efficacy CRC = colorectal cancer Gruenberger T, Gruenberger B, Scheithauer W. Neoadjuvant therapy with bevacizumab. J Clin Oncol 2006;24:2592–3. Gruenberger T, Tamandl D, Herbst F, Scheithauer W, Zielinski C, Gruenberger B. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. Ann Oncol 2006;17(Suppl. 9):ix128 (Abstract 374P). CRC = colorectal cancer Gruenberger T, Gruenberger B, Scheithauer W. Neoadjuvant therapy with bevacizumab. J Clin Oncol 2006;24:2592–3. Gruenberger T, Tamandl D, Herbst F, Scheithauer W, Zielinski C, Gruenberger B. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. Ann Oncol 2006;17(Suppl. 9):ix128 (Abstract 374P).

    26. Avastin in patients with CRC undergoing metastasectomy 11 patients (21%): postoperative complications sepsis (n=3) hyperbilirubinaemia (n=2) biliary leak, post-operative bowel perforation, anastomotic leakage, wound infection and wound haematoma (all n=1) No increased bleeding 3 patients required blood transfusions (6%) Patients received Avastin plus XELOX as scheduled 5 weeks after surgery Last updated: May 31, 2007 Safety analysis showed that peri- and postoperative complications1,2 are consistent with previous studies evaluating chemotherapy alone.3 No patients experienced increased bleeding, but blood transfusions and further surgery were required in three and one patients, respectively. Postoperative complications were seen in 11 (21%) patients; two patients with sepsis and one patient each with biliary leak, post-operative bowel perforation, anastomotic leakage, liver dysfunction, wound infection and wound haematoma. As per schedule, patients received Avastin plus XELOX 5 weeks after surgery. Postoperative liver function and regeneration (assessed by CT scans 3 months after surgery) were normal in all but one patient. CRC = colorectal cancer; CT = computed tomography; XELOX = Xeloda + oxaliplatin Gruenberger T, Tamandl D, Puhalla G, et al. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. ASCO 2007. Gruenberger T, Tamandl D, Herbst F, et al. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. Annal Oncol 2006;17(Suppl. 9):ix128 (Abstract 374P). Data updated via personal communication. Nordlinger B, Sorbye H, Debois M, et al. Feasibility and risks of pre-operative chemotherapy (CT) with Folfox 4 and surgery for resectable colorectal cancer liver metastases (LM). Interim results of the EORTC Intergroup randomized phase III study 40983. J Clin Oncol 2005;23(June 1 Suppl.):253s (Abstract 3528). Last updated: May 31, 2007 Safety analysis showed that peri- and postoperative complications1,2 are consistent with previous studies evaluating chemotherapy alone.3 No patients experienced increased bleeding, but blood transfusions and further surgery were required in three and one patients, respectively. Postoperative complications were seen in 11 (21%) patients; two patients with sepsis and one patient each with biliary leak, post-operative bowel perforation, anastomotic leakage, liver dysfunction, wound infection and wound haematoma. As per schedule, patients received Avastin plus XELOX 5 weeks after surgery. Postoperative liver function and regeneration (assessed by CT scans 3 months after surgery) were normal in all but one patient. CRC = colorectal cancer; CT = computed tomography; XELOX = Xeloda + oxaliplatin Gruenberger T, Tamandl D, Puhalla G, et al. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. ASCO 2007. Gruenberger T, Tamandl D, Herbst F, et al. Bevacizumab plus XELOX as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. Annal Oncol 2006;17(Suppl. 9):ix128 (Abstract 374P). Data updated via personal communication. Nordlinger B, Sorbye H, Debois M, et al. Feasibility and risks of pre-operative chemotherapy (CT) with Folfox 4 and surgery for resectable colorectal cancer liver metastases (LM). Interim results of the EORTC Intergroup randomized phase III study 40983. J Clin Oncol 2005;23(June 1 Suppl.):253s (Abstract 3528).

    27. RESECABILIDAD DE METÁSTASIS HEPÁTICAS En esta diapositiva se comparan los principales datos de resecabilidad recientemente presentados de estudios con Avastin (BEAT y NO16966) y de cetuximab (CRYSTAL) En esta diapositiva se comparan los principales datos de resecabilidad recientemente presentados de estudios con Avastin (BEAT y NO16966) y de cetuximab (CRYSTAL)

    28. Problemas Metodológicos El parámetro TASA DE RESECABILIDAD va a depender: Selección de los pacientes Tradición quirúrgica del centro participante en el estudio Calidad de la respuesta Diseño y análisis de los ensayos

    29. Conclusión La evidencia procedente de amplios estudios con Bevacizumab en combinación de primera línea de CCR indica que mejora las tasas de resecabilidad de metástasis hepáticas de los regímenes con los que se combina

    30. ! Muchas Gracias¡ High LDH, expected to have a poor outcome (39% reduction in risk of progression) High LDH, expected to have a poor outcome (39% reduction in risk of progression)

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