大舜政策研究中心 Dashun Policy Research Centre Ltd Annual Conference 2012

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1 香港樂健會社 Happy Health Society in association with 大舜政策研究中心 Dashun Policy Research Centre Ltd Annual Conference 2012 人人健康由我做起 中西結合預防癌症 Prevention of Cancer East Meets West Approaches 2012 年 12 月 22 日 ( 星期六 ) 上午 9 時至下午 1 時正

2 癌症治療新發展 岑信棠醫生臨床腫瘤科專科醫生 香港大學醫學院臨床腫瘤學系榮譽教授

3 癌症特質 侵犯鄰近的器官及組織 癌細胞可由原位擴散至身體其他地方 ( 經淋巴系統, 或經血管擴散至身體其他部位 )

4 減低癌症的死亡率 癌症的預防 (to next file) 及早發現 : 癌症的期數是預後的重要因素 (prognostic factor) 提升根治性治療成效 手術及 / 或放射治療 輔助性治療 ( 化療, 荷爾蒙療法, 標靶治療 )

5 緩和性癌症治療 延長腫瘤控制, 延長病人壽命 提升全身性治療 ( 化療, 荷爾蒙療法, 標靶治療 ) 成效 恰當地使用手術及 / 或放射治療

6 癌症的治療方案 手術 放射治療 化療 同步化放療 荷爾蒙療法 標靶治療

7 癌症的治療方案 局部治療 (Locoregional treatment) 手術治療 放射治療 全身性治療 (Systemic treatment) 化療 荷爾蒙療法 標靶治療 免疫療法 基因療法

8 治癌技術新改進 增加對腫瘤行為及生長模式的認識 診斷儀器能提供更清晰的影像 各類治療方案的改進

9 Advances in cancer therapy Surgery : minimally invasive surgery Radiotherapy : intensity modulated radiotherapy (IMRT) Chemotherapy : more potent and with less side effects, improve supportive measures Hormone therapy : more effective agents Targeted therapy : completely new developments targeted on behavior characteristic of cancer cells

10 手術治療 微創手術 ( 胸腔及腹腔 ), 容許手術在年齡較大或身體虛弱病人身上進行 Allow surgery in elderly and frail patient, who would otherwise be in-operable Allow early recovery and preserve quality of life Allow early start of post-operative adjuvant treatment

11 手術治療 超大型手術 ( 惠普爾手術 ), 利用微血管手術進行組織重建 ( 頭頸腫瘤切除及組織重建 ), 以及器官移植 ( 肝臟移植 ) 輔以較佳的支援, 包括麻醉技術 以儀器維持心臟 呼吸及腎臟功能, 與及臨床微生物學的應用

12 微創手術 Minimally invasive surgery Allow surgery in elderly and frail patient, who would otherwise be in-operable Allow early recovery and preserve quality of life Allow early start of post-operative adjuvant treatment

13 高準確度放療 Precision radiotherapy 減少鄰近器官放射劑量 Cut down dose to adjacent normal tissue, and thus cut down complications of treatment 容許增強腫瘤放射劑量 Allow escalation of radiation dose, so as to improve tumor control Cut down marginal miss and cause of failure of treatment

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24 同步化放療 同步化放療可提升放射治療之療效 now being used in a large number of tumor types : NPC, other head and neck cancers, brain tumors, lung, esophagus, pancreas, rectum, bladder

25 其他提升放療效果方法 放療 + 荷爾蒙療法 (prostate cancer) 放療 + 靶點治療 (head and neck cancers)

26 化療之效用 ( 肺癌 ) 根治 : 誘導化療, 縮細腫瘤, 有助手術或放療之進行 根治 : 同步化放療可提升放射治療之療效 根治 : 手術後輔助化療 非根治 : 遠轉移之化療, 延長生命及改善病徵

27 新一代的化療藥物 New chemotherapy agents 副作用較少 Drugs with less side effects on marrow, hair follicles, general well being 效用較佳 More effective drugs : oxaliplatin and irinotecan for colorectal cancers, premetrexate (Alimta) for lung cancer, temozolomide for brain tumor 其他減少化療副作用方法 More effective supportive care : anti-emetics, boost WBC production

28 荷爾蒙療法 Hormone therapy 新的乳癌荷爾蒙藥物 New drugs for breast cancer : aromatase inhibitors (15 years) fulvestrant (10 years) 新的前列腺癌荷爾蒙藥物 New drugs for prostate cancer : Zoladex (15 years), Casodex (12 years) Combination of hormone therapy for breast cancer : combination of different mechanisms of action, and combination with mtor inhibitor (1 year) 新的藥物使用方法 New drugs for prostate cancer : abiraterone (that cut down the small amount of androgen produced in adipose tissue, adrenal and prostate tissue) (1 year)

29 標靶治療 Targeted therapy 靶點是癌細胞獨有信息傳導, 正常細胞影響不多 Target on signal transduction that are unique to tumor cells, and seldom found in normal cells, and thus result in cancer cell kill and minimal side effects Revoluntionarize concept of cancer therapy

30 標靶治療 Targeted therapy 過去理解當作單一類型的腫瘤, 可通過使用生物標誌, 細分成對不同標靶藥物有不同反應的不同腫瘤類型 Cancer previous known as one type (eg. Lung cancer, colon cancer, breast cancer, etc) are composed of different subtypes which are characterized by molecular markers (to predict response to different targeted agents)

31 標靶治療 Targeted therapy Lung cancer : EGFR and ALK gene mutation Colorectal cancer : KRAS mutation Breast cancer : HER2 overexpression Melanoma : V600E gene mutation

32 標靶治療 Targeted therapy 改善治療結果 Improved treatment results : breast, lung, colorectal, lymphoma, pancreas, head and neck, brain 過去無藥可治的, 現在有藥可治 Previously no effective treatment : liver, kidney

33 標靶治療使用於根治性治療 Use of targeted therapy for curative treatment 淋巴瘤 follicular lymphoma : combined with induction chemotherapy improves overall survival by 10%, used as maintenance therapy prolong progressionfree-survival by 2 years For large B-cell lymphoma in elderly patients : improves overall survival by 10%

34 標靶治療使用於根治性治療 Use of targeted therapy for curative treatment 乳癌 adjuvant treatment of breast cancer reduce risk of relapse by 1/3 (while adjuvant chemotherapy reduce risk by 1/3 to 1/2) 胃肠道间质瘤 Adjuvant treatment of gastrointestinal stromal tumor (GIST) reduce risk of relapse by 80%

35 標靶治療 Targeted therapy 大多數標靶治療是緩和性的 Unfortunately, most treatment using targeted therapy are not for curative treatment, exceptions are when they are used for lymphoma, and in adjuvant treatment of breast cancer and GIST

36 晚期大腸癌病人的治療成效不斷改善 Improving survival for advanced colorectal cancer 最佳支援性治療 Best supportive care 4-6 單用 5FU/FA 5FU/FA monotherapy 新化療藥物 + 5FU/FA New agent + 5FU/FA 連續使用合併化療 Sequential combination chemotherapy 靶點治療 + 合併化療 Targeted therapy + combination therapy or more 存活期 Median survival (months)

37 標靶治療的成就 Achievements of targeted therapy 肺癌 for patients with EGFR gene mutation, treatment using oral EGFR TKI produce progression-free survival of 6 to 9 months, with good quality of life Adding bevacizumab to chemotherapy for lung cancer increase progression-free survival by 2 to 3 months

38 31/03/03 28/07/03 Started IRESSA 07/07/03 25/08/03

39 標靶治療的成就 Achievements of targeted therapy 惡性腦癌 recurrent glioblastoma multiforme : the addition of bevacizumab to cytotoxic chemotherapy, such as irinotecan, appears to improve progression-free survival in patients progressing on the standard of care, with a 6-month progression-free survival rate of 46%.

40 標靶治療的成就 Achievements of targeted therapy 肝癌 Hepatocellular carcinoma of liver : sorafenib prolonged overall survival by months, extended the time to tumor progression by months, and increased disease control by %.

41 標靶治療的成就 Achievements of targeted therapy 甲狀腺癌 thyroid carcinoma : pazopanib produced 49% partial responses, with likelihood of response lasting longer than 1 year calculated to be 66%.

42 標靶治療的成就 Achievements of targeted therapy 腎癌 Renal cell carcinoma : for first-line therapy, an estimate of progression-free survival with sunitinib, bevacizumab plus interferon, or sorafenib in a 'general' population is 8-9 months,

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45 经过多年的临床研究认为, 手术后用不用中药对患者来说, 病情发展是完全不同的 统计学数据表明, 通过中药调理, 可以给患者一个比较好的体质, 肿瘤复发和转移的情况相 在放疗和化疗过程中, 应用中医中药可以帮助患者减轻不良反应 对减少

46 中医和西医不同的是, 西医是治病, 中医是治人 中医是通过调节人的机体状态, 达到阴阳平衡, 以抵抗肿瘤的产生

47 Advances in cancer therapy Surgery : minimally invasive surgery Radiotherapy : intensity modulated radiotherapy (IMRT) Chemotherapy : more potent and with less side effects, improve supportive measures Hormone therapy : more effective agents Targeted therapy : completely new developments targeted on behavior characteristic of cancer cells

48 Minimally invasive surgery Allow surgery in elderly and frail patient, who would otherwise be in-operable Allow early recovery and preserve quality of life Allow early start of post-operative adjuvant treatment

49 Precision radiotherapy Cut down dose to adjacent normal tissue, and thus cut down complications of treatment Allow escalation of radiation dose, so as to improve tumor control Cut down marginal miss and cause of failure of treatment

50 New chemotherapy agents Drugs with less side effects on marrow, hair follicles, general well being More effective drugs : oxaliplatin and irinotecan for colorectal cancers, premetrexate (Alimta) for lung cancer, temozolomide for brain tumor More effective supportive care : antiemetics, boost WBC production

51 Hormone therapy New drugs for breast cancer : aromatase inhibitors (15 years) fulvestrant (10 years) New drugs for prostate cancer : Zoladex (15 years), Casodex (12 years) Combination of hormone therapy for breast cancer : combination of different mechanisms of action, and combination with mtor inhibitor (1 year) New drugs for prostate cancer : abiraterone (that cut down the small amount of androgen produced in adipose tissue, adrenal and prostate tissue) (1 year)

52 Targeted therapy Target on signal transduction that are unique to tumor cells, and seldom found in normal cells, and thus result in cancer cell kill and minimal side effects Revoluntionarize concept of cancer therapy

53 Targeted therapy Cancer previous known as one type (eg. Lung cancer, colon cancer, breast cancer, etc) are composed of different subtypes which are characterized by molecular markers (to predict response to different targeted agents) Lung cancer : EGFR and ALK gene mutation Colorectal cancer : KRAS mutation Breast cancer : HER2 overexpression Melanoma : V600E gene mutation

54 Targeted therapy Improved treatment results : breast, lung, colorectal, lymphoma, pancreas, head and neck, brain Previously no effective treatment : liver, kidney

55 Targeted therapy Unfortunately, most treatment using targeted therapy are not for curative treatment, exceptions are when they are used for lymphoma, and in adjuvant treatment of breast cancer and GIST

56 Give summary slides on achievements in recent years : lung, breast, colorectal, RCC, GBM, thyroid, etc

57 日期及時間 : 2012 年 12 月 22 日 ( 星期六 ) 上午 9 時至下午 1 時 Date & Time: 22 December 2012 (Saturday) 9:00 am 1:00 pm 地點 : 九龍亞皆老街 147B 醫院管理局大樓閣樓演講廳 Venue: Lecture Theatre, M/F, Hospital Authority Building, 147B Argyle Street, Kowloon 論壇程序 Conference Programme ( 初稿 ) 時間 Time 講題 Topics 講者 Speakers 8:30 9:00 登記 Registration 9:00 9:08 歡迎及開幕辭 Welcome Speech 陳國榮醫生 / 何鍾泰博士 9:08 9:25 論壇主題演說梁智鴻教授 9:25 9 :30 儀式 9:30 10:15 癌症新發現 (1) 莫樹錦醫生 10:15 11:00 病理研究 (2) 杜家輝教授 11:00 11:15 Break 11:15 12:00 癌症預防與治療 (3) 岑信棠教授 12:00 12:45 中醫預防與治療 (4) 劉宇龍醫生 12:45 1:00 總結 李紹鴻教授