SYSTEMIC THERAPY FOR METASTATIC OR LOCALLY ADVANCED CANCER (WHERE LOCAL THERAPY IS NOT INDICATED) 转移性或局部晚期恶性肿瘤（无局部治疗指征）的系统治疗

FIRST-LINE THERAPY 一线治疗山东省肿瘤医院呼吸肿瘤内科张品良

Trastuzumab (with chemotherapy) 曲妥珠单抗(联合化疗)

Trastuzumab 8 mg/kg IV loading dose on Day 1 of cycle 1, then  第1周期的第1天曲妥珠单抗负荷量8mg/kg IV，然后

Trastuzumab 6 mg/kg IV every 21 days  每14天6mg/kg IV

or 或

Trastuzumab 6 mg/kg IV loading dose on Day 1 of cycle 1, then 4 mg/kg IV every 14 days
曲妥珠单抗6mg/kg静脉注射负荷剂量第1周期的第1天，然后4mg/kg静脉注射每14天重复

PREFERRED REGIMENS 首选方案

Fluoropyrimidine and cisplatin 氟嘧啶和顺铂

Cisplatin 75–100 mg/m2 IV on Day 1
顺铂75-100mg/㎡ IV d1

Fluorouracil 750–1000 mg/m2 IV continuous infusion over 24 hours daily on Days 1–4
氟尿嘧啶750-1000mg/㎡持续静脉输注24小时以上每天1次 d1-4

Cycled every 28 days
每28天为1周期

Cisplatin 50 mg/m2 IV daily on Day 1
顺铂50mg/㎡ IV每天1次 d1

Leucovorin 200 mg/m2 IV on Day 1
亚叶酸钙200mg/㎡ IV d1

Fluorouracil 2000 mg/m2 IV continuous infusion over 24 hours daily on Day 1
氟尿嘧啶2000mg/㎡持续静脉输注24小时以上每天1次 d1

Cycled every 14 days
每14天为1周期

Cisplatin 80 mg/m2 IV daily on Day 1
顺铂每天80mg/㎡ IV d1

Capecitabine 1000 mg/m2 PO BID on Days 1–14
卡培他滨1000mg/㎡口服每日两次 d1-14

Cycled every 21 days
每21天重复

Fluoropyrimidine and oxaliplatin 氟嘧啶和奥沙利铂

Oxaliplatin 85 mg/m2 IV on Day 1
奥沙利铂85mg/㎡ IV d1

Leucovorin 400 mg/m2 IV on Day 1
亚叶酸钙400mg/㎡ IV d1

Fluorouracil 400 mg/m2 IV Push on Day 1
氟尿嘧啶400mg/㎡ IV d1

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cycled every 14 days
每14天为1周期

Oxaliplatin 85 mg/m2 IV on Day 1
奥沙利铂85mg/㎡ IV d1

Leucovorin 200 mg/m2 IV on Day 1
亚叶酸钙200mg/㎡ IV d1

Fluorouracil 2600 mg/m2 IV continuous infusion over 24 hours on Day 1
氟尿嘧啶2600mg/㎡持续静脉输注24小时以上 d1

Cycled every 14 days
每14天为1周期

Capecitabine 1000 mg/m2 PO BID on Days 1–14
卡培他滨1000mg/㎡口服每日两次 d1-14

Oxaliplatin 130 mg/m2 IV on Day 1
奥沙利铂130mg/㎡ IV d1

Cycled every 21 days
每21天重复

DCF modifications 改良的DCF

Docetaxel 40 mg/m2 IV on Day 1
多西他赛40mg/㎡ IV d1

Leucovorin 400 mg/m2 IV on Day 1
亚叶酸钙400mg/㎡ IV d1

Fluorouracil 400 mg/m2 IV on Day 1
氟尿嘧啶400mg/㎡ IV d1

Fluorouracil 1000 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1000mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cisplatin 40 mg/m2 IV on Day 3
顺铂40mg/㎡ IV d3

Cycled every 14 days
每14天为1周期

Docetaxel 50 mg/m2 IV on Day 1
多西他赛50mg/㎡ IV d1

Oxaliplatin 85 mg/m2 IV on Day 1
奥沙利铂85mg/㎡ IV d1

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cycled every 14 days
每14天为1周期

Docetaxel 75 mg/m2 IV on Day 1
多西他赛75mg/㎡ IV d1

Carboplatin AUC 6 IV on Day 2
卡铂AUC6 IV d2

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1–3
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1-3

Cycled every 21 days
每21天重复

OTHER REGIMENS 其他方案

Paclitaxel with cisplatin or carboplatin 紫杉醇联合顺铂或卡铂

Paclitaxel 135–200 mg/m2 IV on Day 1
紫杉醇135-200mg/㎡ IV d1

Cisplatin 75 mg/m2 IV on Day 2
顺铂75mg/㎡ IV d2

Cycled every 21 days
每21天重复

Paclitaxel 90 mg/m2 IV on Day 1
紫杉醇90mg/㎡ IV d1

Cisplatin 50 mg/m2 IV on Day 1
顺铂50mg/㎡ IV d1

Cycled every 14 days
每14天为1周期

Paclitaxel 200 mg/m2 IV on Day 1
紫杉醇200mg/㎡ IV d1

Carboplatin AUC 5 IV on Day 1
卡铂AUC5 IV d1

Cycled every 21 days
每21天重复

Docetaxel and cisplatin 多西他赛和顺铂

Docetaxel 70–85 mg/m2 IV on Day 1
多西他赛70-85mg/㎡ IV d1

Cisplatin 70–75 mg/m2 IV on Day 1
顺铂70-75mg/㎡ IV d1

Cycled every 21 days
每21天重复

Fluoropyrimidine 氟嘧啶

Leucovorin 400 mg/m2 IV on Day 1
亚叶酸钙400mg/㎡ IV d1

Fluorouracil 400 mg/m2 IV Push on Day 1
氟尿嘧啶400mg/㎡ IV d1

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cycled every 14 days
每14天为1周期

Fluorouracil 800 mg/m2 IV continuous infusion over 24 hours daily on Days 1–5
氟尿嘧啶800mg/㎡持续静脉输注24小时以上每天1次 d1-5

Cycled every 28 days
每28天为1周期

Capecitabine 1000–1250 mg/m2 PO BID on Days 1–14
卡培他滨1000-1250mg/㎡口服每日两次 d1-14

Cycled every 21 days
每21天重复

Taxane 紫杉烷

Docetaxel 75–100 mg/m2 IV on Day 1
多西他赛75-100mg/㎡ IV d1

Cycled every 21 days
每21天重复

Paclitaxel 135–250 mg/m2 IV on Day 1
紫杉醇135-250mg/㎡ IV d1

Cycled every 21 days
每21天重复

Paclitaxel 80 mg/m2 IV on Day 1 weekly
紫杉醇80mg/㎡ IV d1每周1次

Cycled every 28 days
每28天为1周期

Fluorouracil and irinotecan 氟尿嘧啶和伊立替康

Irinotecan 180 mg/m2 IV on Day 1
伊立替康180mg/㎡ IV d1

Leucovorin 400 mg/m2 IV on Day 1
亚叶酸钙400mg/㎡ IV d1

Fluorouracil 400 mg/m2 IV Push on Day 1
氟尿嘧啶400mg/㎡ IV d1

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cycled every 14 days (only for adenocarcinoma)
每14天为1周期(只适用于腺癌)

Irinotecan 80 mg/m2 IV on Day 1
伊立替康80mg/㎡ IV d1

Leucovorin 500 mg/m2 IV on Day 1
亚叶酸钙500mg/㎡ IV d1

Fluorouracil 2000 mg/m2 IV continuous infusion over 24 hours on Day 1
氟尿嘧啶2000mg/㎡持续静脉输注24小时以上 d1

Weekly for 6 weeks followed by 2 weeks off treatment
每周1次连续6周然后休息2周

ECF
Epirubicin 50 mg/m2 IV on Day 1
表柔比星50mg/㎡ IV d1

Cisplatin 60 mg/m2 IV on Day 1
顺铂60mg/㎡ IV d1

Fluorouracil 200 mg/m2 IV continuous infusion over 24 hours daily on Days 1–21
氟尿嘧啶200mg/㎡持续静脉输注24小时以上每天1次 d1-21

Cycled every 21 days
每21天重复

ECF modifications 改良的ECF

Epirubicin 50 mg/m2 IV on Day 1
表柔比星50mg/㎡ IV d1

Oxaliplatin 130 mg/m2 IV on Day 1
奥沙利铂130mg/㎡ IV d1

Fluorouracil 200 mg/m2 IV continuous infusion over 24 hours daily on Days 1–21
氟尿嘧啶200mg/㎡持续静脉输注24小时以上每天1次 d1-21

Cycled every 21 days
每21天重复

Epirubicin 50 mg/m2 IV on Day 1
表柔比星50mg/㎡ IV d1

Cisplatin 60 mg/m2 IV on Day 1
顺铂60mg/㎡ IV d1

Capecitabine 625 mg/m2 PO BID on Days 1–21
卡培他滨625mg/㎡口服每日两次 d1-21

Cycled every 21 days
每21天重复

Epirubicin 50 mg/m2 IV on Day 1
表柔比星50mg/㎡ IV d1

Oxaliplatin 130 mg/m2 IV on Day 1
奥沙利铂130mg/㎡ IV d1

Capecitabine 625 mg/m2 PO BID on Days 1–21
卡培他滨625mg/㎡口服每日两次 d1-21

Cycled every 21 days
每21天重复

SECOND-LINE THERAPY二线治疗

PREFERRED REGIMENS 首选方案

Ramucirumab and paclitaxel (for adenocarcinoma only)
雷莫芦单抗和紫杉醇（只适用于腺癌）

Ramucirumab 8 mg/kg IV on Days 1 and 15
雷莫芦单抗8mg/kg IV d1、15

Paclitaxel 80 mg/m2 on Days 1, 8, and 15
紫杉醇80mg/㎡ IV d1、15

Cycled every 28 days
每28天为1周期

Taxane 紫杉烷

Docetaxel 75–100 mg/m2 IV on Day 1
多西他赛75-100mg/㎡ IV d1

Cycled every 21 days
每21天重复

Paclitaxel 135–250 mg/m2 IV on Day 1
紫杉醇135-250mg/㎡ IV d1

Cycled every 21 days
每21天重复

Paclitaxel 80 mg/m2 IV on Day 1 weekly
紫杉醇80mg/㎡ IV d1每周1次

Cycled every 28 days
每28天为1周期

Paclitaxel 80 mg/m2 IV on Days 1, 8, 15
紫杉醇80mg/㎡ IV d1、8、15

Cycled every 28 days
每28天为1周期

Irinotecan 伊立替康

Irinotecan 250–350 mg/m2 IV on Day 1
伊立替康250-350mg/㎡ IV d1

Cycled every 21 days
每21天重复

Irinotecan 150–180 mg/m2 IV on Day 1
伊立替康150-180mg/㎡ IV d1

Cycled every 14 days
每14天为1周期

Irinotecan 125 mg/m2 IV on Days 1 and 8
伊立替康125mg/㎡ IV d1、8

Cycled every 21 days
每21天重复

Ramucirumab (for adenocarcinoma only)
雷莫芦单抗（只适用于腺癌）

Ramucirumab 8 mg/kg IV on Day 1
雷莫芦单抗8mg/kg IV d1

Cycled every 14 days
每14天为1周期

OTHER REGIMENS 其他方案

Irinotecan and cisplatin 伊立替康和顺铂

Irinotecan 65 mg/m2 IV on Days 1 and 8
伊立替康65mg/㎡ IV d1、8

Cisplatin 25–30 mg/m2 IV on Days 1 and 8
顺铂25-30mg/㎡ IV d1、8

Cycled every 21 days
每21天重复

Irinotecan and fluoropyrimidine 伊立替康加氟嘧啶

Irinotecan 250 mg/m2 IV on Day 1
伊立替康250mg/㎡ IV d1

Capecitabine 1000 mg/m2 PO BID on Days 1–14
卡培他滨1000mg/㎡口服每日两次 d1-14

Cycled every 21 days
每21天重复

Irinotecan 180 mg/m2 IV on Day 1
伊立替康180mg/㎡ IV d1

Leucovorin 400 mg/m2 IV on Day 1
亚叶酸钙400mg/㎡ IV d1

Fluorouracil 400 mg/m2 IV Push on Day 1
氟尿嘧啶400mg/㎡ IV d1

Fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily on Days 1 and 2
氟尿嘧啶1200mg/㎡持续静脉输注24小时以上每天1次 d1、2

Cycled every 14 days (only for adenocarcinoma)
每14天为1周期(只适用于腺癌)

Docetaxel and irinotecan
多西他赛和伊立替康

Docetaxel 35 mg/m2 IV on Days 1 and 8
多西他赛35mg/㎡ IV d1、8

Irinotecan 50 mg/m2 IV on Days 1 and 8
伊立替康50mg/㎡ IV d1、8

Cycled every 21 days
每21天重复

The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Modifications of drug dose and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and because of individual patient variability, prior treatment, nutritional status, and comorbidity. The optimal delivery of anticancer agents therefore requires a health care delivery team experienced in the use of anticancer agents and the management of associated toxicities in patients with cancer.
抗癌药物的选择、剂量和给药以及相关毒性的处理是复杂的。因为预期的毒性以及个体患者的差异、既往治疗、营养状况及并存疾病，常常有必要调整药物剂量与给药计划并启动支持治疗干预。因此最理想的抗癌药物实施需要有在癌症患者中抗癌药物使用与相关毒性处理经验的保健医疗团队。

食管/食管胃结合处癌 NCCN指南2016v1