Bevacizumab plus chemotherapy as third- or later-line therapy in patients with heavily treated metastatic colorectal cancer
Bevacizumab plus chemotherapy as third- or later-line therapy in patients with heavily treated metastatic colorectal cancer
复制标题
贝伐珠单抗联合化疗作为接受重治疗的转移性结直肠癌患者的三线或后期治疗
DOI：
10.2147/ott.s88679
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发表时间：
2015-01-01
影响因子：
4
通讯作者：
Xia, Liangping
中科院分区：
文献类型：
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作者：
Yang, Qiong;Yin, Chenxi;Xia, Liangping
背景资料：目前可用于转移性结直肠癌（mCRC）的三线或更高线治疗的疗效有限，在二线或二线以上标准治疗后进展的患者中生存获益较弱。我们的回顾性研究旨在探讨贝伐单抗加化疗在this setting.Methods的价值：mCRC患者接受氟嘧啶，奥沙利铂，伊立替康作为一线和二线化疗被选中纳入。治疗包括贝伐单抗加化疗。化疗主要包括奥沙利铂，伊立替康，和fluoropyrimidine.Results：在2010年2月和2012年12月之间，35例mCRC患者接受了贝伐单抗加化疗作为三线或三线以上治疗。无完全缓解，7例部分缓解（20%），22例疾病稳定缓解（62.9%），6例疾病进展缓解（17.1%），客观缓解率为20%，疾病控制率为82.9%。中位随访11.3个月（范围：0.7-48.0个月），中位无进展生存期为5.98个月（95%置信区间：4.76-7.2个月），中位总生存期为14.77个月（95%置信区间：11.45-18.1个月）。在单变量分析中，原发性结肠肿瘤患者的总生存期可能长于原发性直肠肿瘤患者（分别为18.8个月vs 11.1个月; P = 0.037）。常见的化疗相关毒性为恶心/呕吐（48.6%）、疲乏（34.3%）、白细胞减少（40%）、中性粒细胞减少（42.9%）和贫血（42.9%），1例患者发生3级中性粒细胞减少，2例患者发生3级血小板减少。常见的贝伐珠单抗相关毒性为高血压（31.4%）。没有患者停止治疗或死亡，因为贝伐珠单抗相关toxics.Conclusion：我们的数据表明，贝伐珠单抗加入三线或三线后治疗可能会导致肿瘤控制和改善生存在大量预处理的结直肠癌患者。此外，初步数据表明，原发性结肠癌更有可能从含贝伐珠单抗的方案中获益。毒性可接受，未发现新的毒性。需要进一步的研究来验证这些发现。
Background: Currently available third- or later-line therapy for metastatic colorectal cancer (mCRC) is limited in its efficacy, with a weak survival benefit in patients who progressed after two or more lines of standard therapy. Our retrospective study aimed to explore the value of bevacizumab plus chemotherapy in this setting.Methods: Patients with mCRC who received fluoropyrimidine, oxaliplatin, and irinotecan as first-and second-line chemotherapy were selected for inclusion. Treatment consisted of bevacizumab plus chemotherapy. Chemotherapy consisted mainly of oxaliplatin, irinotecan, and fluoropyrimidine.Results: Between February 2010 and December 2012, 35 consecutive patients with mCRC were treated with bevacizumab plus chemotherapy as a third- or later-line treatment. No complete responses, seven partial responses (20%), 22 stable disease responses (62.9%), and six progressive disease responses (17.1%) were obtained, producing an objective response rate of 20% and a disease control rate of 82.9%. With a median follow-up of 11.3 months (range: 0.7-48.0 months), the median progression-free survival was 5.98 months (95% confidence interval: 4.76-7.2 months), and the median overall survival was 14.77 months (95% confidence interval: 11.45-18.1 months). In the univariate analysis, patients with a primary colon tumor might have had a longer overall survival than patients with a primary rectal tumor (18.8 months vs 11.1 months, respectively; P = 0.037). Common chemotherapy-related toxicities were nausea/vomiting (48.6%), fatigue (34.3%), leucopenia (40%), neutropenia (42.9%), and anemia (42.9%), with one patient with grade 3 neutropenia, and two patients with grade 3 thrombocytopenia. The common bevacizumab-associated toxicity was hypertension (31.4%). None of the patients discontinued therapy or died because of bevacizumab-associated toxicities.Conclusion: Our data showed that adding bevacizumab to third-or later-line therapy might lead to tumor control and improved survival in heavily pretreated mCRC patients. In addition, preliminary data suggested that primary colon cancer was more likely to benefit from bevacizumab-containing regimens. Toxicities were acceptable, and no new toxicity was identified. Further studies are needed to validate these findings.