Systemic treatment of colorectal cancer
Systemic treatment of colorectal cancer
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DOI：
10.1016/s0959-8049(02)00062-x
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发表时间：
2002-05-01
影响因子：
8.4
通讯作者：
Kerr, D
中科院分区：
文献类型：
--
作者：
Tebbutt, NC;Cattell, E;Kerr, D
直到最近，结直肠癌的姑息性和辅助治疗在很大程度上依赖于基于5-氟尿嘧啶（5-FU）的化疗。口服氟嘧啶已经在晚期疾病环境中进行了评估，它们似乎与5-FU一样有效，但对大多数患者来说更安全、更方便。伊立替康和奥沙利铂是新的细胞毒性药物，它们在5-FU耐药疾病中有效，但也可与5-FU联合作为晚期疾病的初始治疗。与5-FU单药治疗相比，初始联合治疗提高了缓解率，延长了无进展生存期。辅助治疗的标准方案通常包括使用5-FU和亚叶酸进行6个月的化疗。最近卡培他滨、奥沙利铂和伊立替康在辅助治疗中的试验正在进行中，或最近完成了累积，并可能导致未来临床实践的改变。生物疗法在结直肠癌的治疗中发挥着越来越重要的作用。法尼基转移酶抑制，表皮生长因子受体（EGFR）和血管内皮生长因子（VEGF）的抑制正在进行晚期疾病的评估。在辅助设置，被动和主动免疫治疗方法已经研究。此外，一项大型试验将评估环加氧酶(COX)-2抑制剂作为辅助治疗的作用。需要进一步的研究来确定这些不同的细胞毒性和生物疗法的最佳顺序和组合，以确保不同亚组的早期和晚期结直肠癌患者的最佳结果。(C) 2002年Elsevier Science Ltd.出版
Palliative and adjuvant treatment for colorectal cancer has been, until recently, largely dependent on 5-fluorouracil (5-FU)-based chemotherapy. Oral fluoropyrimidines have been evaluated in the advanced disease setting and they appear to be as effective as 5-FU, but are safer and more convenient for most patients. Irinotecan and oxaliplatin are new cytotoxic agents, which are active in 5-FU-resistant disease, but which may also be combined with 5-FU as initial therapy in advanced disease. Initial combination therapy leads to improved response rates and more prolonged progression-free survival compared with 5-FU monotherapy. Standard regimens for adjuvant therapy usually involve 6 months of chemotherapy using 5-FU and folinic acid. Recent trials of capecitabine, oxaliplatin and irinotecan in the adjuvant setting are ongoing, or have recently completed accrual, and may lead to a change in future clinical practice. Biological therapies are playing an increasing role in the management of colorectal cancer. Farnesyl transferase inhibition, inhibition of the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor (VEGF) are undergoing evaluation in advanced disease. In the adjuvant setting, both passive and active immuno therapeutic approaches have been studied. In addition, a large trial will evaluate the role of cyclo-oxygenase(COX)-2 inhibitors as adjuvant therapy. Further research is required in order to define the optimal sequence and combination of these different cytotoxic and biological therapies, in order to secure the best possible outcome for various subgroups of patients with both early and advanced stage colorectal cancer. (C) 2002 Published by Elsevier Science Ltd.