Rechallenge of oxaliplatin-containing regimens in the third- or later-line therapy for patients with heavily treated metastatic colorectal cancer.
Rechallenge of oxaliplatin-containing regimens in the third- or later-line therapy for patients with heavily treated metastatic colorectal cancer.
复制标题
对于接受重度治疗的转移性结直肠癌患者，在三线或后期治疗中重新挑战含奥沙利铂的方案
DOI：
10.2147/ott.s154220
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发表时间：
2018
影响因子：
4
通讯作者：
Xie D
中科院分区：
文献类型：
--
作者：
Yang Q;Huang Y;Jiang Z;Wang H;Li W;Zhang B;Xie D
目的在转移性结直肠癌(MCRC)患者中，现有的三线或更晚的治疗方案往往对患者的生存有不良影响。该回顾性研究旨在评价含奥沙利铂方案的再挑战的疗效。患者和方法在一线和二线化疗中由氟嘧啶、奥沙利铂和伊立替康进展的mCRC患者，接受含奥沙利铂方案的再暴露治疗。对照组患者接受抗表皮生长因子受体(EGFR)抗体联合伊立替康治疗。结果95~29例患者分别接受奥沙利铂再暴露或抗表皮生长因子受体抗体联合伊立替康三线或晚期治疗。奥沙利铂组的中位治疗失败时间(TTF)和总生存期(OS)分别为3.77个月和12.17个月，对照组分别为4.77个月和11.37个月，两组比较差异无统计学意义(p>；0.05)。奥沙利铂再暴露后客观有效率为6.3%，无完全缓解，6例部分缓解，39例稳定，37例进展。疾病控制率为47.4%(45/95)。多因素分析发现，与有进展性疾病的患者相比，通过再次暴露奥沙利铂获得疾病控制的患者的总转移时间(6.13月比1.7月，p<；0.001)和操作系统(15.73vs6.27个月，p<；0.001)更好。结论奥沙利铂在三线或后一线化疗中的再激发可控制肿瘤，提高mCRC患者的生存率，与伊立替康的抗EGFR抗体相当。临床意义尽管几乎没有证据可用，但在三线或更晚的治疗中再次挑战奥沙利铂方案是一种常见的做法。目前的研究发现，在mCRC中，再次挑战含有奥沙利铂的方案与使用伊立替康的抗EGFR抗体具有相同的肿瘤控制和生存益处。
Purpose The third- or later-line therapy available often yield poor survival benefit in patients metastatic colorectal cancer (mCRC). The retrospective study aimed to evaluate efficacy of rechallenge of oxaliplatin-containing regimens. Patients and methods Patients with mCRC who progressed from fluoropyrimidine, oxaliplatin, and irinotecan in the first- and second-line chemotherapy, were treated by reexposure to oxaliplatin-containing regimen. Patients treated by anti-epidermal growth factor receptor (EGFR) antibodies with irinotecan were included in the control arm. Results Ninety-five and 29 patients were treated with either oxaliplatin reexposure or anti-EGFR antibodies with irinotecan, respectively, as the third- or later-line therapy. The median time to treatment failure (TTF) and overall survival (OS) was 3.77 and 12.17 months in the oxaliplatin arm, with 4.77 months of TTF and 11.37 months of OS in the control arm; there was no significance between the 2 arms (p>0.05). Oxaliplatin reexposure resulted in 6.3% objective response rate with no complete response, 6 partial response, 39 stable disease, and 37 progressive disease. The disease control rate was 47.4% (45/95). The multivariate analysis found that patients who achieved disease control by oxaliplatin reexposure had a superior TTF (6.13 vs 1.7 months, p<0.001) and OS (15.73 vs 6.27 months, p<0.001) compared with those presenting with progressive disease. Conclusion This study showed that rechallenge of oxaliplatin-containing chemotherapy in the third- or later-line therapy may lead to tumor control and improved survival in mCRC patients, which was equivalent to that of anti-EGFR antibodies with irinotecan. Clinical significance Rechallenge of oxaliplatin-containing regimens in the third- or later-line of therapy is a common practice, despite few evidence available. The present study found that rechallenge of oxaliplatin-containing regimens produced equivalent tumor control and survival benefit to that of anti-EGFR antibodies with irinotecan in mCRC.