Neoadjuvant and conversion treatment of patients with colorectal liver metastasis: the potential role of bevacizumab and other antiangiogenic agents.
Neoadjuvant and conversion treatment of patients with colorectal liver metastasis: the potential role of bevacizumab and other antiangiogenic agents.
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DOI：
10.1007/s11523-015-0362-0
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发表时间：
2015-12
影响因子：
5.4
通讯作者：
Lara R
中科院分区：
文献类型：
--
作者：
García-Alfonso P;Ferrer A;Gil S;Dueñas R;Pérez MT;Molina R;Capdevila J;Safont MJ;Castañón C;Cano JM;Lara R
超过50%的结直肠癌患者发生肝转移。手术切除是提高结直肠癌肝转移（CRLM）患者生存率的唯一有效治疗方法。新的抗血管生成靶向治疗，如贝伐单抗，阿柏西普和瑞格非尼，与新辅助和转换化疗联合使用，可能会提高这一人群的缓解率，并增加适合手术切除的患者比例。本综述讨论了在这种情况下，抗血管生成靶向药物的可用数据。这些疗法之一，靶向血管内皮生长因子（VEGF）的贝伐单抗在这种情况下表现出良好的效果。在最初不可切除的CRLM患者中，5-氟尿嘧啶、亚叶酸和奥沙利铂（FOLFOX）联合贝伐珠单抗可获得较高的缓解率和切除率。这种组合对不可切除的CRLM患者也有效。此外，在肝转移的新辅助治疗背景下，在化疗中加入贝伐单抗对病理学缓解率有更高的影响。该药物还具有可管理的安全性，根据最近的数据，贝伐珠单抗可以防止某些细胞毒性药物引起的肝脏窦腔扩张。在II期临床试验中，抗血管生成治疗已证明在CRLM的术前治疗中获益，并可能代表这些患者的新治疗途径。
More than 50 % of patients with colorectal cancer develop liver metastases. Surgical resection is the only available treatment that improves survival in patients with colorectal liver metastases (CRLM). New antiangiogenic targeted therapies, such as bevacizumab, aflibercept, and regorafenib, in combination with neoadjuvant and conversion chemotherapy may lead to improved response rates in this population of patients and increase the proportion of patients eligible for surgical resection. The present review discusses the available data for antiangiogenic targeted agents in this setting. One of these therapies, bevacizumab, which targets the vascular endothelial growth factor (VEGF) has demonstrated good results in this setting. In patients with initially unresectable CRLM, the combination of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab has led to high response and resection rates. This combination is also effective for patients with unresectable CRLM. Moreover, the addition of bevacizumab to chemotherapy in the neoadjuvant setting of liver metastasis has a higher impact on pathological response rate. This drug also has a manageable safety profile, and according to recent data, bevacizumab may protect against the sinusoidal dilation provoked in the liver by certain cytotoxic agents. In phase II trials, antiangiogenic therapy has demonstrated benefits in the presurgical treatment of CRLM and may represent a new treatment pathway for these patients.