西妥昔单抗联合化疗治疗K-Ras野生型转移性结直肠癌的疗效分析  

Efficacy analysis of cetuximab plus chemotherapy for K-Ras wild-type colorectal cancer with metastases

作　　者：秦锐[1] 石燕[1] 陈丽[1] 吴志勇[1] 韩雅琳[1] 戴广海[1] 

机构地区：[1]中国人民解放军总医院肿瘤内二科,北京100853

出　　处：《临床肿瘤学杂志》2014年第6期516-523,共8页Chinese Clinical Oncology

摘　　要：目的观察西妥昔单抗联合化疗治疗K-Ras野生型转移性结直肠癌的疗效及安全性,探讨可能影响疗效及预后的因素。方法收集2007年5月至2012年5月解放军总医院收治的K-Ras野生型转移性结直肠癌患者共90例,采用西妥昔单抗(400mg/m2,静滴,第1周,维持剂量每周250mg/m2或每2周500mg/m2)联合化疗方案,主要为含伊立替康为基础方案(FOLFIRI或XELIRI或单药CPT-11)、含奥沙利铂为基础方案(FOLFOX或XELOX)、5-FU/LV方案或单药卡培他滨。回顾性评估西妥昔单抗联合化疗在治疗中的疗效和安全性,分析患者临床病理特征,并探讨影响疗效的因素以及此类患者预后相关的因素。结果西妥昔单抗中位治疗时间为16周(6～44周),客观缓解率(ORR)为45.6%,疾病控制率(DCR)为87.8%。其中一线治疗ORR为51.6%,二线治疗ORR为40.0%,三线治疗ORR为18.2%。单因素分析显示,年龄、原发灶部位、西妥昔单抗治疗时间与疗效有关,差异具有统计学意义(P<0.05)。90例患者中位随访时间为20.2个月,82例(91.1%)复发转移,60例(66.7%)死亡。患者中位无疾病进展时间(PFS)为7.8个月,中位总生存时间(OS)为22.5个月。其中一线中位PFS为9.1个月,中位OS为27.6个月;二线中位PFS为7.7个月,中位OS为14.5个月;三线中位PFS为2.9个月,中位OS为6.7个月。单因素分析显示:原发灶部位、早期肿瘤缓解者以及西妥昔单抗治疗时间与PFS有关;原发灶部位、早期肿瘤缓解者、西妥昔单抗治疗时间以及转移侵及范围与OS有关。Cox多因素生存分析显示:原发肿瘤病灶部位、早期肿瘤缓解是PFS的独立预后因素,转移侵及范围是OS的独立预后因素。西妥昔单抗相关治疗最常见的不良反应是痤疮样皮疹(78.0%),化疗相关的不良反应主要为腹泻、恶心呕吐、骨髓抑制,经对症处理后,患者均可耐受。结论西妥昔单抗联合多种方案化疗治疗晚期转移性结直肠癌患者,各线治疗均能取得较好Objective To investigate the efficacy and safety of the cetuximab combined with chemotherapy for patients with metastasis from colorectal cancer whose K-Ras status were wild type and explore the factors that may affect the efficacy and prognosis.Methods Retrospectively collected the clinical data of 90 patients with metastasis from colorectal cancer whose K-Ras status were wild type. Cetuximab 400mg /m^2was intravenously given at first dose and maintenance at 250mg /m^2every week or 500mg /m^2every two weeks. Combined chemotherapy regimen included,irinotecan-based chemotherapy（ FOLFIRI or XELIRI or irinotecan monotherapy）,oxaliplatin-based chemotherapy（ FOLFOX or XELOX）,other regimens,such as 5-FU /leucovorin or capecitabine monotherapy. The efficacy and safety of each line of chemotherapy was summarized and assessed,and the relationship between clinicopathology features,treatment characteristics and efficacy,explore the factors associated with prognosis were analyzed retrospectively. Results The median duration treatment of cetuximab was 16 weeks（ 6-44 weeks）. And in all patients the objective response rate（ ORR） was 45. 6%,and the disease control rate（ DCR） was 87. 8%. The DCR in first line treatment was 51. 6% better than in second line,whose was 40. 0%,and the DCR in third line was 18. 2%. The age,location of primary tumor,treatment time of cetuximab might affect the efficacy fo cetuximab plus chemotherapy. In the 90 patients,recurrent metastases were occurred in 82 cases（ 91. 1%） and death in 60 cases（ 66.7%）. The median PFS（ mPFS） was7.8 months and median OS（ mOS） was22.5 months. In the first line treatment of cetuximab plus chemotherapy,mPFS was 9. 1 months and mOS was 27. 6 months. In second line treatment mPFS was 7. 7 months and mOS was14. 5 month. in third line mPFS was 2. 9 months and mOS was 6. 7 months. Univariate survival analysis showed that the location of primary tumor,early tumor response and treatment time of cetuximab were related to PFS and OS of the patie

关 键 词：西妥昔单抗 转移性结直肠癌 靶向治疗 联合化疗 

分 类 号：R735.3[医药卫生—肿瘤]