西妥昔单抗联合化疗治疗转移性结直肠癌的临床疗效观察  

Clinical efficacy observation of cetuximab combined with chemotherapy in the treatment of metastatic colorectal carcinoma

作　　者：张婷婷[1] 苏丹[1] 李娟[1] 王以尚[1] 韩春[1] 焦顺昌[1] 白莉[1] 

机构地区：[1]解放军总医院肿瘤内一科,北京100853

出　　处：《中华胃肠外科杂志》2015年第6期584-588,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：比较西妥昔单抗联合不同化疗方案以及在不同线程中治疗转移性结直肠癌的临床疗效。方法回顾性分析2008年6月至2012年6月间解放军总医院肿瘤内科接受西妥昔单抗治疗的128例转移性结直肠癌患者的临床病理资料，其中一线应用西妥昔单抗治疗者91例，二线及以上应用37例。与西妥昔单抗联合的化疗方案包括奥沙利铂为基础的方案（59例）、伊立替康为基础的方案（58例）及卡培他滨单药方案（10例）。根据RECIST 1．0标准评价患者治疗后肿瘤缓解情况，比较西妥昔单抗联合不同化疗方案以及在不同线程中应用的客观缓解率、疾病控制率及无进展生存时间。结果98例患者获得了疗效评价，西妥昔单抗一线应用治疗的疾病控制率明显高于二线及以上应用[85．9％（61／71）比59．3％（16／27），P＝0．004]；西妥昔单抗联合奥沙利铂为基础化疗方案的疾病控制率明显高于联合伊立替康为基础方案和卡培他滨单药方案[91．1％（41／45）比68．1（32／47）和4／6，P＝0．021]。但客观缓解率在不同联合化疗方案或不同线程间的差异均无统计学意义（均P＞0．05）。西妥昔单抗联合奥沙利铂、伊立替康和卡培他滨治疗患者的中位无进展生存时间分别为8．5月、7．8月和5．2月，在一线和二线及以上应用患者分别为8．2月和7．7月，差异均无统计学意义（均P＞0．05）。结论采用西妥昔单抗治疗转移性结直肠癌患者时，推荐一线应用并联合以奥沙利铂为基础的化疗方案，有助于提高患者疾病控制率。Objective To observe the clinical efficacy of cetuximab plus chemotherapy in the treatment of metastatic colorectal carcinoma. Methods Clinicopathological data of 128 patients with metastatic colorectal cancer admitted in the Department of Oncology , Chinese PLA General Hospital from 2008 to June 2012 were analyzed retrospectively. Among them, 91 patients received cetuximab as the first-line therapy and 37 in the second-line or more-line therapy. The chemotherapy regimens included oxaliplatin-based therapy （FOLFOX/XELOX）, irinotecan-based therapy （FOLFIRI/XELIRI） and fluorouracil-based therapy （Xeloda）. The efficacy was evaluated according to RECIST 1.0 criteria. The remission rate, control rate and time to disease progression were compared among patients receiving cetuximab combined with different chemotherapy regimens in different periods. Results The disease control rate of cetuximab applied in the first-line treatment was higher than that of the second-line or more-line [85.9%（61/71） vs. 59.3%（16/27）, P=0.004]. The disease control rate of the group treated with cetuximab plus oxaliplatin-based chemotherapy was much higher compared to the other two groups [91.1%（41/45） vs. 68.1%（32/47）, 4/6, P=0.021]. But there were no significant differences among three regimens in the terms of overall response rate （all P〉0.05）. The median time to progression of groups with cetuximab plus irinotecan, oxaliplatin or capecitabine was 7.8 months, 8.5 months and 5.2＆nbsp;months respectively. The median time to progression of cetuximab combined with chemotherapy in the first-line treatment and the second-line or more-line was 8.2 and 7.7 months respectively. However , the differences were not statistically significant （P〉0.05）. Conclusions Cetuximab in combination with oxaliplatin-based chemotherapy is recommended as the first-line application in the treatment of metastatic colorectal carcinoma patients, because it is helpful to improve the rate of disease control.

关 键 词：结直肠肿瘤 转移性 西妥昔单抗 化疗 

分 类 号：R735.34[医药卫生—肿瘤]