西妥昔单抗治疗KRAS或全RAS野生型转移性结直肠癌的疗效及预后分析  

Efficacy and Prognostic Factors of Cetuximab Therapy in Treating KRAS or All RAS Wild-type Metastatic Colorectal Cancer

作　　者：吴夕 邓冰彬 白春梅 赵林 程月鹃 李孝远 李宁宁 周建凤 WU Xi;DENG Bingbin;BAI Chunmei;ZHAO Lin;CHENG Yuejuan;LI Xiaoyuan;LI Ningning;ZHOU Jianfeng(Department of Medical Oncology,PUMC Hospital,CAMS and PUMC,Beijing 100052,China;Department of Radiotherapy and Oncology,the Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肿瘤内科,北京100052 [2]苏州大学附属第二医院放疗科,江苏苏州215000

出　　处：《中国医学科学院学报》2018年第5期660-666,共7页Acta Academiae Medicinae Sinicae

基　　金：中国医学科学院医学与健康科技创新工程(2016-I2M-1-001)~~

摘　　要：目的探索影响西妥昔单抗治疗KRAS或全RAS野生型转移性结直肠癌(m CRC)患者疗效及预后的因素。方法从北京协和医院肿瘤内科2007年11月至2016年12月病理确诊为m CRC并行基因检测为KRAS野生型(2013年11月前)或全RAS野生型(2013年11月后)的患者中,筛选出接受西妥昔单抗联合化疗至少2周期的病例,回顾性分析临床病理特征与疗效的关系。结果共入组60例患者,其中一线接受西妥昔单抗治疗34例,客观缓解率(ORR)为55. 9%,中位无进展生存期和总生存期(OS)分别为10和24个月。一线治疗患者中,全RAS野生型较仅KRAS野生型者疾病进展风险降低69. 5%(P=0. 012),左半结肠癌ORR明显高于右半结肠癌(62. 1%比0;χ2=5. 46,P=0. 033)。一线治疗疾病缓解或稳定的8例患者跨线使用西妥昔单抗时中位OS可达35. 0 (95%CI:23. 6～46. 4)个月。结论全RAS野生型、左半部位m CRC患者一线应用西妥昔单抗时疗效更优。一线获益患者继续跨线应用西妥昔单抗生存时间长。Objective To explore the efficacy and prognostic factors of cetuximab therapy for KRAS or all RAS wild-type(WT)metastatic colorectal cancer(mCRC).Methods We screened mCRC patients receiving at least two cycles of cetuximb and chemotherapy from those with KRAS WT(before November 2013)or all-RAS-WT(after November 2013)in the Department of Medical Oncology,Peking Union Medical College Hospital from November 2007 to December 2016.The relationship between the clinicopathological characteristics and the efficacy was retrospectively analyzed.Results A total of 60 patients were included.For the 34 patients receiving cetuximab as first-line treatment,the objective response rate(ORR)was 55.9%,and the progression-free survival and overall survival(OS)was 10 and 24 months,respectively.All-RAS-WT mCRC had significantly lower risk of progression than those with KRAS-only-WT(P=0.012),and left-sided colorectal cancer had higher ORR than right-sided colon cancer(62.1%vs.0,P=0.033)during the first-line treatment.The median OS of the eight patients continuing cetuximab beyond first-line progression was 35.0(95%CI:23.6-46.4)months.Conclusions The efficacy of cetuximab for left-sided colorectal cancer was better than for right-sided colon cancer,and patients with all-RAS-WT have lower risk of progression than those with KRAS-only-WT.Patients benefiting from first-line cetuximab and continuing cetuximab beyond progression survive longer.

关 键 词：转移性结直肠癌 RAS基因 西妥昔单抗 疗效 预后 

分 类 号：R735.3[医药卫生—肿瘤]