伊立替康+奥沙利铂+卡培他滨联合贝伐单抗双周方案一线治疗晚期转移性大肠癌的疗效和安全性  

Efficacy and Safety of the First-Line Treatment of Advanced Metastatic Colorectal Cancer with a Biweekly Regimen of Irinotecan,Oxaliplatin,Capecitabine,and Bevacizumab

作　　者：汤海舰 何益腾 李浩军 姜洋 邹子骅 TANG Haijian;HE Yiteng;LI Haojun;JIANG Yang;ZOU Zihua(Department of Oncology,Third Ring Cancer Hospital,Chaoyang District,Beijing 100023,China;Department of Oncology,Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]北京市朝阳区三环肿瘤医院肿瘤内科,北京100023 [2]福建省肿瘤医院肿瘤内科,福州350014

出　　处：《中国医药指南》2024年第19期26-31,共6页Guide of China Medicine

摘　　要：目的观察伊立替康+奥沙利铂+卡培他滨联合贝伐单抗双周方案一线治疗晚期转移性大肠癌的疗效和安全性。方法回顾性纳入2023年2月至2024年2月我院晚期转移性结直肠癌患者31例,均采用一线治疗:伊立替康160 mg/m^(2)第1天+奥沙利铂85 mg/m2第2天+卡培他滨1000 mg/m^(2)第1~8天(每日2次)+贝伐单抗5 mg/kg第1天(每2周用药1次)。分析该方案在不同基因突变、不同肿瘤位置的人群中的疗效和安全性。结果4例潜在可切除转移性大肠癌患者经三药化疗联合贝伐单抗治疗后成功切除原发灶和转移灶,其中2例存活且无复发转移,2例因复发转移而死亡。27例初始不可切除大肠癌患者接受三药化疗和贝伐单抗治疗后,虽无人手术,但总体缓解率达70.4%,中位持续缓解时间12.2个月,中位无进展生存期(PFS)13个月,中位总生存期(OS)33.5个月。在PFS方面,三药化疗联合贝伐单抗对基因突变大肠癌患者更有优势,但OS上两组相似;对于左半大肠癌患者,该治疗方案在基因突变人群中优势更显著,但OS无统计学差异;右半大肠癌患者数据不足以进行基因型疗效对比。左半大肠癌基因突变患者的PFS较右半更有优势,但两者在OS上无统计学差异。东部肿瘤协作组(ECOG)评分为0分和1分的患者在接受三药化疗联合贝伐单抗治疗后,在PFS和OS上均无统计学差异。共纳入31例,该方案≥3级不良反应发生率为45.2%,因不良反应下调任何一种药物剂量的发生率为45.2%(最常见原因是骨髓抑制包括白细胞、中性粒细胞和血小板减少),有35.5%患者因不良反应中断/推迟治疗,12.9%因不良反应完全终止该方案;另外,对于初始明确不可切除的患者,虽无差异,但左半人群在数值上仍然有所提高。结论伊立替康+奥沙利铂+卡培他滨+贝伐单抗的双周化疗方案在RAS突变的晚期转移性大肠癌的一线治疗中具有一定潜力,能有效降低不良反应,延长生�Objective A retrospective study was conducted on the first-line treatment of advanced metastatic colorectal cancer with a bi weekly regimen of irinotecan,oxaliplatin,capecitabine,and bevacizumab.Methods Data of 31 patients with advanced metastatic colorectal cancer in our hospital from March 2022 to April 2024 were collected.All patients received first-line treatment:irinotecan 160 mg/m^(2) on day 1,oxaliplatin 85 mg/m^(2) on day 2,capecitabine 1000 mg/m^(2) on day 1-8,twice a day,and bevacizumab 5mg/kg on day 1.The medication was administered every two weeks.Analyze the efficacy and safety of this approach in populations with different gene mutations and tumor locations.Results Four potential resectable metastatic colorectal cancer patients were successfully treated with triple drug chemotherapy combined with bevacizumab to remove the primary and metastatic lesions.Two of them survived without recurrence or metastasis,while two died due to recurrence or metastasis.After receiving three drug chemotherapy and bevacizumab treatment in 27 patients with initial unresectable colorectal cancer,although no surgery was performed,the overall response rate reached 70.4%,with a median sustained response time of 12.2 months,a median progression free survival period of 13 months,and a median overall survival period of 33.5 months.In terms of PFS,the combination of three drug chemotherapy and bevacizumab has an effect on gene mutations patients with colorectal cancer have more advantages,but the OS of the two groups is similar;For patients with left colorectal cancer,this treatment regimen has a more significant advantage in the population with gene mutations,but there is no statistically significant difference in OS;The data on patients with right colon cancer is insufficient for genotype efficacy comparison.The PFS of patients with left colon cancer gene mutations is more advantageous than that of patients with right colon cancer,but there is no significant difference in OS between the two.Patients with the Eastern Cooperati

关 键 词：伊立替康 奥沙利铂 卡培他滨 贝伐单抗双周方案 一线治疗 晚期转移性大肠癌 

分 类 号：R735.34[医药卫生—肿瘤]