CAJ | 학술논문

目的评价贝伐单抗联合伊立替康(CPT-11)为主方案一线治疗转移性结直肠癌的疗效和安全性,分析治疗前后血清肿瘤标志物的变化.方法将67例转移性结直肠癌患者分为IFL组、IFL+贝伐单抗组和FOLFIRI组.IFL组采用CPT-11(每周125 mg/m2)+亚叶酸钙(CF,每周20mg/m2)+5-氟尿嘧啶(5-Fu,每周500 mg/m2);IFL+贝伐单抗组采用贝伐单抗(每2周5 mg/kg)+IFL方案(CPT-11每周125 mg/m2,CF每周20 mg/m2,5-Fu每周500 mg/m2);FOLFIRI组采用CPT-11(180 mg/m2)+CF(200 mg/m2)+5-Fu(1000 mg/m2).3组患者均持续治疗至病情进展或毒性不能耐受.结果 67例患者均可评价疗效和毒性.IFL组、IFL+贝伐单抗组和FOLFIRI组的治疗有效率分别为16.0%(4/25)、35.0%(7/20)和18.2%(4/22;x2=6.026,P=0.049),中位无疾病进展时间(PFS)分别为3.7、7.5和4.0个月(x2=11.97 P=0.003).全组患者的1年生存率为47.0%,2年生存率为27.0%,中位生存时间为13.0个月,总生存期在3组间差异无统计学意义(x2=3.42,P=0.18).3组患者治疗前后血清肿瘤标记物均有所下降,但差异无统计学意义(P＞0.05).IFL组和FOLFIRI组的主要不良反应为迟发性腹泻和中性粒细胞减少,IFL+贝伐单抗组增加的不良反应主要有高血压、出血、心脏毒性和伤口愈合延迟.结论以CPT-11为基础方案的化疗联用贝伐单抗提高了晚期结直肠癌患者治疗的有效率,并延长了PFS,不良反应患者可耐受.
목적 평개패벌단항연합이립체강(CPT-11)위주방안일선치료전이성결직장암적료효화안전성,분석치료전후혈청종류표지물적변화.방법 장67례전이성결직장암환자분위IFL조、IFL+패벌단항조화FOLFIRI조.IFL조채용CPT-11(매주125 mg/m2)+아협산개(CF,매주20mg/m2)+5-불뇨밀정(5-Fu,매주500 mg/m2);IFL+패벌단항조채용패벌단항(매2주5 mg/kg)+IFL방안(CPT-11매주125 mg/m2,CF매주20 mg/m2,5-Fu매주500 mg/m2);FOLFIRI조채용CPT-11(180 mg/m2)+CF(200 mg/m2)+5-Fu(1000 mg/m2).3조환자균지속치료지병정진전혹독성불능내수.결과 67례환자균가평개료효화독성.IFL조、IFL+패벌단항조화FOLFIRI조적치료유효솔분별위16.0%(4/25)、35.0%(7/20)화18.2%(4/22;x2=6.026,P=0.049),중위무질병진전시간(PFS)분별위3.7、7.5화4.0개월(x2=11.97 P=0.003).전조환자적1년생존솔위47.0%,2년생존솔위27.0%,중위생존시간위13.0개월,총생존기재3조간차이무통계학의의(x2=3.42,P=0.18).3조환자치료전후혈청종류표기물균유소하강,단차이무통계학의의(P＞0.05).IFL조화FOLFIRI조적주요불량반응위지발성복사화중성립세포감소,IFL+패벌단항조증가적불량반응주요유고혈압、출혈、심장독성화상구유합연지.결론 이CPT-11위기출방안적화료련용패벌단항제고료만기결직장암환자치료적유효솔,병연장료PFS,불량반응환자가내수.
Objective To assess the efficacy and safety of bevacizumab plus irinotecan-based regimen for the first line treatment in metastatic colorectal cancer (mCRC) patients, and to investigate the correlation between serum tumor markers including CEA and CA19-9 and response as well as prognosis.Methods From May 2007 to July 2008, 67 previously untreated mCRC patients received treatment of IFL ( n = 25 ), IFL plus Bevacizumab ( n = 20) or FOLFIRI ( n = 22). The treatment continued until disease progression or unacceptable toxicity. The data were retrospectively analyzed. Results All patients were evaluable for response, survival and toxicity analysis. The objective response rate of IFL, IFL plus Bevacizumab or FOLFIRI regimen groups was 16.0%(4/25), 35.0%(7/20) and 18.2%(4/22),respectively (x2 = 6.026, P = 0.049 ). The median progression-free survival (PFS) of IFL plus bevacizumab group was 7.5 months, significantly improved as compared with 3.7 months in the IFL group and 4 months in FOLFIRI group (x2 = 11.97, P = 0.003 ) . Of all 67 cases, the one-year survival rate was 47.0%, twoyear survival rate was 27.0%, and the median overall survival (OS) was 13.0 months, with no significant difference among the three treatment groups (x2 = 3.42, P = 0.18). The serum CEA and CA19-9 levels were decreased after treatment, but with no significant difference among the three groups (P ＞ 0.05). The common toxicity profiles of IFL and FOLFIRI regimens were diarrhea and neutropenia, while the toxicity related to bevacizumab was consistent with that documented in previous literature, such as hypertension,hemorrhage, cardiac toxicity and delayed wound healing. Conclusion The addition of bevacizumab to irinotecan-based regimen significantly improves the response rate and PFS in first-line treatment for patients with mCRC and its toxicity is well tolerated.