Ho Wing M, Ma B, Mok Tony, Yeo W, Lai Paul, Lim R, Koh Jane, Wong Y Y, King Ann, Leow C K, Chan A T C
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Med Oncol. 2005;22(3):303-12. doi: 10.1385/MO:22:3:303.
The main objectives of this study were to assess the use of irinotecan, 5-fluorouracil (5-FU), and leucovorin (FA) as neoadjuvant chemotherapy for patients with unresectable colorectal liver metastases and to determine the response rate and proportion of patients that could be down-staged to resectable tumors. Forty patients were treated with irinotecan (180 mg/m2 over 30 min) on d 1, FA (200 mg/m2 over 30 min) followed by 5-FU (400 mg/m2 bolus and continuous infusion of 600 mg/m2 over 22 h) on d 1 and 2 every 2 wk. The overall response rate was 55% (95% CI: 39.5-70.4%). The progression-free survival was 12.1 mo (95% CI: 11.4-14.8 mo). The median overall survival was 20 mo (95% CI: 17.7-26.6 mo). Four patients (10%) have undergone liver resection after a median of eight cycles. Those patients remained alive with a median follow up period of 33 mo. The principal grade 3-4 toxicity was neutropenia in 20 patients (50%). We conclude that the regimen of irinotecan/5-FU/FA was highly active in patients with colorectal cancer and liver metastases with limited toxicity. In a subgroup of patients with initial inoperable liver metastases, this regimen was able to down-stage the disease to an operable stage.
本研究的主要目的是评估伊立替康、5-氟尿嘧啶（5-FU）和亚叶酸（FA）作为不可切除的结直肠癌肝转移患者新辅助化疗的应用情况，并确定缓解率以及可降期至可切除肿瘤的患者比例。40例患者每2周在第1天接受伊立替康（180mg/m²，静脉滴注30分钟）治疗，随后在第1天和第2天接受FA（200mg/m²，静脉滴注30分钟），接着接受5-FU（400mg/m²静脉推注，随后22小时持续静脉滴注600mg/m²）治疗。总缓解率为55%（95%CI：39.5 - 70.4%）。无进展生存期为12.1个月（95%CI：11.4 - 14.8个月）。中位总生存期为20个月（95%CI：17.7 - 26.6个月）。4例患者（10%）在中位8个周期后接受了肝切除术。这些患者仍存活，中位随访期为33个月。主要的3 - 4级毒性反应为20例患者（50%）出现中性粒细胞减少。我们得出结论，伊立替康/5-FU/FA方案对结直肠癌和肝转移患者具有高活性且毒性有限。在初始不可切除肝转移的患者亚组中，该方案能够将疾病降期至可手术阶段。
