Chong Geoff, Cunningham David
Royal Marsden Hospital, London and Surrey, United Kingdom.
Semin Oncol. 2005 Dec;32(6 Suppl 9):S55-8. doi: 10.1053/j.seminoncol.2005.04.020.
Much remains to be learned about the best ways to integrate molecular-targeted therapies into the chemotherapeutic armamentarium. The epidermal growth factor receptor inhibitor cetuximab has been extensively evaluated in patients with chemotherapy-resistant metastatic colorectal cancer. In patients with irinotecan-refractory or irinotecan/oxaliplatin-refractory disease, single-agent cetuximab has produced a partial response in 9% to 11.6% of patients and stable disease in 21.6% to 36.8%. In irinotecan-resistant disease, the combination of cetuximab and irinotecan has resulted in partial responses in 17% to 22.9% of patients and stable disease in 31% to 32.6%. The degree of epidermal growth factor receptor expression has not been predictive of treatment response; severity of a characteristic acneiform rash does appear to be predictive of response. Ongoing trials in colorectal cancer are examining the combination of cetuximab and bevacizumab with or without irinotecan in irinotecan-refractory disease, irinotecan with or without cetuximab in oxaliplatin-refractory disease, and FOLFOX4 with or without cetuximab in patients receiving first-line irinotecan treatment.
关于将分子靶向治疗整合到化疗药库中的最佳方法，仍有许多需要了解的地方。表皮生长因子受体抑制剂西妥昔单抗已在化疗耐药的转移性结直肠癌患者中进行了广泛评估。在对伊立替康难治或对伊立替康/奥沙利铂难治的疾病患者中，单药西妥昔单抗使9%至11.6%的患者出现部分缓解，21.6%至36.8%的患者病情稳定。在伊立替康耐药的疾病中，西妥昔单抗与伊立替康联合使用使17%至22.9%的患者出现部分缓解，31%至32.6%的患者病情稳定。表皮生长因子受体表达程度并不能预测治疗反应；特征性痤疮样皮疹的严重程度似乎可预测反应。正在进行的结直肠癌试验正在研究西妥昔单抗与贝伐单抗联合使用（有无伊立替康）用于伊立替康难治性疾病、伊立替康（有无西妥昔单抗）用于奥沙利铂难治性疾病，以及FOLFOX4（有无西妥昔单抗）用于接受一线伊立替康治疗的患者。
