Van Cutsem Eric
Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium.
Oncologist. 2006 Oct;11(9):1010-7. doi: 10.1634/theoncologist.11-9-1010.
Novel targeted agents increase the therapeutic armamentarium in metastatic colorectal cancer (mCRC). Monoclonal antibodies against the epidermal growth factor receptor (EGFR) are active against EGFR-expressing mCRC that is refractory to irinotecan. EGFR monoclonal antibodies also have promise in less advanced stages of CRC. Cetuximab and panitumumab are clearly active agents. It has been shown that cetuximab is more active when administered in combination with irinotecan. Phase II studies also report promising activity when monoclonal antibodies against the EGFR are combined with classic chemotherapeutic regimens in the first-line treatment of mCRC. However, the best means of scheduling such agents and integrating them with each other and with chemotherapy have yet to be established. The management of toxicity (particularly rash) and finding appropriate means of selecting patients pose additional challenges. While the occurrence of rash is associated with greater likelihood of response, EGFR staining by immunohistochemistry at baseline is not. For reasons that are not yet clear, the tyrosine kinase inhibitors of EGFR seem less effective than their monoclonal antibody counterparts in the therapy of mCRC.
新型靶向药物增加了转移性结直肠癌（mCRC）的治疗手段。抗表皮生长因子受体（EGFR）单克隆抗体对表达EGFR且对伊立替康耐药的mCRC有效。EGFR单克隆抗体在CRC较早期阶段也有应用前景。西妥昔单抗和帕尼单抗显然是有效的药物。已表明西妥昔单抗与伊立替康联合使用时活性更强。II期研究也报告称，在mCRC一线治疗中，抗EGFR单克隆抗体与经典化疗方案联合使用时具有有前景的活性。然而，安排此类药物以及将它们相互整合并与化疗整合的最佳方法尚未确立。毒性管理（尤其是皮疹）以及找到合适的患者选择方法带来了额外挑战。虽然皮疹的出现与更高的缓解可能性相关，但基线时通过免疫组织化学进行的EGFR染色并非如此。由于尚不清楚的原因，EGFR酪氨酸激酶抑制剂在mCRC治疗中似乎不如其单克隆抗体对应物有效。
