Giuliani F, Colucci G
Department of Medical Oncology, National Cancer Institute, Bari, Italy.
Int J Biol Markers. 2007 Jan-Mar;22(1 Suppl 4):S62-70.
In the last decade remarkable progress has been made in the treatment of metastatic colorectal cancer due to the introduction of oxaliplatin and irinotecan in clinical practice. The addition of biological agents seems to offer a chance to further enhance the activity of conventional chemotherapy. Cetuximab, a chimeric mouse-human monoclonal antibody targeting the extracellular domain of the epidermal growth factor receptor (EGFR), has shown low but detectable activity when employed in pretreated patients either as a single agent or in combination with irinotecan. Cetuximab in combination with irinotecan has been registered in the USA and Europe for the treatment of patients with metastatic colorectal cancer expressing the EGFR after failure of prior irinotecan-based cytotoxic therapy. The role of cetuximab in first-line therapy is still investigational. Some phase II trials assessing cetuximab plus chemotherapy demonstrated a high objective response rate and promising results in terms of time to progression and overall survival; data from phase III trials are pending. Further studies are needed to investigate the efficacy of cetuximab in combination with conventional chemotherapy in the adjuvant/neoadjuvant setting and to define criteria for a better selection of patients for this type of treatment.
在过去十年中，由于奥沙利铂和伊立替康应用于临床实践，转移性结直肠癌的治疗取得了显著进展。添加生物制剂似乎为进一步提高传统化疗的活性提供了机会。西妥昔单抗是一种靶向表皮生长因子受体（EGFR）胞外域的嵌合型鼠源-人源单克隆抗体，在预处理患者中作为单一药物或与伊立替康联合使用时，显示出低但可检测到的活性。西妥昔单抗联合伊立替康已在美国和欧洲获批，用于治疗既往基于伊立替康的细胞毒性治疗失败后表达EGFR的转移性结直肠癌患者。西妥昔单抗在一线治疗中的作用仍在研究中。一些评估西妥昔单抗加化疗的II期试验显示出高客观缓解率，并且在疾病进展时间和总生存期方面有令人鼓舞的结果；III期试验的数据尚未得出。需要进一步研究来探讨西妥昔单抗联合传统化疗在辅助/新辅助治疗中的疗效，并确定更好地选择此类治疗患者的标准。
