Moosmann Nicolas, Laessig Dorit, Michaely Henrik Jakob, Schulz Christoph, Heinemann Volker
Medizinische Klinik III, Campus Grosshadern, Klinikum der Ludwig-Maximilians-Universität München, Germany.
Onkologie. 2007 Oct;30(10):509-12. doi: 10.1159/000106098. Epub 2007 Sep 21.
Irinotecan-based second-line chemotherapy of metastatic colorectal cancer (CRC) is effective, it might, however, be contraindicated in cases of severe liver dysfunction due to advanced liver metastases.
A 57-year-old woman with diffuse CRC liver metastases showed progressive disease on first-line treatment with capecitabine and oxaliplatin (XELOX). Chronic cholestasis and hyperbilirubinemia caused by advanced liver involvement prohibited second-line treatment with irinotecan-based chemotherapy. We initiated combined antibody treatment with cetuximab and bevacizumab.
Clinical performance status as well as laboratory parameters improved rapidly. Staging investigations after 8 weeks revealed a partial remission. Since bilirubin levels had returned to the upper limit of normal, therapy could be changed to standard irinotecan, 5-fluorouracil, folinic acid, and bevacizumab.
Combined treatment with cetuximab and bevacizumab may be considered as an effective treatment option in patients who cannot be treated with standard chemotherapy regimens due to impaired liver metabolism of cytotoxic substances.
基于伊立替康的转移性结直肠癌（CRC）二线化疗是有效的，然而，由于晚期肝转移导致严重肝功能不全的情况下可能禁忌使用。
一名57岁患有弥漫性CRC肝转移的女性在一线使用卡培他滨和奥沙利铂（XELOX）治疗时出现疾病进展。晚期肝脏受累引起的慢性胆汁淤积和高胆红素血症禁止使用基于伊立替康的化疗进行二线治疗。我们开始使用西妥昔单抗和贝伐单抗联合抗体治疗。
临床性能状态以及实验室参数迅速改善。8周后的分期检查显示部分缓解。由于胆红素水平已恢复到正常上限，治疗可改为标准的伊立替康、5-氟尿嘧啶、亚叶酸和贝伐单抗。
对于因细胞毒性物质肝代谢受损而无法接受标准化疗方案治疗的患者，西妥昔单抗和贝伐单抗联合治疗可被视为一种有效的治疗选择。
