Min Byung Soh, Kim Nam Kyu, Ahn Jung Bai, Roh Jae Kyung, Kim Kyung Sik, Choi Jin Sub, Cha Seung Hwan, Kim Hogeun
Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University Medical Center, Yonsei University College of Medicine, Seoul, Korea.
Onkologie. 2007 Dec;30(12):637-43. doi: 10.1159/000109957. Epub 2007 Nov 30.
The efficacy and safety of a combination of cetuximab, irinotecan, and 5-fluorouracil/leucovorin (FOLFIRI) in downsizing unresectable colorectal liver metastases was investigated.
Patients with unresectable colorectal liver metastases with or without resectable extrahepatic metastasis were enrolled. 23 patients initially received 400 mg/m2 of cetuximab, followed by a weekly infusion of 250 mg/m2 and a biweekly dose of irinotecan (180 mg/m2), with 5-fluorouracil both by bolus (400 mg/m2) and by a 46-h infusion (total of 2,400 mg/m2) with leucovorin (400 mg/m2).
The overall response rate was 39.1% (n = 9; 95% confidence interval (CI): 17.6-60.7%). The most common grade 3-4 toxicities were skin reactions (30.4%) and diarrhea (26.1%). The rate of conversion to resectable liver metastases was 30.4% (n = 7; 95% CI: 10.1-50.8%). The factors found to be significantly associated with R0 resection were lower serum carcinoembryonic antigen levels after chemotherapy (p = 0.039), being chemonaive (p = 0.002), and showing a higher incidence of grade 3-4 skin toxicity (p = 0.011).
Cetuximab with FOLFIRI may be an effective and safe treatment option for downsizing unresectable colorectal liver metastases.
研究了西妥昔单抗、伊立替康和5-氟尿嘧啶/亚叶酸钙（FOLFIRI）联合方案在缩小不可切除的结直肠癌肝转移灶方面的疗效和安全性。
纳入有或无可切除肝外转移的不可切除结直肠癌肝转移患者。23例患者最初接受400mg/m²的西妥昔单抗治疗，随后每周输注250mg/m²，每两周给予伊立替康剂量（180mg/m²），5-氟尿嘧啶采用静脉推注（400mg/m²）和46小时输注（总量2400mg/m²）联合亚叶酸钙（400mg/m²）。
总缓解率为39.1%（n = 9；95%置信区间（CI）：17.6 - 60.7%）。最常见的3 - 4级毒性反应为皮肤反应（30.4%）和腹泻（26.1%）。转化为可切除肝转移灶的比例为30.4%（n = 7；95%CI：10.1 - 50.8%）。发现与R0切除显著相关的因素为化疗后血清癌胚抗原水平较低（p = 0.039）、未接受过化疗（p = 0.002）以及3 - 4级皮肤毒性发生率较高（p = 0.011）。
西妥昔单抗联合FOLFIRI可能是缩小不可切除结直肠癌肝转移灶的一种有效且安全的治疗选择。
