Lee James J, Chu Edward
Section of Medical Oncology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06520, USA.
Clin Colorectal Cancer. 2007 Dec;7 Suppl 1:S16-20. doi: 10.3816/ccc.2008.s.003.
Colorectal cancer (CRC) is a worldwide public health problem, with nearly 800,000 new cases diagnosed each year, resulting in approximately 500,000 deaths. When advanced metastatic disease is diagnosed, CRC is associated with a poor prognosis, and 5-year survival rates are in the range of 5%-8%. Chemotherapy has been the mainstay approach for patients with advanced CRC. For nearly 40 years, the main drug used for this disease was the fluoropyrimidine 5-fluorouracil (5-FU). Significant advances have been made in chemotherapy treatment options for patients with metastatic disease, such that improvements in 2-year survival are now being reported with median survival rates of 21 months to 24 months. Over the past 10 years, 3 new cytotoxic chemotherapy agents have been approved by the FDA for metastatic CRC. These compounds include the topoisomerase I inhibitor irinotecan, the third-generation platinum analogue oxaliplatin, and the oral fluoropyrimidine capecitabine. Since 2004, 3 novel biologic agents have been approved by the FDA, and they include the anti-epidermal growth factor receptor antibodies cetuximab and panitumumab and the anti-vascular endothelial growth factor bevacizumab. The oral fluoropyrimidine capecitabine has been effectively and safely combined with irinotecan (CAPIRI) and/or oxaliplatin (CAPOX). Three randomized phase III studies have now shown that CAPOX is equivalent to FOLFOX (5-FU/leucovorin/oxaliplatin)-based regimens. Significant interest has centered around combining capecitabine-based cytotoxic regimens with the biologic agents, and specifically, bevacizumab and cetuximab. This review will update the current status of these capecitabine-based combination regimens.
结直肠癌(CRC)是一个全球性的公共卫生问题,每年有近80万新病例被诊断出来,导致约50万人死亡。当诊断出晚期转移性疾病时,CRC的预后较差,5年生存率在5%至8%之间。化疗一直是晚期CRC患者的主要治疗方法。近40年来,用于这种疾病的主要药物是氟嘧啶5-氟尿嘧啶(5-FU)。转移性疾病患者的化疗治疗选择取得了重大进展,现在有报道称2年生存率有所提高,中位生存率为21个月至24个月。在过去10年中,3种新的细胞毒性化疗药物已被美国食品药品监督管理局(FDA)批准用于转移性CRC。这些化合物包括拓扑异构酶I抑制剂伊立替康、第三代铂类类似物奥沙利铂和口服氟嘧啶卡培他滨。自2004年以来,3种新型生物制剂已被FDA批准,它们包括抗表皮生长因子受体抗体西妥昔单抗和帕尼单抗以及抗血管内皮生长因子贝伐单抗。口服氟嘧啶卡培他滨已有效且安全地与伊立替康(CAPIRI)和/或奥沙利铂(CAPOX)联合使用。三项随机III期研究现已表明,CAPOX与基于FOLFOX(5-FU/亚叶酸钙/奥沙利铂)的方案等效。人们对将基于卡培他滨的细胞毒性方案与生物制剂,特别是贝伐单抗和西妥昔单抗联合使用产生了浓厚兴趣。本综述将更新这些基于卡培他滨的联合方案的现状。