Gastroenterology and Digestive Oncology Unit, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
BMC Cancer. 2009 Sep 28;9:347. doi: 10.1186/1471-2407-9-347.
The anti-VEGF antibody bevacizumab associated with an irinotecan or oxaliplatin-based chemotherapy was proved to be superior to the chemotherapy alone in first or second line treatment of metastatic colorectal cancer (mCRC). However, it was reported to have no efficacy in 3rd or later-line, alone or with 5FU. The aim of this study was to evaluate the activity of bevacizumab combined with FOLFIRI or FOLFOX in mCRC who have failed prior chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin.
Thirty one consecutive patients treated between May 2005 and October 2006 were included in this retrospective study. All of them have progressed under a chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin and received bevacizumab (5 mg/kg) in combination with FOLFIRI or simplified FOLFOX4 every 14 days.
Ten patients (32.2%) had an objective response (1 CR, 9 PR) and 12 (38.8%) were stabilized. The response and disease control rates were 45.4% and 100% when bevacizumab was administered in 2nd or 3rd line and 25% and 55% in 4th or later line respectively (p = 0.024 and p = 0.008). Among the patients who had previously received the same chemotherapy than that associated with bevacizumab (n = 28) the overall response rate was 35.7% and 39.3% were stabilized. Median progression free survival (PFS) and overall survival (OS) were of 9.7 and 18.4 months respectively. Except a patient who presented a hypertension associated reversible posterior leukoencephalopathy syndrome, tolerance of bevacizumab was acceptable. A rectal bleeding occurred in one patient, an epistaxis in five. Grade 1/2 hypertension occurred in five patients.
This study suggests that bevacizumab combined with FOLFOX or FOLFIRI may have the possibility to be active in chemorefractory and selected mCRC patients who did not receive it previously.
抗血管内皮生长因子抗体贝伐珠单抗联合伊立替康或奥沙利铂为基础的化疗方案在转移性结直肠癌（mCRC）一线或二线治疗中被证实优于单纯化疗。然而，在三线或以后的治疗中，单独使用或与 5FU 联合使用贝伐珠单抗时，并没有显示出疗效。本研究旨在评估贝伐珠单抗联合 FOLFIRI 或 FOLFOX 在氟尿嘧啶加伊立替康和/或奥沙利铂化疗失败的 mCRC 患者中的疗效。
回顾性分析 2005 年 5 月至 2006 年 10 月期间接受治疗的 31 例连续患者。所有患者均在氟尿嘧啶加伊立替康和/或奥沙利铂化疗方案进展后，接受贝伐珠单抗（5mg/kg）联合 FOLFIRI 或简化的 FOLFOX4，每 14 天一次。
10 例患者（32.2%）有客观缓解（1 例完全缓解，9 例部分缓解），12 例患者（38.8%）病情稳定。当贝伐珠单抗在二线或三线治疗时，缓解率和疾病控制率分别为 45.4%和 100%；在四线或以后的治疗中，缓解率和疾病控制率分别为 25%和 55%（p=0.024 和 p=0.008）。在先前接受与贝伐珠单抗联合化疗的患者中（n=28），总体缓解率为 35.7%，病情稳定的患者比例为 39.3%。中位无进展生存期（PFS）和总生存期（OS）分别为 9.7 个月和 18.4 个月。除了 1 例患者出现高血压相关可逆性后部白质脑病综合征外，贝伐珠单抗的耐受性是可以接受的。1 例患者出现直肠出血，5 例患者出现鼻出血。5 例患者出现 1/2 级高血压。
本研究表明，贝伐珠单抗联合 FOLFOX 或 FOLFIRI 可能对先前未接受过该治疗的化疗耐药和选择的 mCRC 患者具有一定的疗效。
